Book of Medical Disorders in Pregnancy - Tintash

consciousness, tonic and/or clonic
movements of extremities, trunk and
face and incontinence of urine and feces.
The family history or patient's past
history may be helpful in separating this
from eclampsia. The signs such as
oedema, proteinuria and hypertension
are distinctly absent incases of epilepsy.
Cerebral tumour - When convulsions
are reported with previous history of
headache, nausea and projectile vomiting;
presence of papilledema and raised
cerebrospinal pressure are very suggestive
features of cerebral tumor. Final
diagnosis will depend on demonstrating
the mass by C.T. or other type of brain
scan.
Head injury:
Inspection and palpation may reveal
bruises and depression of the skull.
There may be leakage of spinal fluid
from nose or ear.
Sub conjunctival hemorrhage usually
indicates the frac-ture of anterior or
middle fossa. Radio-logical evidence of
fracture of skull will confirm the
diagnosis.
Vascular accidents:
Cerebral thrombosis is a common cause
of coma. There is usually some indication
of a local lesion such as facial
asymmetry deviation of eyes or undue
flaccidity of arm and leg on one side.
Cerebral Hemorrhage usually results in
fatal coma. The blood pressure is usually
high, the pulse is slow, the left ventricle
is enlarged and hypertensive retinopathy
may be present.
Intracranial infections
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Meningitis - Any form of meningitis can
cause convulsion. High grade fever,
headache nausea and vomiting with neck
rigidity are highly suggestive. When leukocytes
and organisms are found in the
CSF, the diagnosis is definite.
Fulminating Meningococcal Me-ningitis
may cause coma and death within 24
hours. The temperature is usually
elevated, stiffness of neck and fine
purpuric rash is common. Diagnosis is
made by lumbar puncture which reveals
cloudy fluid containing organism and
polymorph leucocytes.
Cerebral malaria - This tropical disease
can cause convulsions, coma and fever.
The diagnosis will depend on the history
of exposure to the disease and presence
of parasites in the peripheral blood film.
Cerebral malaria is an important cause of
sudden coma. The temperature may be
normal or high. The spleen may or may
not be enlarged.
Tetanus:
In cases where there is previous history
of abrasions or wound of skin, tetanus
needs to be ruled out. The earliest
manifestation in tetanus is trismus or
tonic spasm of the masseter muscles.
This is followed by tetanic spasm of
other muscles and finally leads to
episthotonos and risus sardonicus. During
the interval of tetanic spasms, the
muscles are rigid.
Hypoglycemic convulsions: These
convulsions tend to occur in the early
hours of the day, when a meal has been
missed or unwanted physical exertion