Preeclampsia may cause both overperfusion and underperfusion of the brain: a cerebral perfusion based model

Abstract

Background: The hypothesis was that low cerebral perfusion pressure is more common in women with mild preeclampsia as compared to those with severe preeclampsia, while high cerebral perfusion pressure is more common in women with severe preeclampsia than in women with mild preeclampsia.

Design: Prospective, observational study.

Setting: University teaching hospitals.

Methods: Transcranial Doppler ultrasound was used to measure the blood velocity in the middle cerebral arteries of 54 patients with mild preeclampsia and 44 patients with severe preeclampsia. Blood pressure was measured simultaneously. Cerebral perfusion pressure was calculated and plotted on the same axes as data from 63 normal pregnant women. Data outside of the 95% prediction limits were regarded as abnormal. All studies were prior to labor, and before volume expansion or treatment.

Analysis: Student's t-test, Mann Whitney U test, and Fisher's exact test as appropriate with two-tailed p<0.05.

Main outcome measure: The number of patients in each group with cerebral perfusion pressure values outside the normal 95% prediction limits.

Results: Almost the same number of women with mild (21/54=39%) and severe (15/44=34%) preeclampsia had measurements within the normal range (p=0.78). Mild preeclamptic women were more likely to have low (28/54=52%) rather than high cerebral perfusion pressure (p<0.001), while severe preeclamptics were more likely to have high cerebral perfusion pressure (26/44=59%) than low (p<0.001).

Conclusions: In preeclampsia the brain can be normally perfused, underperfused and over-perfused. Although many women with mild preeclampsia will have underperfusion (52%), and a significant number of women with severe preeclampsia will have overperfusion (59%), many preeclamptic women have cerebral perfusion within the normal range.