56 Posterior reversible encephalopathy syndrome and cerebral vasoconstriction in eclamptic and pre-eclamptic patients: Medical complications of pregnancy related to hypertensive syndromes

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• 作者：Takuma Yamada ; Takehiko Takeda ; Sho Tano ; Kaname Uno ; Michinori Mayama ; Mayu Ukai ; Toko Harata ; Yasuyuki Kishigami ; Hidenori Oguchi
• 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：6
• 期：3
• 页码：203-204
• 全文大小：47 K

文摘

Posterior reversible encephalopathy syndrome (PRES) is frequently observed in patients with eclampsia, and some of them also develop cerebral vasoconstriction. These radiological changes have been suggested as an essential component of eclampsia-mediated primary central nervous system injury. On the other hand, it is also reported that some pre-eclamptic patients with neurological symptoms develop PRES and cerebral vasoconstriction; however, the incidence is still unclear.

Objectives

The aim of this study was to determine the incidence of PRES and cerebral vasoconstriction in pre-eclamptic and eclamptic patients and to assess whether these two patient groups share similar pathophysiological backgrounds by comparing clinical and radiological characteristics.

Materials & methods

This was a retrospective cohort study of 4849 pregnant patients. A total of 49 eclamptic and pre-eclamptic patients with neurological symptoms underwent magnetic resonance imaging (MRI) and magnetic resonance angiography; 10 patients were excluded from further analysis because of a history of epilepsy or dissociative disorder. The age, parity, blood pressure, and routine laboratory data at the onset of symptoms were also recorded. For data that were considered to be normally distributed, unpaired t test or Welch’s test was used based on the homogeneity of variances. Otherwise, the Mann–Whitney U test was used for continuous data.

Results

Among 39 patients with neurological symptoms, 12 out of 13 (92.3%) eclamptic patients and 5 out of 26 (19.2%) pre-eclamptic patients developed PRES. Among PRES patients, 4 out of 12 (33.3%) eclamptic patients and 2 out of 5 (40.0%) pre-eclamptic patients developed cerebral vasoconstriction. Whereas age and systolic and diastolic blood pressure at onset were not different between PRES and non-MRI abnormality patients, hematocrit, serum creatinine, aspartate transaminase, alanine transaminase, and lactate dehydrogenase were higher in patients with PRES than those without MRI abnormalities. In contrast, eclamptic patients with PRES did not show any significant differences in clinical and laboratory data compared with pre-eclamptic patients with PRES. In addition to the parieto-occipital regions, atypical regions such as the frontal and temporal lobes, and basal ganglia were also involved in both eclamptic and pre-eclamptic patients with PRES. Finally, intraparenchymal hemorrhage was detected in one eclamptic patient, and subarachnoid hemorrhage was observed in one pre-eclamptic patient. Both of them developed PRES and cerebral vasoconstriction.

Conclusion

Although the incidence of PRES was high in eclamptic patients, nearly 20% pre-eclamptic patients with neurological symptoms also developed PRES. The similarities in clinical and radiological findings of PRES between the two groups indicate a shared pathophysiological background. Similar incidence of cerebral vasoconstriction in eclamptic and pre-eclamptic patients with PRES also supports this hypothesis. PRES was not benign and reversible disease, and coincidence of PRES and cerebral vasoconstriction might be a high-risk group of hemorrhagic complications. Therefore, MRI studies should be considered for patients with the recent onset of neurological symptoms regardless of the development of eclampsia.