Department of Women's Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore,
J Anesth. 2013 Oct;27(5):757-60. doi: 10.1007/s00540-013-1586-8. Epub 2013 Mar 12.
Preeclampsia can cause myriad organ dysfunction, including cranial nerve palsies that pose diagnostic and management dilemmas. We present an unusual case of third nerve palsy, (presenting as diplopia, ptosis) with hypertension, hyperreflexia, proteinuria, easy bruising in a parturient at 34 + 6/52 weeks of twins gestation. She was treated as for severe preeclampsia and HELLP syndrome; intravenous magnesium sulphate and labetalol commenced and emergent cesarean delivery performed under general anesthesia due to concerns of low platelets and for airway protection should her glascow coma scale (GCS) deteriorate. Postoperatively, stroke, aneurysm and intra-cerebral causes of third nerve palsy were excluded, with subsequent recovery of symptoms upon blood pressure normalization. The eye signs are postulated to be due to two preeclamptic mechanisms involving disordered cerebral autoregulation: (1) hyperperfusion and breakdown of the blood-brain barrier that occurs with rising hypertension, causing fluid/blood product extravasation into brain parenchyma, or (2) focal reactive vasoconstriction and local hypoperfusion, contributed to by endothelial dysfunction.
子痫前期可导致多种器官功能障碍，包括颅神经麻痹，这给诊断和治疗带来了困境。我们报告了一例不常见的第三颅神经麻痹（表现为复视、上睑下垂）病例，伴有高血压、反射亢进、蛋白尿、分娩时 34+6/52 周双胎妊娠的产妇容易瘀伤。她被视为严重子痫前期和 HELLP 综合征进行治疗；静脉注射硫酸镁和拉贝洛尔，并因血小板减少和气道保护的考虑（以防格拉斯哥昏迷评分（GCS）恶化），在全身麻醉下进行紧急剖宫产。术后，排除了中风、动脉瘤和第三颅神经麻痹的颅内原因，随着血压正常化，症状随后恢复。眼部体征被认为是由于两种涉及紊乱的脑自动调节的子痫前期机制引起的：（1）随着高血压的升高，发生过度灌注和血脑屏障破裂，导致液体/血液产物渗出到脑实质中；或（2）由内皮功能障碍引起的局灶性反应性血管收缩和局部低灌注。
