Cross sectional imaging of post partum headache and seizures

Abstract

Objectives: To evaluate spectrum of causes & their characteristic findings in peripartum head ache and seizures on computed tomography & magnetic resonance imaging.

Materials and methods: Forty patients with complaints of peripartum headache and seizures underwent cross sectional imaging with computed tomography and magnetic resonance imaging during period of June 2011 to May 2012. Age group of subjects in this study was 18 to 38 y. Out of 40 patients 15 had history of eclampsia and remaining 25 patients were normotensive. Subjects with complaints of headache and seizures after six weeks of delivery were excluded from the study. Intravenous contrast was administered in cases with diagnostic dilemma. All results were reported and informed to the referring physicians on priority bases.

Results: Nine patients with peripartum headache and seizures revealed no brain parenchymal or cerebral vascular abnormalities on imaging. Eleven patients with a history of eclampsia showed features of eclamptic encephalopathy. Out 40 patients, 17 patients revealed cortical venous thrombosis with 14 patients showing parenchymal changes. One patient each showed features of meningoencephalitis, ischemic watershed territory infarct & region of gliosis. All results were analysed & tabulated.

Conclusion: Eclamptic encephalopathy and cortical venous thrombosis are the major causes for post partum headache and seizures. Rational use of CT & MRI in the early course of the disease helps in characterizing the lesion and providing the appropriate treatment.

Keywords: CT & MR imaging; Cortical venous thrombosis; Eclamptic encephalopathy; Peripartum seizures & headache.

[Table/Fig-1]:

Distribution of cases of peripartum headache & seizures according to the causative factor

[Table/Fig-2]:

Lesion distribution in PRES

[Table/Fig-3]:

Unenhanced CT (first image), axial FLAIR (next four images) & DWI (second row last image)of patient with PRES. Vasogenic edema is noted in bilateral frontal, parieto-occipital & cerebellar hemispheres with free diffusion on DWI

[Table/Fig-4]:

Unenhanced CT sections of patient with PRES. White matter hypodensities in bilateral parieto-occipital region with atypical involvement of bilateral thalami & basal ganglia

[Table/Fig-6]:

Axial FLAIR (first image), T2 gradient(second image), DWI (third image), MRV (first image, second row) & unenhanced CT (last two images of second row) sections of patient with deep cerebral vein thrombosis. Parenchymal changes with mixed free & restricted diffusion are noted in bilateral thalami & basal ganglia. Note parenchymal hemorrhage with intraventricular extension

[Table/Fig-7]:

Axial T2 (first image), FLAIR (second image), T2 gradient (third image), DWI (second image, second row), MRV (last image, second row) & axial T2 at lower section (first image of second row) sections of patient depicting left transverse sinus thrombosis resulting left parieto-temporo-occipital parenchymal changes with hemorrhage & mass effect. Parenchymal changes with mixed free & restricted diffusion are noted in left parieto-temporo-occipital lobe with hemorrhage & mass effect. Note hyperintensity in the left transverse sinus with absent flow void on T2 weighted image (first image of second row{Arrow})

[Table/Fig-8]:

Axial T2 (first image), FLAIR (second image), DWI (first image, second row) and ADC (last image, second row) sections of brain of patient with water shed territory infarct. Well defined band of increased signal intensity in right high parietal lobe on T2 & FLAIR with restricted diffusion on DWI & ADC.

[Table/Fig-9]:

First row- Axial T2 (first image) & FLAIR images (next two images ) shows parenchymal signal changes in left deep gray nuclei and bilateral deep white matter. Second row – DWI (first image ) & ADC (second image) show free diffusion in these lesions. Second row – last image and entire third row images – contrast enhanced T1 weighted images show meningeal enhancement with non enhancing parenchymal changes. The features depict menigoencephalitis.

[Table/Fig-10]:

First row- First image unenhanced axial CT, axial FLAIR (second image), axial T2 (third image), axial T2 gradient (second row – first image), axial DWI & ADC (second row – last two images) sections of patient with straight sinus thrombosis with venous infarct in the splenium of corpus callosum. Subtle hypodensity is noted in the splenium of corpus callosum on CT, which is hyperintense on T2 and FLAIR with restricted diffusion on DWI & ADC.