Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

pregnancy

 

Síndrome de encefalopatía posterior reversible atípico en paciente gestante. Atypical posterior reversible encephalopathy syndrome in a pregnant patient.

Introduction: Posterior reversible encephalopathy syndrome (PRES) was first described by Hinchey in 1996, when he observed that some patients presented with an acute reversible picture comprising mental alterations, loss of vision and headache.

Objective: To present the clinical case of a patient with atypical posterior reversible encephalopathy syndrome.

Clinical case: A 19-year-old woman, 36.5 weeks of gestation, presented with a clinical picture of 4 hours of evolution with high intensity stabbing pain in the epigastrium associated with moderate intensity global headache, accompanied by a self-resolved convulsive episode. Magnetic resonance imaging (MRI) showed bilateral intensity changes in the frontoparietal cortico-subcortical regions, lenticular nuclei and brain stem region with restrictive pattern in some lesions, and diffusion was indicative of ischemic vascular involvement with diffuse edema, in addition, parietooccipital paramedial hemorrhagic foci were observed bilaterally, suggesting a possible PRES.

Conclusions: PRES should be considered as a diagnosis in a previously healthy pregnant woman who has sudden convulsive episodes during labor. The exact etiology of PRES during pregnancy is not entirely clear and remains controversial. Clinical presentation and MRI are used for diagnosis. Immediate treatment should be focused on controlling the underlying cause or pathology, the main one being hypertension. 

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Tratamiento de migraña en embarazo. Treatment of migraine in pregnancy.

Introduction: Migraine is the most disabling primary headache. In pregnancy, its treatment is controversial due to possible side effects.

Objective: Conduct an updated literature search on migraine treatment during pregnancy.

Method: A search was carried out in PubMed, Scopus and Web of Science. Search terms were “pregnancy”, “migraine” and “treatment”. Search date ranged from 2018 to 2023. 315 articles were found; duplicates were eliminated with Rayyan QCRI (Rayyan Systems Inc ©) where selection was carried out by title and summaries, and full text. Finally, 21 articles were selected that included clinical trials, systematic reviews and narratives.

Development: Acute and preventive therapy exists for migraine during pregnancy; non-pharmacological treatment is the first choice in both. For acute treatment, paracetamol, non-steroidal anti-inflammatory drugs only in the second trimester, triptans, metoclopramide and nerve blocks can be used. If the intensity is moderate and is not controlled with acute treatment, prevention is carried out with propranolol; Other drugs do not show safe evidence for use during pregnancy

Conclusion: An appropriate choice of treatment, prioritizing non-pharmacological treatment and taking into account drug associations, is necessary in pregnant women whose migraine attacks do not subside.

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Embarazo y esclerosis múltiple: ¿Existe una relación positiva entre ambas entidades? Pregnancy and multiple sclerosis: Is there a positive relationship between the two?

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