Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia

Objective We sought to investigate the concurrence of posterior reversible encephalopathy syndrome (PRES) with eclampsia and to describe the obstetric, radiological, and critical care correlates. Study Design This was a single-center, 2001-2010 retrospective cohort study of all patients with eclamps...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2013-06, Vol.208 (6), p.468.e1-468.e6
Main Authors: Brewer, Justin, MD, Owens, Michelle Y., MD, Wallace, Kedra, PhD, Reeves, Amanda A., MD, Morris, Rachael, MD, Khan, Majid, MD, LaMarca, Babbette, PhD, Martin, James N., MD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Blood Pressure - physiology
cerebral imaging
Cohort Studies
eclampsia
Eclampsia - physiopathology
Female
Headache - etiology
Humans
Magnetic Resonance Imaging - methods
Obstetrics and Gynecology
Posterior Leukoencephalopathy Syndrome - diagnosis
Posterior Leukoencephalopathy Syndrome - physiopathology
posterior reversible encephalopathy syndrome
Pregnancy
Retrospective Studies
Tomography, X-Ray Computed - methods
Young Adult
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Summary:Objective We sought to investigate the concurrence of posterior reversible encephalopathy syndrome (PRES) with eclampsia and to describe the obstetric, radiological, and critical care correlates. Study Design This was a single-center, 2001-2010 retrospective cohort study of all patients with eclampsia who underwent neuroimaging via magnetic resonance imaging (MRI) or computerized tomography (CT) with or without contrast. Results Forty-six of 47 of eclamptic patients (97.9%) revealed PRES on neuroimaging using 1 or more modalities: MRI without contrast, 41 (87.2%); MRI with contrast, 27 (57.4%); CT without contrast, 16 (34%); CT with contrast, 7 (14.8%); and/or magnetic resonance angiography/magnetic resonance venography, 2 (4.3%). PRES was identified within the parietal, occipital, frontal, temporal, and basal ganglia/brainstem/cerebellum areas of the brain. Eclampsia occurred antepartum in 23 patients and postpartum in 24 patients. Headache was the most common presenting symptom (87.2%) followed by altered mental status (51.1%), visual disturbances (34%), and nausea/vomiting (19.1%). Severe systolic hypertension was present in 22 patients (47%). Conclusion The common finding of PRES in patients with eclampsia suggests that PRES is a core component of the pathogenesis of eclampsia. Therapy targeted at prevention or reversal of PRES pathogenesis may prevent or facilitate recovery from eclampsia.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2013.02.015