Cerebral edema on MRI in severe preeclamptic women developing eclampsia
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Hideo Matsuda
, Kenichiro Sakaguchi , Tomoko Shibasaki , Hironori Takahashi , Yuichi Kawakami , Kenichi Furuya and Yoshihiro Kikuchi
Abstract
Objective: The aim of this study is to identify suitable applications for cerebral MR (magnetic resonance) scanning in cases of severe preeclampsia and eclampsia through comparison of clinical course and easily accessible parameters.
Methods: From January 2001 to December 2003, cerebral MR scans were performed on 43 women with severe preeclampsia; of those 41 were enrolled in data analyses. Twenty clinical parameters, including age, body mass index, blood pressure, liver and renal function, and coagulation status, were compared for each patient. Data were analyzed using the SPSS program on a VAX main frame.
Results: Among 41 severe preeclamptic women, abnormal MR images were observed in 11 cases including six with systemic seizures. Predictive accuracy of eclampsia with abnormal cerebral MR imaging was 84.9% (P=0.00001), while only 14.3% of severe preeclampsia cases had been diagnosed radiologically. Statistical analysis suggests diastolic BP and serum AST as predictive parameters for abnormal MR images with 82.9% predictive accuracy (P=0.0007).
Conclusions: Cerebral edema can be observed in preeclamptic patients developing eclampsia. Rapid delivery is indicated when diastolic BP and AST are elevated. MR scanning is useful when delivery is delayed due to fetal immaturityin cases of severe preeclampsia.
References
1 Antunes NL, TN Small, D George, F Boulad, E Lis: Posterior leukoencephalopathy syndrome may not be reversible. Pediatr Neurol20(3) (1999 Mar) 24110.1016/S0887-8994(98)00148-9Search in Google Scholar
2 Apollon KM, JN Robinson, RB Schwartz, ER Norwitz: Cortical blindness in severe preeclampsia: Computed tomoguraphy, magnetic resonance imaging, and single-photon-emission computed tomography findings. Obstet Gynecol95 (2000) 1017Search in Google Scholar
3 Brackley KJ, MM Ramsay, FB Pipkin, PC Rubin: The maternal cerebral circulation in preeclampsia: Investigations using Laplace transform analysis of Doppler waveforms. Br J Obstet Gynecol107 (2000) 492Search in Google Scholar
4 Brown CEL, PD Purdy, FG Cunningham: Head computed tomographic scans in women with eclampsia. Am J Obstet Gynecol159 (1988a) 91510.1016/S0002-9378(88)80170-4Search in Google Scholar
5 Cunningham FG, CO Fernandez, C Hernandez: Blindness associated with preeclampsia and eclampsia. Am J Obstet Gynecol172 (1995) 1291Search in Google Scholar
6 Cunningham FG, D Twickler: Cerebral edema complicating eclampsia. Am J Obstet Gynecol182 (2000) 94Search in Google Scholar
7 Garg RK: Posteriior leukoencephalopathy syndrome. Postgrad Med J77 (2001) 2410.1136/pmj.77.903.24Search in Google Scholar
8 Hinchey J, C Chaves, B Appignani, J Breen, L Pao, A Wang, MS Pessin, C Lamy, JL Mas, LR Caplan: A reversible posterior leukoencephalopathy syndrome. N Engl J Med334 (1996) 494Search in Google Scholar
9 Jurgensen JS, L Nibbe, KT Hoffmann, L Niehaus: Postpartum blindness. Lancet358 (2001) 1338Search in Google Scholar
10 Magpie Trial Collaborative Group: Do Women with preeclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomized placebo-controlled trial. Lancet359 (2002) 187710.1016/S0140-6736(02)08778-0Search in Google Scholar
11 Matter F, BM Sibai: Eclampsia. Risk factors for maternal morbidity. Am J Obstet Gynecol182 (2000) 307Search in Google Scholar
12 Morris MC, DM Twickler, MR Hatab, GD Clarke, RM Peshok, FG Cunnigham: Cerebral blood flow and cranial magnetic resonance imaging in eclampsia and severe preeclampsia. Obstet Gynecol89 (1997) 561Search in Google Scholar
13 National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol183 (2000) 5110.1016/S0002-9378(00)40820-3Search in Google Scholar
14 Peterkin IR, R Wee, RL Desmarais: Reversible cerebral, hepatic and renal lesions in severe preeclampsia. Can Assoc Radiol J43(1) (1992 Feb) 60Search in Google Scholar
15 Rutherford JM, A Moody, S Crawshaw, PC Rubin: Magnetic resonance spectroscopy in preeclampsia: evidence of cerebral ischaemia. BJOG110(4) (2003 Apr) 41610.1046/j.1471-0528.2003.00416.xSearch in Google Scholar
16 Schaefer PW, FS Buonanno, RG Gonzalez, LH Schwamm: Diffusion-Weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke28 (1997) 1082Search in Google Scholar
17 Schwartz RB, SK Feske, JF Polak, U DeGirolami, A Iaia, KM Beckner, SM Bravo, RA Klufas, RYC Chai, JT Repke: Preeclampsia-Eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology217 (2000) 371Search in Google Scholar
18 Weingarten K, D Barbut, C Filippi, RD Zimmerman: Acute hypertensive encephalopathy: Findings on spin-echo and gradient-echo MR imaging. AJR162 (1994) 664Search in Google Scholar
19 Williams KP, S Wilson: Persistence of cerebral hemodynamic changes in patients with eclampsia: a report of 3 cases. Am J Obstet Gynecol181 (1999) 1162Search in Google Scholar
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Articles in the same Issue
- Pregnancy outcome of euploid fetuses with increased nuchal translucency: how bad is the news?
- Cerebral edema on MRI in severe preeclamptic women developing eclampsia
- Smoking during pregnancy and bulimia nervosa in offspring
- Stimulation of hCG protein and mRNA in first trimester villous cytotrophoblast cells in vitro by glycodelin A
- Umbilical artery Doppler and umbilical cord pH at birth in small-for-gestational-age fetuses: valid estimate of their relationship
- Hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound – longitudinal comparison to normal fetuses
- Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers
- Obstetric and neonatal outcomes in apparently isolated mild fetal ventriculomegaly
- Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome
- Multiple positive results during a neonatal screening program: a retrospective analysis of incidence, clinical implications and outcomes
- Thrombocytopoiesis in healthy term newborns
- Infected neonatal cephalohematomas caused by anaerobic bacteria
- Endothelin-1 concentrations in cord blood of neonates with meconium-stained amniotic fluid
- Fetal alcohol syndrome and pyloric stenosis: alcohol induced or an association?
- Course of pregnancy and birth in a patient with Bernard-Soulier syndrome – a case report