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Clinical Correlates of Posterior Reversible Encephalopathy Syndrome in Pregnancy

Fisher, Nelli; Saraf, Sumit; Egbert, Neha; Homel, Peter; Stein, Evan G; Minkoff, Howard
The authors aimed to determine whether clinical findings of preeclampsia predict magnetic resonance imaging (MRI) diagnosis of posterior reversible encephalopathy syndrome (PRES). The course among preeclamptics/eclamptics with clinically suspected PRES with vs without MRI diagnosis of PRES was compared. Of 46 patients who underwent MRI (eight eclamptics, 38 preeclamptics), five eclamptics (62.5%) and four preeclamptics (10.5%) had confirmed PRES (P=.004). Patients with PRES were younger (26 years vs 31 years, P=.008) and had a higher prevalence of thrombocytopenia (33% vs 8%, P=.04), a greater prevalence of proteinuria (100% vs 61%, P=.04), and higher peak systolic and diastolic blood pressures (P<.05). As opposed to findings from previous reports, PRES was not seen uniformly among eclamptic women and was found in 10.5% of preeclamptics with clinical suspicion of PRES in this study. Given that no single or set of findings were reliable predictors of PRES, consideration for rigorous management of hypertension should be applied to all patients with preeclampsia and eclampsia.
PMID: 26293622
ISSN: 1751-7176
CID: 3897122

Intrapartum Spontaneous Ureteral Rupture [Case Report]

Narasimhulu, Deepa M; Egbert, Neha M; Matthew, Silverman
BACKGROUND:Although spontaneous rupture of the renal pelvis during pregnancy has been reported, albeit rarely, spontaneous ureteral rupture is extremely rare. CASE/METHODS:We present the case of a 22-year-old nulliparous woman with spontaneous ureteral rupture after vaginal delivery diagnosed on contrast-enhanced computed tomography scan. Ureteroscopy revealed a rupture of her right midureter and a JJ stent was successfully placed. CONCLUSION/CONCLUSIONS:This case compels us to consider spontaneous ureteral rupture in the differential diagnosis for postpartum abdominal pain when common causes have been ruled out. We report this case to inform clinicians of this rare complication so that diagnosis is not delayed. Diagnosis can be made with contrast-enhanced computed tomography scan and cystoscopy, and ureteral stenting is a reasonable option for management.
PMID: 25923026
ISSN: 1873-233x
CID: 3897112