We describe a rare case of cerebral venous thrombosis and liver infarction with HELLP syndrome in a 25-year-old woman with eclampsia. She had complained of epigastric pain and had visited a local hospital for treatment. Also, signs of fetal distress were presented. After an emergency cesarean section, generalized tonic-clonic seizure occurred twice at a 10-minute interval. The patients was transferred to our emergency room, and the neurologic examination at that time, revealed a deep drowsy mentality and positive Babinski's sign; the deep tendon reflex was two positive. The laboratory findings revealed thrombocytopenia, an elevated liver function test, abnormal coagulation profiles. A bilateral ischemic change with left basal ganglia hemorrhage was seen on brain CT, and multiple foci of ill defined low-density lesions, mainly in the subcapsular portion of the liver and perivascular space, were visible on the abdominal CT. There was a faint showing of the deep venous system on the angiogram of both carotid arteries and a cerebral venous thrombosis was confirmed by using 4-vessel angiography. During the following 2 days, the cerebral hemorrhage and the low-density lesion were resolved through applications of heparin, and the patient returned to a nearly alert mental status. Finally she died of a hemorrhagic shock as a complication of disseminated intravascular coagulation.
Adult ; Angiography ; Basal Ganglia Hemorrhage ; Brain ; Carotid Arteries ; Cerebral Hemorrhage ; Cesarean Section ; Disseminated Intravascular Coagulation ; Eclampsia ; Emergencies ; Emergency Service, Hospital ; Female ; Fetal Distress ; HELLP Syndrome* ; Heparin ; Humans ; Infarction* ; Intracranial Thrombosis ; Liver Function Tests ; Liver* ; Neurologic Examination ; Pregnancy ; Reflex, Babinski ; Reflex, Stretch ; Seizures ; Shock, Hemorrhagic ; Thrombocytopenia ; Tomography, X-Ray Computed ; Venous Thrombosis*

PURPOSE: This study was conducted for investigation of the recovery rate and prognostic factors of Bell's palsy treated with steroid and antiviral agents in the emergency department (ED). METHODS: A retrospective review of electronic medical records of patients with acute, unilateral Bell's palsy within 72 hrs of onset who were admitted from the ED between March 2008 and February 2010 was conducted. All patients were treated uniformly with high-dose steroid and valaciclovir. The House-Brackmann (HB) grading system was used for evaluation of the severity of facial palsy. Satisfactory recovery was defined as facial palsy that recovered to Grade I on the HB grading scale. RESULTS: During the three-year period, 231 patients (age, 51+/-15) with confirmed Bell's palsy were included in this study. Initial grade of paralysis was as follows: 43 patients (18.6%) were HB grade II, 107 patients (46.3%) were grade III, 72 patients (31.2%) were grade IV, and nine patients (3.9%) were grade V. The satisfactory recovery rate was 77.9% at three months, and 88.3% at 12 months from diagnosis. Satisfactory recovery rate was significantly lower in patients with initial HB grade III/IV (85.2% vs. 92.7%, p<0.01), and age over 40 years (85.72% vs. 95.2%, p=0.04). CONCLUSION: The satisfactory recovery rate of patients with Bell's palsy treated with steroid and antiviral agents was 77.9% at three months, and 88.3% at 12 months, and initial severity was found to be an important factor in predicting the long term prognosis of Bell's palsy.
Acyclovir ; Antiviral Agents ; Bell Palsy ; Electronic Health Records ; Emergencies ; Facial Nerve ; Facial Paralysis ; Humans ; Paralysis ; Prognosis ; Retrospective Studies ; Valine