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Seizures in Critical Care pp 219–231Cite as

Extreme Hypertension, Eclampsia and Critical Care Seizures

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Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

The association between seizures and blood pressure elevation remains a common medical emergency encountered in an ICU setting. Syndromes such as pre-eclampsia or eclampsia, hypertensive encephalopathy, and posterior leukoencephalopathy commonly present with seizures. The primary treatment goal is to reduce the arterial blood pressure. In most cases seizure control is thus achieved, but unique medications, such as magnesium sulfate, may be needed. Fortunately, if treated immediately and aggressively, the pathophysiologic mechanism leading to seizures is reversible in most cases. Delayed treatment may result in irreversible brain injury or increased mother or fetus mortality.

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References

  1. Finnerty FA Jr (1968) Hypertensive encephalopathy. Am Heart J 75(4):559–563

    Article  PubMed  Google Scholar 

  2. Delanty N (2002) Seizures: medical causes and management. Cur Clin Neurol. Humana Press, Totowa, N.J., pp xii, 368

    Google Scholar 

  3. Hesdorffer DC et al (1996) Severe, uncontrolled hypertension and adult-onset seizures: a case-control study in Rochester, Minnesota. Epilepsia 37(8):736–741

    Article  PubMed  CAS  Google Scholar 

  4. National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy (1990) Am J Obstet Gynecol 163(5 Pt 1):1691–1712

    Google Scholar 

  5. Deparment of Health (1994) Report on Confidential Enquiries into Maternal Deaths in the UK 1988–90, in DoH. London

    Google Scholar 

  6. Cunningham FG, Lindheimer MD (1992) Hypertension in pregnancy. N Engl J Med 326(14):927–932

    Article  PubMed  CAS  Google Scholar 

  7. O’Dowd MJ, Phillip EE (1994) The history of obstetrics and gynecology. Parthenon Publishing Group, New York

    Google Scholar 

  8. Mushambi MC, Halligan AW, Williamson K (1996) Recent developments in the pathophysiology and management of pre-eclampsia. Br J Anaesth 76(1):133–148

    Article  PubMed  CAS  Google Scholar 

  9. MacKay AP, Berg CJ, Atrash HK (2001) Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 97(4):533–538

    Article  PubMed  CAS  Google Scholar 

  10. Witlin AG et al (1997) Cerebrovascular disorders complicating pregnancy – beyond eclampsia. Am J Obstet Gynecol 176(6):1139–1145; discussion 1145–1148

    Google Scholar 

  11. Munro PT (2000) Management of eclampsia in the accident and emergency department. J Accid Emerg Med 17(1):7–11

    Article  PubMed  CAS  Google Scholar 

  12. Douglas KA, Redman CW (1994) Eclampsia in the United Kingdom. BMJ 309(6966):1395–1400

    Article  PubMed  CAS  Google Scholar 

  13. Leitch CR, Cameron AD, Walker JJ (1997) The changing pattern of eclampsia over a 60-year period. Br J Obstet Gynaecol 104(8):917–922

    Article  PubMed  CAS  Google Scholar 

  14. Ramin KD (1999) The prevention and management of eclampsia. Obstet Gynecol Clin North Am 26(3):489–503, ix

    Google Scholar 

  15. Lyall F, Greer IA (1994) Pre-eclampsia: a multifaceted vascular disorder of pregnancy. J Hypertens 12(12):1339–1345

    Article  PubMed  CAS  Google Scholar 

  16. Odent M (2001) Hypothesis: preeclampsia as a maternal-fetal conflict. MedGenMed 3(5):2

    PubMed  CAS  Google Scholar 

  17. Usta IM, Sibai BM (1995) Emergent management of puerperal eclampsia. Obstet Gynecol Clin North Am 22(2):315–335

    PubMed  CAS  Google Scholar 

  18. Lopez-Llera M (1992) Main clinical types and subtypes of eclampsia. Am J Obstet Gynecol 166(1 Pt 1):4–9

    Article  PubMed  CAS  Google Scholar 

  19. Katz VL, Farmer R, Kuller JA (2000) Preeclampsia into eclampsia: toward a new paradigm. Am J Obstet Gynecol 182(6):1389–1396

    Article  PubMed  CAS  Google Scholar 

  20. Dziewas R et al (2002) Late onset postpartum eclampsia: a rare and difficult diagnosis. J Neurol 249(9):1287–1291

    Article  PubMed  Google Scholar 

  21. Sibai BM et al (1984) Effect of magnesium sulfate on electroencephalographic findings in preeclampsia-eclampsia. Obstet Gynecol 64(2):261–266

    PubMed  CAS  Google Scholar 

  22. Kirby JC, Jaindl JJ (1984) Cerebral CT findings in toxemia of pregnancy. Radiology 151(1):114

    PubMed  CAS  Google Scholar 

  23. Milliez J, Dahoun A, Boudraa M (1990) Computed tomography of the brain in eclampsia. Obstet Gynecol 75(6):975–980

    PubMed  CAS  Google Scholar 

  24. Gaitz JP, Bamford CR (1982) Unusual computed tomographic scan in eclampsia. Arch Neurol 39(1):66

    Article  PubMed  CAS  Google Scholar 

  25. Schwaighofer BW, Hesselink JR, Healy ME (1989) MR demonstration of reversible brain abnormalities in eclampsia. J Comput Assist Tomogr 13(2):310–312

    Article  PubMed  CAS  Google Scholar 

  26. Celik O, Hascalik S (2003) Reversible posterior leukoencephalopathy in eclampsia. Int J Gynaecol Obstet 82(1):67–69

    Article  PubMed  CAS  Google Scholar 

  27. Kilpatrick SJ, Matthay MA (1992) Obstetric patients requiring critical care. A five-year review. Chest 101(5):1407–1412

    Article  PubMed  CAS  Google Scholar 

  28. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial (1995) Lancet 345(8963):1455–1463

    Google Scholar 

  29. Duley L, Gulmezoglu AM, Henderson-Smart DJ (2003) Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev 2:CD000025

    PubMed  Google Scholar 

  30. Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, Smith D, Magpie Trial Collaboration Group (2002) Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 359(9321):1877–1890

    Article  PubMed  Google Scholar 

  31. Belfort MA et al (2003) A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med 348(4):304–311

    Article  PubMed  CAS  Google Scholar 

  32. Pritchard JA et al (1954) Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy. N Engl J Med 250(3):89–98

    Article  PubMed  CAS  Google Scholar 

  33. Weinstein L (1982) Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 142(2):159–167

    PubMed  CAS  Google Scholar 

  34. Haddad B et al (2000) Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol 183(2):444–448

    Article  PubMed  CAS  Google Scholar 

  35. Magann EF et al (1994) Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 171(4):1154–1158

    Article  PubMed  CAS  Google Scholar 

  36. Magann EF et al (1994) Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). Am J Obstet Gynecol 171(4):1148–1153

    Article  PubMed  CAS  Google Scholar 

  37. Oppenheimer BS, Fishburg A (1928) Hypertensive encephalopathy. Arch Intern Med 41:264–278

    Article  Google Scholar 

  38. Healton EB et al (1982) Hypertensive encephalopathy and the neurologic manifestations of malignant hypertension. Neurology 32(2):127–132

    Article  PubMed  CAS  Google Scholar 

  39. He J, Whelton PK (1997) Epidemiology and prevention of hypertension. Med Clin North Am 81(5):1077–1097

    Article  PubMed  CAS  Google Scholar 

  40. Bennett NM, Shea S (1988) Hypertensive emergency: case criteria, sociodemographic profile, and previous care of 100 cases. Am J Public Health 78(6):636–640

    Article  PubMed  CAS  Google Scholar 

  41. Berlowitz DR et al (1998) Inadequate management of blood pressure in a hypertensive population. N Engl J Med 339(27):1957–1963

    Article  PubMed  CAS  Google Scholar 

  42. Auer LM (1978) The pathogenesis of hypertensive encephalopathy. Experimental data and their clinical relevance with special reference to neurosurgical patients. Acta Neurochir Suppl (Wien) 27:1–111

    CAS  Google Scholar 

  43. Furchgott RF, Zawadzki JV (1980) The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 288(5789):373–376

    Article  PubMed  CAS  Google Scholar 

  44. Kuchan MJ, Frangos JA (1993) Shear stress regulates endothelin-1 release via protein kinase C and cGMP in cultured endothelial cells. Am J Physiol 264(1 Pt 2):H150–H156

    PubMed  CAS  Google Scholar 

  45. Torocsik HV et al (1999) FK506-induced leukoencephalopathy in children with organ transplants. Neurology 52(7):1497–1500

    Article  PubMed  CAS  Google Scholar 

  46. Delanty N et al (1997) Erythropoietin-associated hypertensive posterior leukoencephalopathy. Neurology 49(3):686–689

    Article  PubMed  CAS  Google Scholar 

  47. Schwartz RB et al (1998) Diffusion-weighted MR imaging in hypertensive encephalopathy: clues to pathogenesis. AJNR Am J Neuroradiol 19(5):859–862

    PubMed  CAS  Google Scholar 

  48. Vaughan CJ, Delanty N (2000) Hypertensive emergencies. Lancet 356(9227):411–417

    Article  PubMed  CAS  Google Scholar 

  49. Hinchey J et al (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334(8):494–500

    Article  PubMed  CAS  Google Scholar 

  50. Covarrubias DJ, Luetmer PH, Campeau NG (2002) Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. AJNR Am J Neuroradiol 23(6):1038–1048

    PubMed  Google Scholar 

  51. Kastrup O et al (2002) Posterior reversible encephalopathy syndrome due to severe hypercalcemia. J Neurol 249(11):1563–1566

    Article  PubMed  CAS  Google Scholar 

  52. Giner V et al (2002) Reversible posterior leukoencephalopathy secondary to indinavir-induced hypertensive crisis: a case report. Am J Hypertens 15(5):465–467

    Article  PubMed  Google Scholar 

  53. Pavlakis SG, Frank Y, Chusid R (1999) Hypertensive encephalopathy, reversible occipitoparietal encephalopathy, or reversible posterior leukoencephalopathy: three names for an old syndrome. J Child Neurol 14(5):277–281

    Article  PubMed  CAS  Google Scholar 

  54. Garg RK (2001) Posterior leukoencephalopathy syndrome. Postgrad Med J 77(903):24–28

    Article  PubMed  CAS  Google Scholar 

  55. Port JD, Beauchamp NJ Jr (1998) Reversible intracerebral pathologic entities mediated by vascular autoregulatory dysfunction. Radiographics 18(2):353–367

    PubMed  CAS  Google Scholar 

  56. Trommer BL, Homer D, Mikhael MA (1988) Cerebral vasospasm and eclampsia. Stroke 19(3):326–329

    Article  PubMed  CAS  Google Scholar 

  57. Casey SO et al (2000) Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol 21(7):1199–1206

    PubMed  CAS  Google Scholar 

  58. Donaldson JO (1994) Eclampsia. Adv Neurol 64:25–33

    CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA

    Errol Gordon

  2. Stroke Critical Care Program, Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA

    Michel T. Torbey (Director)

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  1. Errol Gordon
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  2. Michel T. Torbey
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Correspondence to Michel T. Torbey .

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Editors and Affiliations

  1. Dept. Neurology, Henry Ford Hospital, W. Grand Blvd. 2799 , Detroit, 48202-2689, U.S.A.

    Panayiotis Varelas

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Gordon, E., Torbey, M.T. (2010). Extreme Hypertension, Eclampsia and Critical Care Seizures. In: Varelas, P. (eds) Seizures in Critical Care. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-532-3_9

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  • DOI: https://doi.org/10.1007/978-1-60327-532-3_9

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  • Publisher Name: Humana Press, Totowa, NJ

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