Beware of delayed severe brain swelling after intracerebral haematoma in HELLP syndrome

Abstract

Haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a condition associated with increased risk of adverse outcomes during pregnancy and peripartum, including neurological complications. We report the third case in the world literature of delayed brain swelling following cerebral haemorrhage as a complication of HELLP syndrome. A 36-year-old woman in labour developed HELLP, which was complicated with intracerebral haematoma. This was evacuated, but motor impairment persisted after surgery and unfortunately the patient died unexpectedly during the 11th postoperative day. Computer tomographic brain scans documented diffuse cerebral swelling, which we think may have been caused by cerebral vasospasm. Cerebral vasospasm should always be considered when managing patients who suffered from stroke complicating HELLP syndrome. Close monitoring is advised even in later stages of recovery.

Keywords: Cerebral swelling; HELLP syndrome; cerebral vasospasm; intracerebral haemorrhage.

Figure 1.

Preoperative axial computed tomographic (CT) brain scan showing haematoma in the right centrum semiovale (left) and reconstructed coronal CT brain scan showing haemorrhage in the right parietal region extending into lateral ventricles and ventriculomegaly and evidence of midline shift (right).

Figure 2.

Axial computed tomographic (CT) brain scans immediately following the revision of cerebrospinal fluid (CSF) drainage device (left) and 12 hours later (right) at the level of the pineal gland. There has been marked cerebral swelling with effacement of the lateral ventricles. The external ventricular drain is seen in the right frontal horn of the lateral ventricle.