Neuroimaging findings in women who develop neurologic symptoms in severe preeclampsia with or without eclampsia

Abstract

Eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide, and its pathogenesis remains elusive. Our objective was to investigate neuroimaging findings in women who developed neurologic symptoms in severe preeclampsia with or without eclampsia to further understand the relationship between neuroimaging findings and the pathogenesis of eclamptic seizures. This retrospective study included 79 women with severe preeclampsia/eclampsia who underwent brain MRI/CT examination between 2005 and 2017. We analyzed imaging findings, clinical data, and laboratory data in order to compare patients with severe preeclampsia to those with eclampsia and patients with abnormal imaging findings to those with normal CT or MRI. A total of 41 of 79 women were diagnosed with eclampsia, 36 (88.80%) of which had abnormal neuroimaging findings, including cerebral edema (19 cases), infarction (5 cases), cerebral venous thrombosis (5 cases), and cerebral hemorrhage (7 cases). Five patients died of cerebral hemorrhage. Of the 38 cases of severe preeclampsia, 21 (55.26%) cases had abnormal imaging findings, including cerebral edema (20 cases), and 1 case had cerebral hemorrhage. Serum uric acid was significantly higher in patients with abnormal imaging findings than in patients without them (P = 0.004). The imaging findings in women with neurologic symptoms were similar between the severe preeclampsia and eclampsia groups. Our results suggest that eclampsia may not be a diagnosis with a unique pathogenesis; rather, it may be best considered a severe symptom of the intracranial pathophysiology of preeclampsia. We suggest that cranial imaging should be performed early in the management of patients with severe preeclampsia who develop new neurologic symptoms.