Neuroimaging features and predictors of outcome in eclamptic encephalopathy: a prospective observational study

• Published in: American journal of neuroradiology : AJNR 2014-09, Vol.35 (9), p.1728-1734
• Main Authors: Junewar, V, Verma, R, Sankhwar, P L, Garg, R K, Singh, M K, Malhotra, H S, Sharma, P K, Parihar, A
• Format: Article
• Language: English
• Subjects: Adult; Brain; Brain - metabolism; Brain - pathology; Brain - physiopathology; Eclampsia - pathology; Fellows' Journal Club; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Neuroimaging; Posterior Leukoencephalopathy Syndrome - etiology; Posterior Leukoencephalopathy Syndrome - metabolism; Posterior Leukoencephalopathy Syndrome - pathology; Posterior Leukoencephalopathy Syndrome - physiopathology; Pregnancy; Prospective Studies
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a3923

Posterior reversible encephalopathy syndrome is associated with eclampsia. We assessed the distribution and nature of typical and atypical cranial MR imaging findings in these patients and their correlation with clinical and laboratory data and predictors of outcome. Forty-five clinically confirmed cases of eclampsia were included in this prospective observational study. Subjects with hemolysis, elevated liver enzymes, and low platelets syndrome (n = 9) and pre-existing neurologic conditions (1 with cerebral solitary cysticercus granuloma) were excluded. Patients underwent blood investigations and cranial MR imaging. Twenty-seven patients had abnormal while 8 had normal MR imaging findings. Involvement of brain regions was as follows: frontal, 88.89%; temporal, 44.44%; parietal, 100%; occipital, 100%; deep gray matter, 29.63%; cerebellum, 22.22%; brain stem, 14.81%. Cytotoxic edema was present in 33.33% of cases; 66.67% of patients had mild posterior reversible encephalopathy syndrome; 25.92% had moderate posterior reversible encephalopathy syndrome; and 7.41% had severe posterior reversible encephalopathy syndrome. Abnormal neuroimaging findings were significantly associated with altered sensorium; visual disturbances; status epilepticus; and elevated serum creatinine, uric acid, and lactate dehydrogenase (P=.006, P=.018, P=.015, P=.019, P=.003, and P=.001, respectively). Serum creatinine, uric acid, and lactate dehydrogenase values and the presence of moderate or severe posterior reversible encephalopathy syndrome were significantly associated with mortality (P