Long‐term cerebral imaging after pre‐eclampsia

Aukes, Annet M.; Groot, de Jan; Wiegman, Marjon J.; Aarnoudse, Jan G.; Sanwikarja, G.S.; Zeeman, Gerda G.

doi:10.1111/j.1471-0528.2012.03406.x

Cited by 105 publications

(103 citation statements)

References 23 publications

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“…186 Early-onset preeclampsia is also associated with an increase in white matter lesions independent of hypertension in women years after pregnancies complicated by preeclampsia or eclampsia, which suggests a vulnerability to future events. 187 The basis of the association between preeclampsia and future stroke is not entirely known but is hypothesized to be possibly related to genetic factors; shared risk factors (hypertension, dyslipidemia, endothelial dysfunction) between preeclampsia/eclampsia or other pregnancy complications and stroke; unmasking of underlying metabolic or vascular disease; or the induction during pregnancy of cardiovascular or cerebrovascular abnormalities that persist long-term. 188 To assess the contribution by preeclampsia/eclampsia to future risk for CVD and stroke and the possible impact that lifestyle interventions may have on this risk, Berks et al 189 performed a series of literature-based calculations on risk estimates.…”

mentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Women

Bushnell¹,

McCullough²,

Awad³

et al. 2014

Stroke

751

414

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1545Purpose-The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. Results-We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. Conclusions-To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted. (Stroke. 2014;45:1545-1588.)

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mentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Women

Bushnell¹,

McCullough²,

Awad³

et al. 2014

Stroke

751

414

View full text Add to dashboard Cite

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“…29 Long-term cerebral imaging after preeclampsia showed an increased number and severity of white matter lesions in former preeclamptic women. 30 Furthermore, women with a history of preeclampsia have more atherosclerotic plaques in the carotid arteries, a higher intima-media thickness, and an increased risk of stroke later in life. 31 We thus assume that persistent changes of DCA might be an explanation for this observation.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia

et al. 2014

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Abstract-Preeclampsia may affect severely the cerebral circulation leading to impairment of cerebral autoregulation, edema, and ischemia. It is not known whether impaired autoregulation occurs before the clinical onset of preeclampsia, and whether this can predict the occurrence of preeclampsia. Seventy-two women at 25 to 28 weeks of gestation were studied. Control values were derived from 26 nonpregnant women. Dynamic properties of cerebral autoregulation (DCA) were measured in the middle and posterior cerebral artery using transcranial Doppler and transfer function analysis (phase and gain) of respiratory-induced 0.1 Hz hemodynamic oscillations. Uterine artery ultrasound was performed to search for a notch sign as an early marker of general endothelial dysfunction. All women were followed up until 6 weeks after delivery for the occurrence of preeclampsia. The autoregulation parameter gain did not differ between pregnant and nonpregnant women. Phase was slightly but significantly higher in pregnant women, indicating better DCA. Women with a notch sign did not show altered DCA. A history of preeclampsia during a previous pregnancy was associated with lower phase in middle cerebral artery and posterior cerebral artery (P<0.05 each). During follow-up, 9 women developed preeclampsia. None of the DCA parameters were associated with the occurrence of preeclampsia. In conclusion, DCA is well preserved during late midterm pregnancy, even in women with disturbed uterine blood flow. Yet, pregnant women with preeclampsia in a previous pregnancy seem to have poorer DCA. Although limited in statistical power, this study does not support DCA as a strong early risk marker of preeclampsia. (Hypertension. 2014;63:161-166.)

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“…Several years after a pregnancy, formerly preeclamptic women have cerebral white matter lesions more often and more severely than control women with normotensive pregnancies. 12 So these patients should be on close neurologic follow-up for the remainder of their lives. We recommend MRI for symptomatic patients with suspected PRES as well as for asymptomatic patients with severe pregnancy induced hypertension to determine whether cerebral edema exists so that the patient can undergo urgent delivery to prevent devastating neurological consequences.…”

Section: Resultsmentioning

confidence: 99%

Brain MRI findings of a 24-week pregnant woman with HELLP syndrome

Beker‐Acay

Ünlü

Okur

et al. 2016

Polish Annals of Medicine

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Available online xxxKeywords: Eclampsia Hypertensive encephalopathy Magnetic resonance imaging a b s t r a c t Introduction: HELLP syndrome (acronym comprised of hemolysis, elevated liver enzymes and low platelets) is seen in 0.1% of pregnant women. Posterior reversible encephalopathy syndrome (PRES) was reported to be 5% in patients with the HELLP syndrome. Atypical imaging appearances include contrast enhancement, hemorrhage and restricted diffusion on MRI.Aim: We aimed to improve clinicians' perception about brain lesions in the HELLP syndrome with imaging findings.Case study: Here, we present a case of an 18-year-old patient with a pregnancy of 24 weeks admitted with HELLP syndrome, with CT and MRI findings of PRES and intracerebral hematoma. MRI scan of the brain showed vasogenic edema in the occipital, frontal and parietal lobes bilaterally, basal ganglia and brainstem. An emergency cesarean section was successfully performed to end the pregnancy on the same day. Repeat MRI of the brain three days after initial admission showed partial improvement of the previous abnormalities with full clinical recovery.Results and discussion: The patient in this report had a variant form of PRES where the pathologic process encompassed both the posterior and anterior circulations.Conclusions: An appropriate multidisciplinary approach is the key for reducing the morbidity and mortality of PRES syndrome.

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Long‐term cerebral imaging after pre‐eclampsia

Cited by 105 publications

References 23 publications

Guidelines for the Prevention of Stroke in Women

Guidelines for the Prevention of Stroke in Women

Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia

Brain MRI findings of a 24-week pregnant woman with HELLP syndrome

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