Question 8 of 10

(demo test)

Product Demo for RITE®

Sample Case Description

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A 24-year woman who is 1 week postpartum from a pregnancy that was complicated by pre-eclampsia presents to the emergency department with intractable headache and a witnessed tonic-clonic seizure this morning. Her blood pressure is 240/100 and her heart rate is 100 bpm. She is somnolent but will awaken with noxious stimulation.

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Sample Case Question 1 of 3

Which of the following conditions are associated with pregnancy and may explain her current presentation?

A. cerebral venous sinus thrombosis (CVST)

B. eclampsia

C. posterior reversible encephalopathy syndrome (PRES)

D. reversible cerebral vasoconstriction syndrome (RCVS)

E. all of the above

Heads up! This question and its explanation are locked because of G-type Sample Cases restrictions. Please answer all questions in current sample case to see explanations.

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Category:

Clinical Adult

Topic:

Clinical Adult

High Yield:

No

Your Answer:

U

Correct Answer:

E

Explanation:

Pregnant and early postpartum patients are at increased risk for several neurologic complications. These complications include ischemic stroke with or without CVST, hemorrhage with or without CVST, eclampsia, PRES and RCVS (also called postpartum angiopathy). CVST may result in venous infarction, hemorrhages and seizure. Given her focal exam, stroke onset seizure is also a possibility, though this is less common than the options listed. Eclampsia, PRES, and RCVS may be thought to lie on an overlapping spectrum with similar underlying pathophysiology. PRES typically presents with headache, visual symptoms, and seizures. Classically this is thought to result from increased vascular tone and endothelial cell dysfunction leading to hypertension, increased vascular permeability and vasogenic cerebral edema. RCVS presents with thunderclap headache, convexity subarachnoid hemorrhage, lobar hemorrhage, seizures, and focal neurologic deficits. This results from a noninflammatory reversible vasoconstriction of cerebral vessels. Eclampsia is a prothrombotic state and may predispose to strokes, but also leads to changes in vascular physiology. 

References:  

Feske SK and Singhal AB. Cerebrovascular disorders complicating pregnancy. Continuum (Minneap Minn). 2014 Feb;20(1 Neurology of Pregnancy):80-99.

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