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The last two decades have witnessed a remarkable reinvention of the role of the neurologist, from an outpatient consultant to a critical presence in the inpatient setting. Spotting a neurologist in an emergency room or intensive care unit is no longer incongruous, rather an expectation of their relatively new roles as acute stroke doctors and neurointensivists. With this shift in patient care setting came a shift in research and many questions that have plagued the neurologic community for decades have resurfaced. The groundbreaking neurophysiologic discoveries of the previous century have armed us with an understanding of how the normal neuron functions. Now, in the inpatient, critically ill population, we once again find ourselves wondering what is happening within the shroud of the skull.
Eclampsia is associated with increased risk of maternal and fetal morbidity and mortality. Aggressive attempts should be made to control seizures and hypertension. It usually develops after 20 weeks of gestation and just over one-third of cases occur at term, usually developing intrapartum or within 48 hours of delivery. Two hypotheses have been proposed: (1) cerebral overregulation in response to high blood pressure results in vasospasm of cerebral arteries, localized ischemia, and intracellular edema; (2) loss of autoregulation of cerebral blood flow in response to high blood pressure results in hyperperfusion, and vasogenic edema. In addition to the management principles that apply to other seizures with different etiologies such as prevention of hypoxia, trauma, and recurrent seizures, management of eclamptic seizures includes control of severe hypertension if present, and evaluation for prompt delivery. Magnesium sulfate is considered the drug of choice for prevention and treatment of eclampsia.