J Korean Soc Emerg Med.  2005 Apr;16(2):317-321.

A Case of HELLP Syndrome with Liver Infarction and Cerebral Venous Thrombosis

• Kim YK
• Lee KH
• Oh SB
• Cha KC
• Kim SH
• Kim HJ
• Kim H
• Hwang SO

Abstract

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.

Keyword

Hellp syndrome; Liver; Infarction; Cerebral thrombosis

MeSH Terms

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*
Heparin