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Pearls & Oy-sters: Reversible Postpartum Pseudocoma State Associated With Magnesium Therapy: A Report of 2 Cases
Tal Friedman-Korn1, Yosef Lerner2, Shalom Haggiag2
1From the Department of Neurology (T.F.-K., Y.L., S.H., A.N., D.E., Z.A., A.V.-D., M.G.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Neurology (S.H.), San Camillo-Forlanini, Rome, Italy; and Department of Emergency Medicine (A.N.), Hadassah Medical Center, Jerusalem, Israel. tali.korn@mail.huji.ac.il.
Abstract:
Magnesium (Mg) competes with calcium in normal synaptic transmission, inhibiting neurotransmitter release. As a drug, it is usually given as a treatment for eclampsia and preeclampsia. Two eclamptic pregnant women treated with Mg developed a pseudocoma state immediately after emergency Caesarian section. The clinical presentation was flaccid quadriparesis, areflexia, absent respiratory effort and vestibular-ocular reflexes, but with preserved pupillary responses. Decremental responses on repetitive nerve stimulation were found in both women. Recovery was obtained after cessation of Mg. The persistence of pupillary reflexes in the absence of reflexes involving striated muscles was an important clinical clue, indicating neuromuscular junction dysfunction.
