Neuromyelitis optica in pregnancy complicated by posterior reversible encephalopathy syndrome, eclampsia and fetal death

Catherine Igel; Diana Garretto; Matthew S Robbins; Michael Swerdlow; Nancy Judge; Ashlesha Dayal

doi:10.14740/jocmr2031w

Neuromyelitis optica in pregnancy complicated by posterior reversible encephalopathy syndrome, eclampsia and fetal death

J Clin Med Res. 2015 Mar;7(3):193-5. doi: 10.14740/jocmr2031w. Epub 2014 Dec 29.

Authors

Catherine Igel¹, Diana Garretto¹, Matthew S Robbins², Michael Swerdlow², Nancy Judge¹, Ashlesha Dayal¹

Affiliations

¹ Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
² Department of Neurology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.

Abstract

Neuromyelitis optica (NMO) is a demyelinating syndrome characterized by optic neuritis and acute myelitis with poor recovery and a progressive course. We report a poor outcome complicated by posterior reversible encephalopathy syndrome (PRES) and eclampsia and review available literature and current evidence for anticipation of adverse fetal and maternal effects. After a pregnancy complicated by multiple admissions for painful NMO exacerbations, a primiparous patient with seropositive NMO presented at 31 + 3/7 weeks with eclampsia, HELLP and subsequent fetal death. MRI confirmed PRES. NMO may be associated with eclampsia and leads to adverse maternal and fetal outcomes. Posited mechanisms include antibody-mediated placental damage and a heightened risk of eclampsia-associated PRES. Further characterization of the course of NMO and its relationship with pregnancy outcomes in larger series would be invaluable.

Keywords: Aquaporin 4; Devic’s disease; Eclampsia; Neuromyelitis optica; Posterior reversible encephalopathy syndrome.

Publication types

Case Reports