Eclampsia differential diagnosis: Difference between revisions
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{{Eclampsia}} | {{Eclampsia}} | ||
{{CMG}} | '''To go back to the main page, click [[Microchapter templates|here]]''' | ||
{{CMG}} {{AE}}[[User:Navneet|Navneet Kaur M.B.,B.S.]] | |||
==Overview== | ==Overview== | ||
Seizures during pregnancy that are unrelated to [[Preeclampsia]] need to be distinguished from [[Eclampsia]]. | Seizures during pregnancy that are unrelated to [[Preeclampsia]] need to be distinguished from [[Eclampsia]]. This is essential to recognize the correct cause and provide the targeted treatment necessary in a timely manner. | ||
==Differentiating Eclampsia from other Diseases== | ==Differentiating Eclampsia from other Diseases== | ||
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*[[Adrenal Insufficiency]] or Acute [[Adrenal crisis]] | *[[Adrenal Insufficiency]] or Acute [[Adrenal crisis]] | ||
*[[Aneurysm]] of the brain | *[[Aneurysm]] of the brain | ||
*Brain tumor | *[[Brain tumor]] | ||
*[[Cerebellar Haemorrhage]] | *[[Cerebellar Haemorrhage]] | ||
*[[Disseminated herpes simplex]]/ [[Herpes Simplex Encephalitis]]([[HSE]]) | *[[Disseminated herpes simplex]]/ [[Herpes Simplex Encephalitis]] ([[HSE]]) | ||
*[[Disseminated sepsis syndromes]] | *[[Disseminated sepsis syndromes]] | ||
*[[Drug Overdose]] syndromes | *[[Drug Overdose]] syndromes | ||
*[[Drug Withdrawal]] syndromes | *[[Drug Withdrawal]] syndromes | ||
*[[Encephalitis]] | *[[Encephalitis]] | ||
*[[Fatty liver of pregnancy]] | *[[Acute Fatty liver of pregnancy]] ([[AFLP]]) | ||
*[[Hemolytic uremic syndrome]] | *[[Hemolytic uremic syndrome]] ([[HUS]]) | ||
*[[Hypertensive encephalopathy]] | *[[Hypertensive encephalopathy]] | ||
*[[Hypoglycemia]] | *[[Hypoglycemia]] | ||
*Medication- or drug- | *[[Medication- or drug-induced seizures]] | ||
*[[Meningitis]] | *[[Meningitis]] | ||
*[[Posterior reversible encephalopathy syndrome]] ([[PRES]]) | *[[Posterior reversible encephalopathy syndrome]] ([[PRES]]) | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Disseminated herpes simplex/ [[Herpes Simplex Encephalitis]]([[HSE]]) | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Disseminated herpes simplex/ [[Herpes Simplex Encephalitis]]([[HSE]]) | ||
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* On physical exam and history [[Herpes Simplex Encephalitis]]([[HSE]]) may present with Headache, Seizures, vision abnormalities, confusion, hyperactivity also observed in eclampsia. | * On physical exam and history [[Herpes Simplex Encephalitis]]([[HSE]]) may present with Headache, Seizures( seen in 50% of cases <ref name="pmid18754956">{{cite journal| author=Misra UK, Tan CT, Kalita J| title=Viral encephalitis and epilepsy. | journal=Epilepsia | year= 2008 | volume= 49 Suppl 6 | issue= | pages= 13-8 | pmid=18754956 | doi=10.1111/j.1528-1167.2008.01751.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18754956 }} </ref>), vision abnormalities, confusion, hyperactivity also observed in eclampsia. | ||
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* On physical exam and history [[Herpes Simplex Encephalitis]]([[HSE]]) demonstrates high fever, [[stiff neck]], altered reflexes, drowsiness with [[stupor]], localised symptoms such as [[aphasia]], [[anosmia]] that distinguish it from [eclampsia]. Also, skin lesions in dermatomal distribution, immunocompromised status, [[retinitis]] points towards [[HSE]]. Detection of [[DNA]] or Zoster [[Antigen]] in [[CSF]] and [[Polymerase chain reaction]][[(PCR)]] on CSF confirms infection with [[HSV]]. Treatment with [[antivirals]]([[acyclovir]]) results in dramatic improvement. | * On physical exam and history [[Herpes Simplex Encephalitis]]([[HSE]]) demonstrates high fever, [[stiff neck]], altered reflexes, drowsiness with [[stupor]], localised symptoms such as [[aphasia]], [[anosmia]] that distinguish it from [eclampsia]. Also, skin lesions in dermatomal distribution, immunocompromised status, [[retinitis]] points towards [[HSE]]. Detection of [[DNA]] or Zoster [[Antigen]] in [[CSF]] and [[Polymerase chain reaction]][[(PCR)]] on CSF confirms infection with [[HSV]]. Treatment with [[antivirals]]([[acyclovir]]) results in dramatic improvement. | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Drug overdose/[[Drug Intoxication]] | ||
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* On physical exam and history drug intoxication can present with Seizures, Hypertension, nausea and vomiting also observed in eclampsia. The most common drugs accountable for seizures include [[Antidepressants]], [[Diphenhydramine]], [[Stimulants]]([[Cocaine]], [[Methamphetamines]]) [[Tramadol]], and [[isoniazid]].<ref name="pmid26174744">{{cite journal| author=Chen HY, Albertson TE, Olson KR| title=Treatment of drug-induced seizures. | journal=Br J Clin Pharmacol | year= 2016 | volume= 81 | issue= 3 | pages= 412-9 | pmid=26174744 | doi=10.1111/bcp.12720 | pmc=4767205 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26174744 }} </ref> | |||
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* Careful history and past records will indicate if the patient is taking any recreational or prescriptional medication respectively that could lead to overdose. Other symptoms of preeclampsia like proteinuria, edema are generally absent. Urine drug screening and Blood screening will confirm the diagnosis. | |||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Drug Withdral Syndromes | |||
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* [[Drug Withdral]] Symptoms are precipitated by sudden absence of a drug from one's system after development of [[physiological dependence]] on the drug. They could include Hypertesnion, tremors , seizures([[GTCS]]), agitation, nausea and vomiting, also seen in eclampsia. Common responsible agents include, [[Short acting opoids]](such as [[Heroin]], some painkillers), [[Long acting opoids]](eg.[[methadone]]), benzodiazepines(eg. [[clonazepam]], [[Xanax]]), [[Alcohol]]. | |||
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* Presence of past history of drug intake, and symptoms like [[anxiety]], [[insomnia]], [[hallucinations]], [[Psychological]] disturbances, [[Diarrhea]]([[Benzodiazepines]]), [[Delerium Tremens]]([[alcohol withdrawal]]), frequent yawning, goosebumps, body aches([[opioids]]) point towards drug withdrawal. A [[urine drug screen]] helps confirm the diagnosis. | |||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Encephalitis | |||
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* Encephalitis, inflammation of the brain, is most often caused by viral infection <ref name="pmid22946723">{{cite journal| author=Michael BD, Solomon T| title=Seizures and encephalitis: clinical features, management, and potential pathophysiologic mechanisms. | journal=Epilepsia | year= 2012 | volume= 53 Suppl 4 | issue= | pages= 63-71 | pmid=22946723 | doi=10.1111/j.1528-1167.2012.03615.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22946723 }} </ref> , presents with seizures in 2-67% of cases <ref name="pmid18754956">{{cite journal| author=Misra UK, Tan CT, Kalita J| title=Viral encephalitis and epilepsy. | journal=Epilepsia | year= 2008 | volume= 49 Suppl 6 | issue= | pages= 13-8 | pmid=18754956 | doi=10.1111/j.1528-1167.2008.01751.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18754956 }} </ref>, and headache also seen in eclampsia. | |||
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* On history and physical exam a patient with Encephalitis demonstrates: [[fever]], [[stiff neck]], [[sensitivity to light]], increased [[drowsiness]], [[confusion]] and [[disorientation]], [[irritability]], anxiety and if severe: weakness, partial [[paralysis]], [[double vision]], [[impaired speech]] or hearing, [[coma]], [[psychosis]], [[hallucinations]], etc. often not seen in eclampsia. Neuroimaging (brain MRI or CT scan), [[PCR]] or a [[lumbar puncture]] ([[spinal tap]]) is performed to check for signs of infection. Eg. if the cause is viral, the CSF will show: moderately elevated protein (60-80 mg/dL), normal glucose, and a moderate [[pleocytosis]] (up to 1000 [[leukocytes]]/µL)([[Mononuclear cells]] usually predominate). Blood, urine and stool tests to look for organisms or antibodies responsible for an infection often helps establish diagnosis. | |||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Acute Fatty Liver of Pregnancy ([[AFLP]]) | |||
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* On | * On history and physical exam [[AFLP]] demonstrates nausea and vomiting (seen in 50-60%), abdominal pain (50-60%), edema, mental status changes (altered sensorium, confusion, disorientation, [[psychosis]], restlessness, [[seizures]] or [[coma]]) (60–80%), [[tachycardia]] (50%) also seen in [[eclampsia]]. <ref name="pmid16432556">{{cite journal| author=Ko H, Yoshida EM| title=Acute fatty liver of pregnancy. | journal=Can J Gastroenterol | year= 2006 | volume= 20 | issue= 1 | pages= 25-30 | pmid=16432556 | doi=10.1155/2006/638131 | pmc=2538964 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16432556 }} </ref> | ||
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* | * Presence of [[Disseminated intravascular coagulation]] (55% cases), [[jaundice]] (>70%), [[gastrointestinal bleeding]] ( seen in 20–60% cases), [[acute renal failure]] (seen in 50% cases), [[Oliguria]] (seen in 40–60% cases), fever(late onset) <ref name="pmid16432556">{{cite journal| author=Ko H, Yoshida EM| title=Acute fatty liver of pregnancy. | journal=Can J Gastroenterol | year= 2006 | volume= 20 | issue= 1 | pages= 25-30 | pmid=16432556 | doi=10.1155/2006/638131 | pmc=2538964 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16432556 }} </ref> and absence of hypertension, proteinuria differentiates it from eclampsia. Abdominal pain is usually right upper quadrant, midepigastric or radiating to back in AFLP(seen in 50-60% cases) <ref name="pmid16432556">{{cite journal| author=Ko H, Yoshida EM| title=Acute fatty liver of pregnancy. | journal=Can J Gastroenterol | year= 2006 | volume= 20 | issue= 1 | pages= 25-30 | pmid=16432556 | doi=10.1155/2006/638131 | pmc=2538964 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16432556 }} </ref> and mostly epigastric and non radiating in eclampsia. | ||
* Severe coagulopathy such as disseminated intravascular coagulation is rare in pre-eclampsia but the prevalance is 55% in AFLP. <ref name="pmid16432556">{{cite journal| author=Ko H, Yoshida EM| title=Acute fatty liver of pregnancy. | journal=Can J Gastroenterol | year= 2006 | volume= 20 | issue= 1 | pages= 25-30 | pmid=16432556 | doi=10.1155/2006/638131 | pmc=2538964 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16432556 }} </ref> | |||
* Lab tests in AFLP shows raised, [[hyperbilirubinemia]], [[hypoglycemia]], elevated [[ammonia]], [[leukocytosis]] and [[thrombocytopenia]], prolonged [[PT]] and [[hypofibrinogenemia]] if DIC is present, which differentiates it from eclampsia. | |||
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Latest revision as of 06:52, 14 August 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Navneet Kaur M.B.,B.S.
Overview
Seizures during pregnancy that are unrelated to Preeclampsia need to be distinguished from Eclampsia. This is essential to recognize the correct cause and provide the targeted treatment necessary in a timely manner.
Differentiating Eclampsia from other Diseases
Eclampsia must be differentiated from other diseases that can cause seizures during pregnancy. The differentiation can be done by obtaining a proper history, physical examination, diagnostic tests, or imaging. Such disorders include:
- Acute exacerbation of systemic lupus erythematous
- Adrenal Insufficiency or Acute Adrenal crisis
- Aneurysm of the brain
- Brain tumor
- Cerebellar Haemorrhage
- Disseminated herpes simplex/ Herpes Simplex Encephalitis (HSE)
- Disseminated sepsis syndromes
- Drug Overdose syndromes
- Drug Withdrawal syndromes
- Encephalitis
- Acute Fatty liver of pregnancy (AFLP)
- Hemolytic uremic syndrome (HUS)
- Hypertensive encephalopathy
- Hypoglycemia
- Medication- or drug-induced seizures
- Meningitis
- Posterior reversible encephalopathy syndrome (PRES)
- Primary Hyperaldosteronism
- Seizure disorders and Epilepsy
- Stroke (Hemorrhagic or Ischemic)
- Thrombotic thrombocytopenic purpura
Usually, the presence of the signs of severe preeclampsia that precede and accompany eclampsia facilitates the diagnosis.
Differential Diagnosis | Similar Features | Differentiating Features |
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Acute exacerbation of SLE |
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Acute adrenal insufficiency |
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Brain tumor(s) |
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Intracranial Haemorrhage/ Ruptured Brain Aneurysm |
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Disseminated herpes simplex/ Herpes Simplex Encephalitis(HSE) |
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Drug overdose/Drug Intoxication |
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Drug Withdral Syndromes |
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Encephalitis |
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Acute Fatty Liver of Pregnancy (AFLP) |
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References
- ↑ A. Chrisoulidou, C. Williamson, M. De Swiet, Assessment of adrenocortical function in women taking exogenous glucocorticoids during pregnancy. J. Obstet. Gynaecol. 23(6), 643–644 (2003)
- ↑ Drucker D, Shumak S, Angel A. Schmidt's syndrome presenting with intrauterine growth retardation and postpartum addisonian crisis. Am J Obstet Gynecol. 1984 May 15;149(2):229-30. doi: 10.1016/0002-9378(84)90206-0. PMID: 6720805.
- ↑ Hala M. Goma (April 10th 2013). Management of Brain Tumor in Pregnancy — An Anesthesia Window, Clinical Management and Evolving Novel Therapeutic Strategies for Patients with Brain Tumors, Terry Lichtor, IntechOpen, DOI: 10.5772/54250. Available from: https://www.intechopen.com/chapters/43971
- ↑ 4.0 4.1 Misra UK, Tan CT, Kalita J (2008). "Viral encephalitis and epilepsy". Epilepsia. 49 Suppl 6: 13–8. doi:10.1111/j.1528-1167.2008.01751.x. PMID 18754956.
- ↑ Chen HY, Albertson TE, Olson KR (2016). "Treatment of drug-induced seizures". Br J Clin Pharmacol. 81 (3): 412–9. doi:10.1111/bcp.12720. PMC 4767205. PMID 26174744.
- ↑ Michael BD, Solomon T (2012). "Seizures and encephalitis: clinical features, management, and potential pathophysiologic mechanisms". Epilepsia. 53 Suppl 4: 63–71. doi:10.1111/j.1528-1167.2012.03615.x. PMID 22946723.
- ↑ 7.0 7.1 7.2 7.3 Ko H, Yoshida EM (2006). "Acute fatty liver of pregnancy". Can J Gastroenterol. 20 (1): 25–30. doi:10.1155/2006/638131. PMC 2538964. PMID 16432556.