Pontine stroke in a female patient with HELLP syndrome: description of a clinical case with a literature review
https://doi.org/10.24884/2078-5658-2025-22-3-87-96
Abstract
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 both HELLP syndrome and other types of thrombotic microangiopathy. Despite the fact that ischemic stroke is not an indication for therapeutic apheresis procedures, probably, their early onset with the development of stroke against the background of any of the options for obstetric thrombotic microangiopathy allows to gain time for a differential diagnosis and in a short time to improve the neurological status, laboratory parameters and general condition of the patient.
The objective was 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. Obstetric thrombotic microangiopathy can be the cause of ischemic stroke; it requires an urgent differential diagnosis with hemorrhagic stroke, thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and catastrophic antiphospholipid syndrome, an interdisciplinary approach to diagnosis and treatment, as well as early inclusion in the complex therapy of therapeutic apheresis.
About the Authors
E. N. Plakhotina
Vidnovsky Perinatal Center; M. F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation
Russian Federation
Plakhotina Elena N. - Dr. of Sci. (Med.), Head of Anesthesiology and Intensive Care Department; Professor of Anesthesiology and Intensive Care Department
Vidnoe, 17, Zavodskaya str., Moscow Region, 142700
61/2, Shchepkina str., Moscow, 129110
T. N. Belousova
Vidnovsky Perinatal Center
Russian Federation
Russian Federation
Belousova Tamara N. - Dr. of Sci. (Med.), Chief Physician
Vidnoe, 17, Zavodskaya str., Moscow Region, 142700
O. V. Chaplygina
Vidnovsky Perinatal Center
Russian Federation
Russian Federation
Chaplygina Oksana V. - Physician of Anesthesiology and Intensive Care Department
Vidnoe, 17, Zavodskaya str., Moscow Region, 142700
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For citations:
Plakhotina E.N., Belousova T.N., Chaplygina O.V. Pontine stroke in a female patient with HELLP syndrome: description of a clinical case with a literature review. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2025;22(3):87-96. (In Russ.) https://doi.org/10.24884/2078-5658-2025-22-3-87-96
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