Clinical features and stages of an eclamptic convulsion
THE CONTEXT
Eclamptic patients usually have premonitory manifestations of acute fulminating preeclampsia. Eclamptic fits are epileptiform and have four stages.
Premonitory stage
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The patient becomes unconscious, with twitching of the face, tongue and limbs. The eyeballs roll or turn to one side and become fixed.
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This stage lasts about 30 seconds.
Tonic stage
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The whole body develops tonic spasm, with opisthotonus of the trunk, flexed limbs and clenched hands.
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Respiration ceases, the tongue protrudes between the teeth, cyanosis appears and the eyeballs become fixed.
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This stage lasts about 30 seconds.
Clonic stage
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Voluntary muscles alternately contract and relax. Twitching begins in the face, spreads to one side of the extremities and eventually involves the whole body.
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Tongue biting occurs. Breathing is stertorous, blood-stained frothy secretions fill the mouth and cyanosis gradually disappears.
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This stage lasts 1–4 minutes.
Stage of coma
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Coma follows the fit and may be brief or persist deeply until another convulsion.
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Some patients have confusion and cannot remember the events after the fit. Rarely, coma occurs without a preceding convulsion.
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Fits are usually multiple and recur at varying intervals.