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Hypertensive Encephalopathy Mimicking Postdural Puncture Headache in a Parturient Beyond the Edge of Reproductive Age

Minville, Vincent MD; N’Guyen, Luc MD; Coustet, Bernard MD; Fourcade, Olivier MD; Samii, Kamran MD

doi: 10.1213/01.ANE.0000137806.09323.36
Letters to the Editor: Letters & Announcements

Departement d’anesthésie et de réanimation; Centre Hospitalo-Universitaire de Toulouse; Toulouse, France;

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To the Editor:

Caring for the parturient beyond the edge of reproductive age is a new (and challenging) aspect of practice of many obstetricians and obstetric anesthesiologists. Although some complications (e.g., pregnancy-induced hypertension [PIH]) may occur more frequently in older mothers (1), there is no universal consensus that older age per se complicates either gestation and/or parturition (2,3).

Hypertensive encephalopathy is a syndrome consisting of headache, visual changes, seizures, and other neurological disturbances in patients with elevated systemic blood pressure. Diagnosis based on clinical and radiological findings, which are not specific, may be difficult to establish (4). Jurcic et al. (5) reported that hypertensive encephalopathy might develop gradually even when blood pressure is lower than that of malignant hypertension.

Indeed, we recently encountered a 52-year-old otherwise healthy parturient with twin gestation (assisted reproduction after oocyte donation) who required Cesarean delivery (conducted under uneventful epidural anesthesia) at 33 weeks gestation for worsening PIH. Postoperatively, the patient developed headache initially thought to resemble postdural puncture headache, however, neurological consultation and diagnostic radiological studies established the diagnosis of hypertensive encephalopathy. The most likely etiology was PIH. To our knowledge, this is the first reported case of a hypertensive encephalopathy-related headache in the parturient.

Krzysztof M. Kuczkowski, MD

Ulrike B. Eisenmann, MD

Department of Anesthesiology

UCSD Medical Center

San Diego, CA

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1. Weerasekera DS, Udugama SG. Pregnancy at 40 and over: a case-control study in a developing country. J Obstet Gynaecol 2003;23:625–7.
2. Blickstein I. Motherhood at or beyond the edge of reproductive age. Int J Fertil Womens Med 2003;48:17–24.
3. Edge V, Laros RK Jr. Pregnancy outcome in nulliparous women aged 35 or older. Am J Obstet Gynecol 1993;168:1881–5.
4. Williams O, Brust JC. Hypertensive encephalopathy. Curr Treat Options Cardiovasc Med 2004;6:209–16.
5. Jurcic V, Ferluga D, Jeruc J, et al. Hypertensive encephalopathy mimicking brainstem tumour in psychiatric patient. Folia Neuropathol 2004;42:37–41.
© 2004 International Anesthesia Research Society