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21-01-2024 | Eclampsia | Original Article

Neuroimaging Features in Eclamptic Encephalopathy and their Correlation with Clinical and Laboratory Parameters: a Prospective Observational Study

Authors: Kirtirekha Mohapatra, Nahida Nigar Sultana, Sasmita Behuria, Debaprasad Sahoo, Mamata Singh

Published in: The Journal of Obstetrics and Gynecology of India

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Abstract

Background

New onset seizures in pregnancy and postpartum are considered eclampsia as the default diagnosis. Other causes, such as intracranial haemorrhage, subarachnoid haemorrhage, cerebral venous sinus thrombosis or acute ischaemic stroke, have a similar mode of presentation, but need prompt diagnosis and institution of specific measures to decrease the risk of mortality and morbidity. Neuroimaging plays an important role in providing a specific diagnosis and hence aids in proper management. We hypothesised to find any correlation of laboratory parameters with neuroimaging abnormalities along with providing an insight to specific diagnoses in patients of new onset seizures in pregnancy with a presumptive diagnosis of eclampsia.

Methods

This was a hospital-based descriptive observational study conducted in SCB Medical College, Odisha, in the year 2018–2020 with a total of 70 clinically confirmed cases of eclampsia. They were subjected to cranial MR imaging along with routine investigations with no change in the emergency treatment protocol followed in the department. Data was compiled using Microsoft Excel 2016 and IBM SPSS statistics for Windows, version 27, and comparisons among MRI normal and abnormal group were stated.

Results

58 (82.86%) were MR imaging positive or abnormal, while 12 (17.14%) were MR imaging negative or normal. Cortical venous thrombosis without infarction was diagnosed in 25 (43.1%) patients, 6 (10.34%) had infarction, posterior reversible encephalopathy syndrome was seen in 19 (32.76%) cases, and 8 (13.79%) had hypertensive leukoencephalopathy. The mean gestational age at the time of presentation was significantly lower in the MRI abnormal group (p = 0.012). The AST and LDH values were found to be significantly higher in the MRI abnormal group, with p = 0.02 and 0.01, respectively.

Conclusion

Patients with imaging abnormalities have a severe form of disease in eclampsia. Neuroimaging in provisionally diagnosed cases of eclampsia will modify the management and hence prognosis in these patients.
Literature
1.
go back to reference Sajith M, Nimbargi V, Modi A, Sumariya R, Pawar A. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharma Sci Res. 2014;23:4. Sajith M, Nimbargi V, Modi A, Sumariya R, Pawar A. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharma Sci Res. 2014;23:4.
2.
go back to reference Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.CrossRefPubMed Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.CrossRefPubMed
4.
go back to reference Edlow JA, Caplan LR, O’Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol. 2013;12(2):175–85.CrossRefPubMed Edlow JA, Caplan LR, O’Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol. 2013;12(2):175–85.CrossRefPubMed
5.
go back to reference Patil MM. Study of neuroimaging in patients with refractory eclampsia. J South Asian Federation Obstet Gynaecol. 2013;5(1):4–7.CrossRef Patil MM. Study of neuroimaging in patients with refractory eclampsia. J South Asian Federation Obstet Gynaecol. 2013;5(1):4–7.CrossRef
6.
go back to reference Shah AK, Rajamani K, Whitty JE. Eclampsia: a neurological perspective. J Neurol Sci. 2008;271(1–2):158–67.CrossRefPubMed Shah AK, Rajamani K, Whitty JE. Eclampsia: a neurological perspective. J Neurol Sci. 2008;271(1–2):158–67.CrossRefPubMed
7.
go back to reference Aya AG, Ondze B, Ripart J, Cuvillon P. Seizures in the peripartum period: epidemiology, diagnosis and management. Anaesth Crit Care Pain Med. 2016;1(35):S13-21.CrossRef Aya AG, Ondze B, Ripart J, Cuvillon P. Seizures in the peripartum period: epidemiology, diagnosis and management. Anaesth Crit Care Pain Med. 2016;1(35):S13-21.CrossRef
8.
go back to reference Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A, Beckner KM, Bravo SM, Klufas RA, Chai RY, Repke JT. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology. 2000;217(2):371–6.CrossRefPubMed Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A, Beckner KM, Bravo SM, Klufas RA, Chai RY, Repke JT. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology. 2000;217(2):371–6.CrossRefPubMed
9.
go back to reference Demirtas Ö, Gelal F, Vidinli BD, Demirtas LO, Uluç E, Baloglu A. Cranial MR imaging with clinical correlation in preeclampsia and eclampsia. Diagn Interv Radiol. 2005;11(4):189. Demirtas Ö, Gelal F, Vidinli BD, Demirtas LO, Uluç E, Baloglu A. Cranial MR imaging with clinical correlation in preeclampsia and eclampsia. Diagn Interv Radiol. 2005;11(4):189.
10.
go back to reference Gao B, Liu FL, Zhao B. Association of degree and type of edema in posterior reversible encephalopathy syndrome with serum lactate dehydrogenase level: initial experience. Eur J Radiol. 2012;81(10):2844–7.CrossRefPubMed Gao B, Liu FL, Zhao B. Association of degree and type of edema in posterior reversible encephalopathy syndrome with serum lactate dehydrogenase level: initial experience. Eur J Radiol. 2012;81(10):2844–7.CrossRefPubMed
11.
go back to reference American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 202: gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):e1-25. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 202: gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):e1-25.
12.
go back to reference Strandgaard S, Sengupta D, Mackenzie ET, Rowan JO, Olesen J, Skinhøj E, Lassen NA, Harper AM. The lower and upper limits for autoregulation of cerebral blood flow. Cerebral circulation and metabolism. 1975 (3–6) Strandgaard S, Sengupta D, Mackenzie ET, Rowan JO, Olesen J, Skinhøj E, Lassen NA, Harper AM. The lower and upper limits for autoregulation of cerebral blood flow. Cerebral circulation and metabolism. 1975 (3–6)
13.
go back to reference Benedetti TJ, Quilligan EJ. Cerebral edema in severe pregnancy-induced hypertension. Am J Obstet Gynecol. 1980;137(7):860–2.CrossRefPubMed Benedetti TJ, Quilligan EJ. Cerebral edema in severe pregnancy-induced hypertension. Am J Obstet Gynecol. 1980;137(7):860–2.CrossRefPubMed
14.
go back to reference Will AD, Lewis KL, Hinshaw D, Jordan K, Cousins L, Hasso A, Thompson J. Cerebral vasoconstriction in toxemia. Neurology. 1987;37(9):1555–7.CrossRefPubMed Will AD, Lewis KL, Hinshaw D, Jordan K, Cousins L, Hasso A, Thompson J. Cerebral vasoconstriction in toxemia. Neurology. 1987;37(9):1555–7.CrossRefPubMed
15.
go back to reference Qureshi AI, Frankel MR, Ottenlips JR, Stern BJ. Cerebral hemodynamics in preeclampsia and eclampsia. Arch Neurol. 1996;53(12):1226–31.CrossRefPubMed Qureshi AI, Frankel MR, Ottenlips JR, Stern BJ. Cerebral hemodynamics in preeclampsia and eclampsia. Arch Neurol. 1996;53(12):1226–31.CrossRefPubMed
16.
go back to reference Gant NF, Daley GL, Chand S, Whalley PJ, MacDonald PC. A study of angiotensin II pressor response throughout primigravid pregnancy. J Clin Investig. 1973;52(11):2682–9.CrossRefPubMedPubMedCentral Gant NF, Daley GL, Chand S, Whalley PJ, MacDonald PC. A study of angiotensin II pressor response throughout primigravid pregnancy. J Clin Investig. 1973;52(11):2682–9.CrossRefPubMedPubMedCentral
17.
go back to reference Chakravarty A, Chakrabarti SD. The neurology of eclampsia: some observations. Neurol India. 2002;50(2):128. Chakravarty A, Chakrabarti SD. The neurology of eclampsia: some observations. Neurol India. 2002;50(2):128.
18.
go back to reference Chandra I, Sun L. Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes. Postgrad Med. 2018;130(8):703–7.CrossRefPubMed Chandra I, Sun L. Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes. Postgrad Med. 2018;130(8):703–7.CrossRefPubMed
19.
go back to reference Bojja V, Keepanasseril A, Nair PP, Sunitha VC. Clinical and imaging profile of patients with new-onset seizures & a presumptive diagnosis of eclampsia–a prospective observational study. Pregnancy Hypertens. 2018;1(12):35–9.CrossRef Bojja V, Keepanasseril A, Nair PP, Sunitha VC. Clinical and imaging profile of patients with new-onset seizures & a presumptive diagnosis of eclampsia–a prospective observational study. Pregnancy Hypertens. 2018;1(12):35–9.CrossRef
20.
go back to reference Sharma G, Joshi G, Purohit RC. Cranial MR imaging in eclampsia and severe preeclampsia: a prospective study. J Evol Med Dent Sci. 2014;3(13):3250–60.CrossRef Sharma G, Joshi G, Purohit RC. Cranial MR imaging in eclampsia and severe preeclampsia: a prospective study. J Evol Med Dent Sci. 2014;3(13):3250–60.CrossRef
21.
go back to reference Dogra R, Thakur R, Thakur V, Pal A, Chamotra S, Chaudhary A. Neuro-imaging in severe hypertensive disorders of pregnancy: a study from North Indian tertiary health care institution. Int J Reprod Contracept Obstet Gynecol. 2020;9(6):2347.CrossRef Dogra R, Thakur R, Thakur V, Pal A, Chamotra S, Chaudhary A. Neuro-imaging in severe hypertensive disorders of pregnancy: a study from North Indian tertiary health care institution. Int J Reprod Contracept Obstet Gynecol. 2020;9(6):2347.CrossRef
22.
go back to reference Kokila MS, Dwivedi AD. Correlation of clinical and neuroimaging findings affecting management in postpartum eclampsia: a prospective study. J South Asian Federation Obstet Gynaecol. 2013;3(3):125–30.CrossRef Kokila MS, Dwivedi AD. Correlation of clinical and neuroimaging findings affecting management in postpartum eclampsia: a prospective study. J South Asian Federation Obstet Gynaecol. 2013;3(3):125–30.CrossRef
23.
go back to reference Harandou M, Madani N, Labibe S, Messouak O, Boujraf S, Benkirane S, Houssni B, Maaroufi M, Lemhadri M, Tizniti S, Belahsen F. Neuroimaging findings in eclamptic patients still symptomatic after 24 hours: a descriptive study about 19 cases. Ann Francaises D’anesthesie et de Reanim. 2006;25(6):577–83.CrossRef Harandou M, Madani N, Labibe S, Messouak O, Boujraf S, Benkirane S, Houssni B, Maaroufi M, Lemhadri M, Tizniti S, Belahsen F. Neuroimaging findings in eclamptic patients still symptomatic after 24 hours: a descriptive study about 19 cases. Ann Francaises D’anesthesie et de Reanim. 2006;25(6):577–83.CrossRef
Metadata
Title
Neuroimaging Features in Eclamptic Encephalopathy and their Correlation with Clinical and Laboratory Parameters: a Prospective Observational Study
Authors
Kirtirekha Mohapatra
Nahida Nigar Sultana
Sasmita Behuria
Debaprasad Sahoo
Mamata Singh
Publication date
21-01-2024
Publisher
Springer India
Published in
The Journal of Obstetrics and Gynecology of India
Print ISSN: 0971-9202
Electronic ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-023-01899-w