Estudios de imagen cerebral en el diagnóstico diferencial de enfermedades hipertensivas del embarazo y convulsiones. Reporte de dos casos

Abstract

BACKGROUND: Seizures during pregnancy are the most frequent neurological com- plication. Most occur in patients with epilepsy. When the first crisis appears during pregnancy, the cause must be determined. FIRST CASE: A 28-year-old patient with a history of high blood pressure. She was in the late puerperium with over-added preeclampsia when she presented three seizures. She went to the emergency room and started magnesium sulfate, evolving to epileptic status. Neuroimaging studies were performed and reported thrombosis of the left frontal cortical vein. Neuroprotection measures were applied with adequate clinical evolution. She was discharge without motor, sensory and cognitive deficits. SECOND CASE: A 22-year-old patient with a history of a chronic progressive external ophthalmoplegia mitochondrial cytopathy. She was in her first pregnancy without pre-natal control. At the 28 week she began with headache and had a seizure. She went to the emergency department with high blood pressure, so she was given antihypertensive therapy and magnesium sulfate. Neuroimaging studies reported a posterior reversible behavior or may be life-threatening. We propose a diagnostic algorithm for the approach of these patients, highlighting the clinical suspicion of other causes of seizures as the main indication of imaging studies.