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Observational Study
. 2020 Apr:20:119-123.
doi: 10.1016/j.preghy.2020.04.003. Epub 2020 Apr 7.

Neuroradiological perspectives of severe preeclampsia and eclampsia spectrum - Correlation from posterior reversible encephalopathy syndrome

Darshan Hosapatna Basavarajappa  1 , Pradip Kumar Saha  2 , Rashmi Bagga  1 , Niranjan Khandelwal  3 , Manish Modi  4
Affiliations
Observational Study

Neuroradiological perspectives of severe preeclampsia and eclampsia spectrum - Correlation from posterior reversible encephalopathy syndrome

Darshan Hosapatna Basavarajappa et al. Pregnancy Hypertens. 2020 Apr.

Abstract

Objectives: Posterior reversible encephalopathy syndrome (PRES) is the neuroradiological appearance of eclampsia. This study was conducted to understand the neuroradiological aspects of severe preeclampsia by recognition of PRES. We hypothesized that posterior reversible encephalopathy syndrome is the sole background manifestation of neurological involvement in preeclampsia patients. Detecting and demonstrating the extent of PRES and hence, cerebral involvement of preeclampsia was the main objective.

Study design: It was a prospective and observational study conducted in a tertiary referral center of northern India. A total of 75 women were recruited on admission to the emergency room, 30 of them with cerebral symptoms i.e., headache, visual disturbances and depressed consciousness, 30 patients of severe preeclampsia who were neurologically asymptomatic and 15 of eclampsia patients. Magnetic resonance imaging of the brain was performed in postpartum period within 48 h of delivery.

Outcome measures: Correlation of the MRI brain picture with the neurological disease status of preeclampsia and the symptoms of cerebral involvement and identification of predictors in development of PRES.

Results: PRES was identified in 86.7% of patients in eclampsia group (P value - 0.001), also in 20% and 26.6% of symptomatic and asymptomatic severe preeclampsia patients too (P value - 0.06 and 0.195). There was a shorter mean duration of high blood pressure records in those who developed PRES.

Conclusion: True cerebral involvement of preeclampsia believed to be translated as PRES was witnessed even in asymptomatic severe preeclampsia patients and hence, extending the indications of neuroimaging in such patients. Treatment focused on PRES would induce early reversibility and avoid long term neurological sequel.

Keywords: Eclampsia; Headache; MRI brain; Neuroimaging; PRES; Severe preeclampsia.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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