Postpartum stroke successfully treated with high-dose pentobarbitone therapy: a case report

A case is presented of a primigravida with severe preeclampsia who, 24 hours after delivery, became hemiparetic and deeply comatose due to acute ischaemia of the left cerebral hemisphere. She was treated with high-dose pentobarbitone therapy when conventional treatment to control raised ICP had failed. A loading dose of pentobarbitone 400 mg (5 mg/kg) was followed by a continuous infusion of 1.0 to 2.5 mg/kg/hour. Withdrawal of the barbiturate after four days of therapy resulted in a rise in ICP above 20 mmHg which necessitated resumption of the drug. After an additional eight days of pentobarbitone therapy with normal ICP values the infusion was discontinued without any change in ICP. The patient made an excellent recovery with no neurologic deficit. The specific pathophysiologic features of pre-eclampsia which were encountered in the patient are detailed. The potential problems which may arise in the pre-eclamptic patient who requires intensive care in the puerperium are emphasised.