Neurologic Involvement in Hypertensive Disease of Pregnancy

Royburt, Moshe; Ds, Seidman; Serr, D M; Mashiach, S

doi:10.1097/00006254-199110000-00002

Cited by 51 publications

(26 citation statements)

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“…It is possible that both theories are operant in patients with end result of cerebral edema. 7,10 Such changes are responsible for various symptoms in patients of eclampsia and become evident on CT and more so on MRI as observed in our study, in two patients the CT did not show any abnormal feature that might have correlated to clinical presentation of having one episode of seizures and headache. Both these patients had only one episode if seizures.…”

Section: Discussionsupporting

confidence: 75%

“…5,[6][7][8][9] There is a failure of normal cerebral blood flow auto regulation in patients with hypertensive encephalopathy and probably in patients with eclampsia. 10 Vasospasm which follows vasoconstriction as a result of severe hypertension is thought to cause local ischemia, arteriolar necrosis, and disruption of the blood brain barrier, which leads to cerebral edema and has been demonstrated in several angiographic case reports in eclampsia. 11 Conversely, some data favor the forced dilation theory at increased arterial pressure, initially some vessels dilate and some remain constricted.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia

Jindal

Gaikwad

Hasija

et al. 2013

Int J Reprod Contracept Obstet Gynecol

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia

Jindal

Gaikwad

Hasija

et al. 2013

Int J Reprod Contracept Obstet Gynecol

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“…Vasospasm which follows vasoconstriction as a result of severe hypertension is thought to cause local ischemia, arteriolar necrosis and disruptions of blood brain barrier which leads to cerebral oedema. 6 It is possible that both vasoconstriction as well as forced vasodilatation causes cerebral edema. 7 These are due to irregularities in the auto regulation of cerebral circulation.…”

Section: Discussionmentioning

confidence: 99%

CT scan findings in patients of eclampsia

Gurjar

Rawat

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Eclampsia is defined as the occurrence of one or more convulsions in association with raised blood pressure and proteinuria in a pregnant or puerperal woman, usually between 20 weeks’ gestation and the first 48 hours postpartum. Maternal mortality in India due to eclampsia is 2 to 30% and perinatal mortality is 30 to 50%. Abnormal findings on neuroimaging have been noted in as many as 80-90% of women with eclampsia. Most common lesions are seen in parieto-occipital lobes in the distribution of posterior cerebral arteries. This lesion occurs as a result of vasogenic oedema induced by endothelial damage and other changes contributing to pathophysiology of eclampsia. Objectives of present work were to study involvement of different areas of brain in eclampsia and to study maternal and fetal outcomes.Methods: This is a prospective study done over a period of 6 months the study population were chosen by random sampling who were eclampsia patients admitted trough emergency and also indoor patients who develop eclampsia after admission. Total 12 patients were analyzed. CT scan of brain performed after confinement of fetus and after stabilising the mother. Maternal and fetal outcomes were observed in these cases.Results: 58.33% (7cases) eclamptic mothers were primigravida and 41.66% (5 cases) were multigravida. Among them 16.66% (2 cases) had postpartum eclampsia while 83.33% (10 cases) had antepartum eclampsia. 75% mothers delivered by vaginal route and 25% mothers undergone LSCS. There were 14 births including 2 twin deliveries, out which 12 were live births and 2 Intra uterine deaths. On CT Scan- Brain stem edema was seen in 9 cases, infarction in 1case, hemorrhage in 1case and in 1 case CT was normal. Most common lobe involved is parietal (10 cases) followed by occipital (7 cases), frontal (4 cases), temporal (3 cases).Conclusions: Early recognition of the disorder and prompt management by control of blood pressure, removal of the offending medications or treatment of associated diseases is essential to prevent irreversible brain damage. CT scan of brain in eclampsia can provide useful intra cerebral information and should be done in cases with severe neurologic manifestations, if possible for every eclamptic mother.

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“…Approximately 40% of women with preeclampsia report subjective visual disturbances. 11 In some patients, conditions such as cortical blindness, serous retinal detachments, Purtscher's-like retinopathy, and retinal and vitreous hemorrhages 12 have been documented to accompany preeclampsia. Many women with normal pregnancies may also report subjective visual disturbances associated with an increase or decrease in refractive error, as well as extraocular changes including ptosis.…”

mentioning

confidence: 99%

Choroidal and Retinal Thickening in Severe Preeclampsia

Garg

Wapner

Ananth

et al. 2014

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To compare choroidal thickness and retinal macular volume (RMV) among three groups of women: severe preeclampsia postpartum, normotensive postpartum, and normotensive nongravid. While visual disturbances often accompany severe preeclampsia, the underlying choroidal and retinal changes responsible for these symptoms have not been described.METHODS. This case-control study was based on 15 severe preeclampsia cases and 15 ethnicityand parity-matched normotensive controls recruited during the postpartum hospital stay. A reference group of 19 age-matched, nongravid, normotensive women was also studied. Choroidal thickness and RMV were measured by using enhanced depth imaging spectraldomain optical coherence tomography. Two retinal specialists, one of whom was masked to the case-control status, reviewed all images.RESULTS. Severe preeclampsia cases demonstrated greater mean choroidal thickness (425 6 90 lm vs. 354 6 140 lm; P ¼ 0.021) and RMV (9.0 6 0.4 mm 3 vs. 8.7 6 0.5 mm 3 ; P ¼ 0.006) than controls. In contrast, control and reference groups were similar with respect to choroidal thickness (354 6 140 lm vs. 363 6 82 lm; P ¼ 0.764) and RMV (8.7 6 0.5 mm 3 vs. 8.8 6 0.4 mm 3 ; P ¼ 0.870). Follow-up imaging of two severe preeclampsia cases within 3 months of delivery revealed decreasing choroidal thickness.CONCLUSIONS. Our results demonstrate subclinical retinal and choroidal thickening in the setting of severe preeclampsia. This is the likely source of its associated visual phenomena and may reflect rising levels of vascular endothelial growth factor. Retinal and choroidal markers could serve as novel predictive markers of severe preeclampsia.

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Neurologic Involvement in Hypertensive Disease of Pregnancy

Cited by 51 publications

References 0 publications

Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia

Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia

CT scan findings in patients of eclampsia

Choroidal and Retinal Thickening in Severe Preeclampsia

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