Páralisis del sexto par craneal, una rara e inusual presentación de preeclampsia
Sixth cranial nerve palsy, a rare and unusual presentation of preeclampsia
Rev. chil. anest; 52 (4), 2023
Publication year: 2023
We report the case of a 34-year-old female patient, without relevant medical records, with a single pregnancy of 36 + 5 weeks, who suddenly presented diplopia and pain in the right eye of 4 days’ evolution. During the evaluation in the Emergency Department, hypertension 144/93 mmHg was evidenced. No other neurological symptoms were found. The neurologist confirms a right abducens nerve palsy, with the rest of the neurological examination being normal. She was admitted to the Critical Patient Unit for imaging studies and hemodynamic monitoring. Magnetic Resonance Imaging (MRI) of the brain was normal. Laboratory tests showed proteinuria in preeclampsia range, so it was decided to interrupt the pregnancy at 37 weeks by cesarean delivery due to lack of obstetrical conditions. During surgery, spinal anesthesia was provided with standard technique, a cerebrospinal fluid (CSF) sample was taken for cytochemical and microbiological studies, which were subsequently reported as normal. No significant hemodynamic alterations were presented during surgery, concluding without incidents. After 48 hours of delivery the NC VI palsy resolves completely. Similar cases have been reported by other authors, highlighting isolated cranial nerve palsy as a unique presentation, without other neurological involvement, a very rare presentation of preeclampsia. The most likely etiology is the compromise of the vessels of the affected nerve, and it is essential to study with a MRI and rule out autoimmune, endocrinologic, neurologic and any infectious disease of the CNS. The approach must be multidisciplinar to decide the risk/benefit of continuing pregnancy. Resolution is spontaneous and during puerperium. It is recommended to manage in the Critical Patient Unit with both neurological and ophthalmologic follow-up during the pre and post delivery period.
Presentamos el caso de una paciente femenina de 34 años, sin antecedentes médicos relevantes, cursando embarazo único de 36 + 5 semanas de gestación, quien comienza de forma aguda con diplopía y dolor en ojo derecho de 4 días de evolución. Durante la evaluación en el Servicio de Urgencias se objetiva hipertensión 144/93 mmHg. No se refieren otros síntomas neurológicos. Neurólogo constata una parálisis del nervio abducens (NC VI) derecho, con resto de examen neurológico normal. Se decide su ingreso a la unidad de paciente critico para estudio imagenológico y vigilancia hemodinámica. RNM de encéfalo normal. Al laboratorio destaca proteinuria en rango de preclampsia por lo que se decide interrumpir el embarazo a las 37 semanas mediante cesarea a falta de condiciones obstetricas. Durante la resolución se realiza anestesia espinal con técnica habitual, y se toma muestra de LCR para estudio citoquímico y microbiológico, posteriormente, informado como normal. No se presentaron alteraciones hemodinamicas significativas durante el intraoperatorio, concluyendo sin incidentes. Luego de 48 h del parto la parálisis del NC VI se resuelve completamente. Casos similares han sido reportados por otros autores, destacando la parálisis aislada de un nervio creneal como presentacion única, sin otra afectación neurológica, una muy rara presentación de preeclampsia. Su etiologia más probable es el compromiso de la vasculatura del nervio afectado y es fundamental realizar un estudio con neuroimágen (RNM) y descartar enfermedad propia del SNC infecciosa, sistemica autoinmune u otro tipo de enfermedad endocrinológica. El enfrentamiento es miltidisciplinario para decidir el riesgo/beneficio de continuar con el embarazo. La resolución es espontánea y durante el puerperio, se recomienda su manejo en Unidad de Paciente Crítico junto a seguimiento neurológico y evaluación oftalmológica durante el pre y posoperatorio.