Postpartum Trifecta: Simultaneous Eclamptic Intracerebral Hemorrhage, PRES, and Herniation Due to Intracranial Hypotension

Authors: Orehek EK, Burns JD, Koyfman F, Azocar RJ, Holsapple JW, Green DM.

BACKGROUND: In the postpartum patient, sudden depression of consciousness may be caused by a number of etiologies and can result in serious consequences. Rapid, accurate diagnosis allows for specific treatments that optimize outcome, but diagnosis can be challenging in this population. We present a case of postpartum herniation due to intracranial hypotension in a patient with eclampsia, posterior reversible encephalopathy syndrome (PRES), and intracerebral hemorrhage (ICH).

Emergency Neurological Life Support: Intracranial Hypertension and Herniation

Authors: Stevens RD, Huff JS, Duckworth J, Papangelou A, Weingart SD, Smith WS.

Sustained intracranial hypertension and acute brain herniation are "brain codes," signifying catastrophic neurological events that require immediate recognition and treatment to prevent irreversible injury and death. As in cardiac arrest, evidence supports the organized implementation of a stepwise management algorithm. Because there are multiple etiologies and many treatments that can potentially reverse cerebral herniation, intracranial hypertension and herniation was chosen as an Emergency Neurological Life Support (ENLS) protocol.

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