CASE REPORT
Brain Tumor in Differential Diagnosis of Seizures in Puerperium: Case Report
Luíza Guazzelli Pezzali3, *, Gabriela Francoes Rostirolla1, 3, Carina Bauer Luiz3, Lúcio Brandão Gomes4, Raquel Camara Rivero5, 6, Edimárlei Gonsales Valério1, 2, 3, Janete Vettorazzi1, 2, 3
Article Information
Identifiers and Pagination:
Year: 2019Volume: 13
First Page: 67
Last Page: 71
Publisher ID: TONEUJ-13-67
DOI: 10.2174/1874205X01913010067
Article History:
Received Date: 25/10/2018Revision Received Date: 13/03/2019
Acceptance Date: 04/04/2019
Electronic publication date: 30/04/2019
Collection year: 2019
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Convulsive crisis is a transient disturbance of cerebral function, and the etiology of which may be manifold. Its clarification is essential for establishing adequate therapy and seizure control. In the pregnancy-puerperal cycle, eclampsia is the most common cause of it, but brain tumor, epilepsy and other disorders are part of the differential diagnosis. We report a case of seizure triggered by tumor in a primigest, 22 years old, at 38 weeks’ gestation with premature rupture of membranes. Cesarean section was performed due to non-reassuring fetal condition. On the second day of puerperium, she presented recurrent episodes of generalized tonic-clonic seizures and elevated blood pressure. She received magnesium sulfate for 24 hours and persisted with severe headache. Magnetic resonance imaging of the brain showed an expansive lesion in the left frontoparietal region. The patient underwent intracranial microsurgery on the eighth day after cesarean section, with complete resection of the lesion and anatomopathological diagnosis of schwannoma. She went through good postoperative evolution, without neurological deficits, and stayed on phenobarbital, with no seizures until 6 months of follow-up. From the case we conclude that although the first diagnosis in pregnant or puerperal women with seizures should be eclampsia, there are other causes, such as brain tumor and Posterior Reversible Encephalopathy Syndrome (PRES). Careful evaluation is required, especially in refractory cases and not responding to usual treatment.
