Zerebrale Perfusionsstörung und reversibles posteriores Leukenzephalopathie-Syndrom bei Eklampsie

Abstract

Eclampsia and preeclampsia are the leading causes of maternal death in developed countries. We present three case reports and review the literature on the pathophysiology of impaired cerebral circulation and the resulting neurologic problems in women with eclampsia. Eclampsia is a systemic condition with pregnancy-induced hypertension, generalized endothelial dysfunction, coagulation disorders and dysregulation of vascular and inflammatory mediators. This causes lesions of multiple visceral organs and the brain. Cerebral arteriopathy induces complex disturbances of cerebral perfusion with regional or generalized hyperperfusion or hypoperfusion. Imaging techniques show a pattern of lesions resembling the reversible posterior leukoencephalopathy syndrome. This syndrome is characterized by multifocal cerebral edema, predominantly in the posterior regions of the cerebral hemispheres. It usually resolves completely but cerebral infarction or hemorrhage have been described. Doppler sonography in women with eclampsia shows increased cerebral blood flow velocities due to hyperperfusion or vasoconstriction. The systemic pathophysiology and varied clinical presentation of eclampsia requires interdisciplinary collaboration for diagnosis and treatment. Eclamptic encephalopathy is characterized by seizures, impaired consciousness and focal neurologic deficits. Magnetic resonance (MR) imaging and neurologic studies are required to distinguish eclamptic encephalopathy from other acute neurological events. Monitoring cerebral perfusion with transcranial Doppler and color-coded duplex sonography and MR angiography is advisable. With severe vasoconstriction and cerebral ischemia blood pressure should be controlled in the range of mild hypertension to support sufficient transstenotic and collateral blood flow. Eclamptic seizures are treated with magnesium sulphate or anticonvulsants.