Brain Lesions Several Years After Eclampsia

Long‐term cerebral imaging after pre‐eclampsia

“…Women who were admitted with pre-eclampsia between 1988 and 2005 were selected and matched for age and year of index pregnancy (both within 2 years) with women who experienced eclampsia, who have been reported in previous studies. 3,8 These formerly pre-eclamptic women were invited to participate in the current study by mail. In addition to this group, all women admitted to obstetric high care with severe pre-eclampsia and/or with HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) over a 2-year period (1 January 2005 to 31 December 2006) were invited by mail to participate.…”

“…The sequences used included: T 1 [repetition time (TR) = 700 ms; echo time (TE) = 8.4 ms; flip angle (a) = 65°; number of averages, 1], proton density (TR = 3000 ms; TE = 26.7 ms; a = 90°), T 2 (TR = 3000 ms; TE = 120 ms; a = 90°) and fluid attenuation inversion recovery [FLAIR; TR = 11 000 ms; TE = 100 ms; inversion time (TI) = 2800 ms; a = 90°; number of averages, 2]. For all women who underwent imaging in the second half of the study, additional scans were performed in order to detect microbleeds [venous blood oxygenation level-dependent (BOLD) volume scan with a voxel size of 0.45 · 0.45 · 1.00 mm 3 ; TR = 34.9 ms; TE = 49.9 ms; a = 15°; matrix, 512 · 512]. These were performed in 36 formerly pre-eclamptic women and 46 control women.…”

“…Previously, we have shown that formerly eclamptic women demonstrate cerebral white matter lesions (WMLs) several years following the index pregnancy, and we hypothesised that this is a long-term result of posterior reversible encephalopathy syndrome (PRES). 3 Severe cerebral vasogenic oedema in PRES may cause compression of cerebral tissue, resulting in reduced perfusion, followed by ischaemia, hypoxia and cell death. 4 This may appear as WMLs or infarction on magnetic resonance imaging (MRI) several years later.…”

“…4 This may appear as WMLs or infarction on magnetic resonance imaging (MRI) several years later. 3,4 Tonic-clonic seizures are not mandatory for the diagnosis of PRES and pre-eclamptic women may demonstrate signs, symptoms and imaging features of PRES in the absence of an eclamptic seizure. [5][6][7] The incidence and possible sequelae of PRES in women with pre-eclampsia are unknown, because cerebral imaging in such women is not standard practice.…”

Prediction of pregnancy-induced hypertension by a shift of blood pressure class according to the JSH 2009 guidelines

“…1,4,5 Furthermore, the long-term prognosis of women with a history of PIH includes increased risks of cerebrovascular disease, ischemic heart disease and renal disease. [6][7][8][9][10][11][12] These data indicate that the early identification, and subsequent monitoring and management of PIH are critical for maternal and fetal well-being.…”