Pontine infarction in a patient with HELLP syndrome: сase report with a review
Description
INTRODUCTION. The prevalence of HELLP syndrome ranges from 0.5% to 0.9%. The mortality rate during its development reaches 24%. One of the reasons for the unfavorable outcome of this complication is acute cerebrovascular accident, but the true frequency of this complication in HELLP syndrome is currently not specified. An even rarer complication is ischemic brainstem stroke. Progressive endothelial dysfunction leading to generalized microthrombosis and coagulopathy may be the cause of neurological complications in HELLP syndrome and requires a rapid differential diagnosis with other thrombotic microangiopathies (TMA). In case of negative dynamics after delivery, early initiation of plasma exchange or plasma filtration helps stabilize the condition and allows one to safely exclude other variants of TMA. CASE PRESENTATION. The purpose of the publication is to present a clinical case of the development of brainstem stroke in a patient with an atypical course of HELLP syndrome without clinical and laboratory signs of liver failure, to summarize existing data on the frequency of strokes during pregnancy, risk factors, etiology, as well as diagnostic and treatment strategies. CONCLUSION. TMA with the development of HELLP syndrome can be the cause of ischemic stroke; it requires an urgent differential diagnosis with hemorrhagic stroke, thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremic syndrome (aHUS), an interdisciplinary approach to diagnosis and treatment, as well as early inclusion in complex therapy therapeutic apheresis.