Preeclampsia-Eclampsia: Clinical and Neuroradiographic Correlates and Insights into the Pathogenesis of Hypertensive Encephalopathy

Schwartz, Richard B.; Feske, Steven K.; Polak, Joseph F.; DeGirolami, Umberto; Iaia, Alberto; Beckner, Kara M.; Bravo, Stephen M.; Klufas, Roman A.; Chai, Richard Y. C.; Repke, John T.

doi:10.1148/radiology.217.2.r00nv44371

Cited by 345 publications

(247 citation statements)

References 33 publications

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“…9,14 It could be because ours is a tertiary care hospital where patients are referred from other centers and also because facilities for neuroimaging are not universally available. Incidence of PRES in eclamptic women is 54.5% in the present study as compared to 62.5% in Nelli et al study, 19.2% in Mayama study. 14,6 In present study mean age of women diagnosed with PRES was 26±5.1 years and common in multigravidas.…”

Section: Resultscontrasting

confidence: 56%

“…3%).Whereas several studies reported headache and visual disturbances/visual loss to be the common symptoms. 3,4,8,[19][20][21] We observed epigastric pain in 26.7% patients and visual disturbances were present in very few patients (3.3%). Since MRI is safe to use in pregnancy, its widespread utilization enhances the diagnosis of PRES in eclamptic women with neurological findings (Figure 2a-2d).…”

Section: Figure 1: Persistent Symptomsmentioning

confidence: 65%

“…18 Recent study done by Mayama et al showed that patient who received antenatal steroid to enhance lung maturation or for treatment for HELLP revealed faster normalization of central nervous system function in eclamptic patients with PRES. 6,19 In the present study even though patients received corticosteroids for the treatment or to enhance the lung maturity effect on recovery is not studied.…”

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

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Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital

Karanth

Gonsalves

Sheela

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: PRES can be associated with number of medical conditions and was observed frequently in patients with preeclampsia and eclampsia. Neuroimaging is important for the diagnosis of PRES. Study was conducted to find out the maternal and perinatal outcome in patients with eclampsia complicated by posterior reversible encephalopathy syndrome (PRES).Methods: This is a retrospective study done at St. Johns Medical College Bangalore, between October 2013 and October 2016. We reviewed case records of all the patients with eclampsia who underwent neuro imaging studies and a diagnosis of PRES was made. The maternal and perinatal outcomes in these women were studiedResults: In the past three years we had 55 cases of eclampsia who underwent neuroimaging studies for persistent neurological symptoms after 24 hours of MgSO4 treatment. Of these women 30 were diagnosed to have PRES. In the present study PRES was common in multiparous women and more in patients with antepartum eclamptic women. Mean age at diagnosis of PRES was 26±5.1 years. Common presenting symptoms were headache (93.3%) and vomiting (53.3%). The mean SBP/DBP was 180/110 mmHg. All patients who had recurrent seizures were controlled with MgSO4 alone. 53.3% of our patients had eclampsia related complications and 36.7% required ICU care. There were 3 maternal deaths (10%). Perinatal mortality was 20%.Conclusions: Neuroimaging in eclamptic patients with persistent neurological symptoms could help in early diagnosis of PRES and multidisciplinary approach in management could contribute significantly in reducing the maternal mortality and morbidity.

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Section: Resultscontrasting

confidence: 56%

Section: Figure 1: Persistent Symptomsmentioning

confidence: 65%

Section: Figure 2a 2b 2c and 2d: Mri Images Of One Of The Patients mentioning

confidence: 99%

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Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital

Karanth

Gonsalves

Sheela

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…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. Whether long-term cerebrovascular outcome, such as stroke, in formerly pre-eclamptic women is a result of the constitutionally increased risk for cardiovascular disease ª 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2012 RCOG in these women, 1,2 or whether the pre-eclamptic pregnancy and episode of PRES are additional risk factors, remains speculative so far.…”

Section: Introductionmentioning

confidence: 99%

Long‐term cerebral imaging after pre‐eclampsia

Aukes

Groot

Wiegman

et al. 2012

BJOG

108

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Objective Formerly eclamptic women demonstrate cerebral white matter lesions (WMLs) several years following the index pregnancy. The pathophysiology is unclear and may be related to the predisposition for cerebrovascular/cardiovascular disease in such women and/or the occurrence of posterior reversible encephalopathy syndrome whilst pregnant. The aim of this study was to assess the presence and severity of WMLs and their relationship with the severity of the neurological symptoms during the index pregnancy and several current cardiovascular risk factors in formerly pre-eclamptic women.Design This was a retrospective cohort study.Setting The Neuroimaging Centre at the School for Behavioural and Cognitive Neurosciences, Groningen, the Netherlands.Population Seventy-three formerly pre-eclamptic women were matched for age (37 ± 6 years) and elapsed time since index pregnancy (5.1 ± 3.7 years) with parous control women.Methods Cerebral magnetic resonance imaging scans were performed on cases and controls. Scans were rated by a neuroradiologist blind to the patient category.Main outcome measures The presence and severity of cerebral WMLs.Results Formerly pre-eclamptic women had WMLs significantly more often (37%) and more severely (mean, 0.11; median, 0.00; range, 0-2.34 ml) than controls (21%, P = 0.04; mean, 0.015; median, 0.00; range, 0-0.13 ml; P = 0.02). Current hypertension and a history of early-onset pre-eclampsia (<37 weeks) were independently associated with the presence of WMLs (b = 1.34, P = 0.02 and b = 1.73, P = 0.01, respectively).Conclusions Our findings indicate that pre-eclampsia might be a risk marker for early cerebrovascular damage. The predisposition of formerly pre-eclamptic women to later cardiovascular and cerebrovascular disease may be an important factor for the development of cerebral WMLs. Whether a history of posterior reversible encephalopathy syndrome may be an additive risk factor for the development of these lesions remains unknown.

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“…Schwartz et al (2000) estudando pacientes com eclâmpsia e pré-eclâmpsia, encontraram que os sintomas neurológicos estavam associados com alterações morfológicas nas hemácias e níveis elevados da DHL, achados que indicam hemólise microangiopática sugerindo dano endotelial 24 . Este dano endotelial é considerado como ponto central na fisiopatologia da eclâmpsia e pré-eclâmpsia nos múltiplos órgãos e acredita-se que esteja relacionado com toxinas endoteliais circulantes ou anticorpos contra o endotélio 24 . Ressalta-se que no nosso estudo nenhuma das pacientes com alterações eritrocitárias e aumento da DHL apresentou alteração na RM hepática.…”

Section: Discussionunclassified

Ressonância magnética hepática em puérperas estáveis com síndrome HELLP

Carvalho

Amorim²,

Katz³

et al. 2008

Rev. Assoc. Med. Bras.

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436RESUMO OBJETIVOS. Descrever os achados hepáticos na ressonância magnética em puérperas estáveis com síndrome HELLP. MÉTODOS. Realizou-se um estudo descritivo, do tipo série de casos, envolvendo 40 puérperas internadas na UTI obstétrica do Instituto Materno Infantil Prof. Fernando Figueira (IMIP), com diagnóstico de síndrome HELLP completa (presentes todas as alterações laboratoriais) e incompleta (uma ou mais alterações laboratoriais, porém sem todos os critérios diagnósticos) no período de agosto de 2005 a julho de 2006. RESULTADOS. A idade média foi de 26,8 ± 6,4 anos, com idade gestacional média no parto de 34 semanas. A ressonância magnética foi realizada entre oito e 96 horas depois do diagnóstico de síndrome HELLP (média de 56 + 31horas). O achado mais freqüente foi ascite em 20% (n = 8), seguindo-se derrame pleural (17,5%) e esteatose hepática (7,5%). A intensidade de sinal periportal foi normal em todos os casos e não se observaram casos de isquemia/infarto hepático ou de hematoma parenquimatoso ou subcapsular. CONCLUSÃO. Os achados da ressonância magnética pós-parto em puérperas estáveis com síndrome HELLP foram inespecíficos e, na presente série, não foram encontradas lesões importantes como hematoma parenquimatoso ou subcapsular, representando risco de vida para a paciente. Os resultados encontrados não corroboram a utilização desse exame de rotina para o seguimento de pacientes com síndrome HELLP.UNITERMOS: Síndrome HELLP. Pré-eclâmpsia. Imagem por ressonância magnética. Gravidez de alto risco. INTRODUÇÃOA síndrome HELLP (H = hemolysis, EL = elevated liver function, LP = low platelet count), descrita por Weinstein, em 1982, caracteriza-se por hemólise, aumento de enzimas hepáticas e plaquetopenia 1 . Freqüentemente encontra-se associada à pré-eclâmpsia e eclâmpsia e cursa com disfunção hepática durante a gestação 2 .Dentre os casos de pré-eclâmpsia, sua freqüência é variável, provavelmente devido às diferentes formas clínicas das síndromes hipertensivas e aos diferentes critérios diagnósticos utilizados 2,3 . Em nosso meio encontrou-se uma freqüência de 46% de síndrome HELLP entre pacientes admitidas em uma UTI obstétrica por distúrbios hipertensivos 4 .O diagnóstico precoce é laboratorial e deve ser pesquisado de maneira sistemática nas mulheres com pré-eclâmpsia e eclâmpsia. Sibai et al., em 1990, propuseram uma sistematização dos padrões laboratoriais e bioquímicos para o diagnóstico dessa síndrome, como hemólise (esfregaço de sangue periférico com esquizócitos, bilirrubina total > 1,2 mg/dl e desidrogenase láctica -DHL > 600 U/L), elevação de enzimas hepáticas (aspartato aminotranferase -AST > 70 U/L e DHL > 600 U/l) e plaquetopenia (plaquetas < 100.000/mm 3 ) 2 .Diversas críticas em relação ao rigor dos critérios diagnósticos foram feitas 5-8 , e muitos autores passaram a utilizar o conceito de síndrome HELLP parcial ou incompleta, ou seja, pacientes com uma ou mais, porém não todas as alterações laboratoriais consideradas como critérios diagnósticos da síndrome 9 . Considerando que a doença ...

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Preeclampsia-Eclampsia: Clinical and Neuroradiographic Correlates and Insights into the Pathogenesis of Hypertensive Encephalopathy

Abstract: Brain edema at MR imaging in patients with preeclampsia-eclampsia was associated with abnormalities in endothelial damage markers and not with hypertension level.

Cited by 345 publications

References 33 publications

Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital

Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital

Long‐term cerebral imaging after pre‐eclampsia

Ressonância magnética hepática em puérperas estáveis com síndrome HELLP

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