Báo cáo y học: Neurocysticercosis as an important differential of seizures in pregnancy: two case reports

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Báo cáo y học: "Neurocysticercosis as an important differential of seizures in pregnancy: two case reports"Singhal et al. Journal of Medical Case Reports 2011, 5:206 JOURNAL OF MEDICALhttp://www.jmedicalcasereports.com/content/5/1/206 CASE REPORTS CASE REPORT Open AccessNeurocysticercosis as an important differential ofseizures in pregnancy: two case reportsSavita R Singhal1*, Smiti Nanda1 and Suresh K Singhal 2 Abstract Introduction: Seizures in pregnancy usually result from eclampsia, epilepsy or central nervous system disorders. Neurocysticercosis is a rare, but an important, cause of first-time convulsions in pregnancy. Case presentations: We report the cases of two Indian women, aged 20 and 24 years old respectively, with neurocysticercosis presenting in the second trimester of pregnancy with convulsions. Both had marginally raised blood pressure with 1+ urine albumin and neither had a past history of convulsions. The neurocysticercosis was diagnosed on magnetic resonance imaging of the head, which showed spherical ring-enhancing lesions in the brain. In one woman, pregnancy was terminated due to spina bifida in the fetus and she was discharged on albendazole and phenytoin. The second woman was put on carbamazepine: she had an emergency Cesarean section at term for fetal distress and delivered a healthy baby. Her postnatal period was uneventful. Conclusion: Neurocysticercosis should be considered in pregnant women presenting with seizures which cannot be explained by eclampsia, especially in early pregnancy.Introduction Case presentationsSeizures in pregnancy usually result from eclampsia, epi- Case 1lepsy or central nervous system disorders. Neurocysti- A 20-year-old Indian woman who was an unbooked pri-cercosis, although rare, is an important cause of first- migravida presented as an emergency at 27 weeks of gesta-time convulsions in pregnancy. Del Brutto has proposed tion with generalised tonic clonic seizures over a six hourcertain definitive and probable criteria for the diagnosis period. She had been unconsciousness for one hour. Sheof neurocysticercosis: histology; imaging; epidemiology; was referred by a general practitioner with a diagnosis ofserology; clinical symptoms; and follow-up scans [1]. eclampsia. There was no past history of seizures and sheMagnetic response imaging (MRI) is superior to a com- was not on any medication. On examination, she was in aputed tomography (CT) scan in diagnosis and follow-up grade III coma and her pulse and blood pressure were 92studies [2]. The signs and symptoms range from a single beats/min and 130/90 mmHg, respectively. Her urineseizure to coma and death. It can be treated with mini- albumin was +1 and the liver function, renal function andmal interruption to the course of the pregnancy and fundus examinations were normal. An ultrasound showedmedical treatment is effective in most cases although a live 26-week-size fetus with spina bifida. An emergency MRI of our patient’s head showed a 4-5 mm sphericalsurgery may be indicated for a few women [3]. Wereport two cases of neurocysticercosis in women who ring-enhancing lesion in the frontal region of her brain. Apresented with convulsions in the second trimester of diagnosis of neurocysticercosis was made on the basis oftheir pregnancy. the MRI finding, symptoms and living in an endemic area. She was put on intravenous phenytoin and the pregnancy was terminated in view of the fetus’ spina bifida with miso- prostol. She aborted after 16 hours and regained con- sciousness after 24 hours: she was discharged on albendazole and phenytoin.* Correspondence: savita06@gmail.com1 Department of Obstetrics and Gynecology, Pandit Bhagwat Dayal Sharma,Post Graduate Institute of Medical Sciences, Rohtak (124001), Haryana, IndiaFull list of author information is available at the end of the article © 2011 Singhal et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Singhal et al. Journal of Medical Case Reports 2011, 5:20 ...