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Preeclampsia-Eclampsia: Clinical and Neuroradiographic Correlates and Insights into the Pathogenesis of Hypertensive Encephalopathy¹

¹ From the Departments of Radiology (R.B.S., J.F.P., A.I., K.M.B., R.A.K., S.M.B.), Neurology (S.K.F., U.D.), and Pathology (U.D.), Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; the Department of Radiology, Massachusetts General Hospital, Boston (R.Y.C.C.); and the Department of Obstetrics and Gynecology, University of Nebraska School of Medicine, Omaha (J.T.R.). Received March 31, 1998; revision requested May 19; final revision received March 13, 2000; accepted March 24. R.Y.C.C. was supported by a 1995 RSNA Medical Student Award. Address correspondence to R.B.S. (e-mail: rbschwartz@partners.org).

PURPOSE: To investigate the clinical parameters that are associated with the development of brain edema of hypertensive encephalopathy in patients with preeclampsia-eclampsia.

MATERIALS AND METHODS: Twenty-eight patients with preeclampsia-eclampsia and neurologic symptoms underwent magnetic resonance (MR) imaging. Clinical parameters recorded at the time of MR imaging included serum electrolytes and various indices of hematologic, renal, and hepatic function. Several data were available 1 week prior to the development of neurologic symptoms in 11 patients. Univariate analysis and multivariate logistic regression analyses were performed to study possible associations between these parameters and brain edema at MR imaging.

RESULTS: The 20 patients with brain edema at MR imaging had a significantly greater incidence of abnormal red blood cell morphology (14 [82%] of 17 patients vs two [25%] of eight, P < .005) and higher levels of lactic dehydrogenase (LDH) (339 U/L ± 65 [SD] vs 258 U/L ± 65, P = .007) than the eight with normal MR imaging findings; multivariate logistic regression analysis showed a strong association with red blood cell morphology only. Moreover, LDH levels were elevated before the development of neurologic abnormalities (P < .05). Blood pressures were not significantly different between groups at any time.

CONCLUSION: Brain edema at MR imaging in patients with preeclampsia-eclampsia was associated with abnormalities in endothelial damage markers and not with hypertension level.

Index terms: Brain, abnormalities, 10.59, 10.862 • Brain, MR, 10.121413, 10.12143 • Hypertension • Pregnancy, complications

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