Clinicopathological study of neurological complications due to hypertensive disorders of pregnancy.

Abstract

SUMMARY Forty-three women with neurological complications secondary to eclampsia or severe pre-eclampsia were studied by CT scanning and in six intracranial pressure (ICP) monitoring was carried out. In seven women who died, neuropathological findings were correlated with clinical features. Cerebral oedema was present in 27 of the patients studied and the severity of oedema correlated to the duration of intermittent seizures. In five of the six women who had ICP measured, this was found to be transiently high. Intracranial haemorrhage was demonstrated in four of the 43 women, all of whom died. Hypoxic-ischaemic cerebral damage and fibrinoid necrosis were the most important neuropathological lesions identified. The management of neurological complications of eclampsia may be placed upon a more rational basis by an understanding of the mechanisms responsible for these lesions.Neurological complications due to hypertensive disorders of pregnancy are the most common cause of maternal death from these disorders. -3 However, the pathogenesis of these complications, namely eclamptic seizures, coma, visual disturbances and localising neurological defects, remains poorly understood. The purpose of this report is to document the neuropathological findings of seven women dying from eclampsia or severe pre-eclampsia. These changes are related to clinical and CT observations in a larger series of 43 women with pregnancy-induced hypertension (PIH) and one or more of the above mentioned neurological complications. The pathophysiological mechanisms which may have led to these lesions are reviewed.

Occipital Lobe Seizures as the Major Clinical Manifestation of Reversible Posterior Leukoencephalopathy Syndrome: Magnetic Resonance Imaging Findings

“…The convulsions are commonly occipital in onset, correlating with the characteristic posteriorly predominant brain lesions noted on MRI (23). RPLS may be associated with a variety of medical conditions such as malignant hypertension (4,12-15,2 l), eclamptic/toxemic states of pregnancy (16)(17)(18)(19)(20)28), or immunosuppressive drug toxicity (4-1 1). Recognition of RPLS is important, because the neurologic disorder is readily treatable by correcting the underlying medical cause.…”

Intracranial haemorrhage in pregnancy

“…13 Intracerebral haemorrhage has been found in up to 40% of patients with eclampsia in autopsy series. 28 Eclampsia is an important cause of serious haemorrhagic stroke -in an intensive care admission study, four of 11 pregnant patients admitted with haemorrhagic stroke were eclamptic. 29 Haemorrhages may be extensive or petechial.…”

Cerebrovascular Function in Pregnancy and Eclampsia

“…31 Both hypertensive encephalopathy and PRES can arise from an acute elevation in blood pressure that overcomes the myogenic vasoconstriction of cerebral arteries and arterioles causing loss of autoregulatory capacity, BBB disruption, and vasogenic edema. 8,[12][13][14][15] The concept that eclampsia can cause PRES has arisen from numerous similarities in clinical presentation including comparable imaging findings on computed tomography and MRI, 3,5,18,[31][32][33] the same neurologic symptoms (headache, vomiting, cortical blindness, and seizures), 3,9,16,17 and the prompt reversibility of symptoms after blood pressure has been restored. 3,9 The difference between hypertensive encephalopathy and PRES is that PRES can develop without a significant elevation in blood pressure.…”