OBJECTIVE
To assess the prevalence, clinical presentations, and neuroimaging abnormalities in
a series of patients treated for eclampsia at Mayo Clinic in Rochester, MN.
PATIENTS AND METHODS
We reviewed the records of all pregnant patients diagnosed as having eclampsia at
Mayo Clinic in Rochester, MN, between January 1, 2001, and December 31, 2008. All
patients who underwent neuroimaging were identified, and all studies were reviewed
by an independent neuroradiologist. Comparisons were made between groups who did and
did not undergo imaging to identify differentiating clinical or laboratory variables.
RESULTS
Thirteen cases of eclampsia were found, with neuroimaging studies available for 7:
magnetic resonance imaging (n=6) and computed tomography (n=1). All 7 patients developed
eclamptic seizures, and 2 of 7 patients had severe hypertension, with recorded systolic
blood pressures exceeding 180 mm Hg. Neuroimaging showed characteristic changes of
posterior reversible encephalopathy syndrome (PRES) in all patients. Follow-up imaging
showed resolution in 2 of 3 patients; 1 patient had residual neuroimaging abnormalities.
CONCLUSION
Our results suggest that the clinical syndrome of eclampsia is associated with an
anatomical substrate that is recognizable by neuroimaging as PRES. The levels of blood
pressure elevation are lower than those reported in cases of PRES because of hypertensive
encephalopathy. Further studies are needed to determine whether more aggressive blood
pressure control and early neuroimaging may have a role in the management of these
patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy.Am J Obstet Gynecol. 2000; 183: S1-S22
- Pregnancy-related mortality in the United States, 1998-2005.Obstet Gynecol. 2010; 116: 1302-1309
- ASH position paper: hypertension in pregnancy.J Clin Hypertens (Greenwich). 2009; 11: 214-225
- Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases.Acta Obstet Gynecol Scand. 2006; 85: 929-936
- Births: final data for 1998.Natl Vital Stat Rep. 2000; 48: 1-100
- Eclampsia in the United Kingdom.BMJ. 1994; 309: 1395-1400
- A reversible posterior leukoencephalopathy syndrome.N Engl J Med. 1996; 334: 494-500
- Postpartum blindness.Lancet. 2001; 358: 1338
- Posterior reversible encephalopathy syndrome (PRES) in critically ill obstetric patients.Intensive Care Med. 2003; 29: 2323-2326
- Cerebral infarction in eclampsia.Am J Obstet Gynecol. 2004; 190: 714-720
- Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings.Mayo Clin Proc. 2010; 85: 427-432
- Posterior reversible encephalopathy syndrome: is there a difference between pregnant and non-pregnant patients?.Eur Neurol. 2009; 62: 142-148
- Cerebrovascular function in pregnancy and eclampsia.Hypertension. 2007; 50: 14-24
- Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure.Obstet Gynecol. 2005; 105: 246-254
- Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images.AJNR Am J Neuroradiol. 2002; 23: 1038-1048
- Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features.AJNR Am J Neuroradiol. 2008; 29: 1036-1042
- Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema.AJNR Am J Neuroradiol. 2008; 29: 1043-1049
- Maternal cerebral blood flow changes in pregnancy.Am J Obstet Gynecol. 2003; 189: 968-972
- Magnesium sulfate decreases cerebral perfusion pressure in preeclampsia.Hypertens Pregnancy. 2008; 27: 315-327
- Hypertension in pregnancy as a risk factor for cardiovascular disease later in life.J Hypertens. 2010; 28: 826-833
- Self-reported cognitive functioning in formerly eclamptic women.Am J Obstet Gynecol. 2007; 197: 365.e1-365.e6
Article Info
Identification
Copyright
© 2011 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
