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

Abstract

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. 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 48h of delivery. 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. 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. 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.