MRI CHANGES AMONG PATIENTS OF ECLAMPSIA AND PREECLAMPSIA WITH ASSOCIATED NEUROLOGICAL SYMPTOM ANALYSIS
AbstractBackground: Pregnancy poses some stress on normal homeostasis of the human body and brings changes in the body which predisposes the individual towards various pathological conditions as well. Objective: Objective of the study was to determine the magnetic resonance imaging (MRI) changes and clinical symptoms associated with these changes among patients of eclampsia and preeclampsia managed at tertiary care unit. It was a cross-sectional study, conducted at Gynaecology and obstetrics department Pak Emirates Military Hospital (PEMH) Rawalpindi. January to June 2019. Methods: A total of 80 pregnant women who were diagnosed by consultant obstetrician for eclampsia or pre-eclampsia were included in the study. All the patients underwent Plain MRI brain including TIWI, T2WI, FLAIR, DWI, ADC, GRE and SWI sequences at radiology department of PEMH RWP. Positive MRI findings were defined as presence of cerebral oedema, infarction, cerebral venous sinus thrombosis and cerebral haemorrhage. Headache, seizures, altered mental status and visual problems were correlated with MRI changes among the target population. Results: Out of 80 pregnant women with eclampsia or pre-eclampsia, 49 (61.2%) had no changes on MRI while 31 (38.8%) had significant changes on MRI. Cerebral oedema 12 (15%) was the most common MRI finding followed by cerebral haemorrhage 8 (10%). Mean age of participants was 36.33±2.238 years. With Pearson chi-square analysis, it was found that presence of seizures and altered mental state had statistically significant relationship with presence of MRI findings among the target population. Conclusion: MRI changes were a common finding among the patients of eclampsia or pre-eclampsia. Cerebral oedema was the commonest finding in our study. Patients with serious clinical symptoms like seizures and altered mental state had more chances of having MRI changes as compared to patients without the serious clinical symptoms.
Kepley JM, Mohiuddin SS. Physiology, Maternal Changes. [Updated 2019 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. [cited 2020 Aug]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539766/
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27(2):89–94.
Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives [published correction appears in Circ Res. 2020 Jan 3;126(1):e8]. Circ Res 2019;124(7):1094–112.
Magley M, Hinson MR. Eclampsia. [Updated 2020 Feb 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. [cited 2020 Aug]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554392/
Mayrink J, Souza RT, Feitosa FE, Rocha Filho EA, Leite DF, Vettorazzi J, et al. Incidence and risk factors for Preeclampsia in a cohort of healthy nulliparous pregnant women: a nested case-control study. Sci Rep 2019;9(1):9517.
Duhig K, Vandermolen B, Shennan A. Recent advances in the diagnosis and management of pre-eclampsia. F1000Res 2018;7:242.
Demirtaş O, Gelal F, Vidinli BD, Demirtaş LO, Uluç E, Baloğlu A. Cranial MR imaging with clinical correlation in preeclampsia and eclampsia. Diagn Interv Radiol 2005;11(4):189–94.
Di X, Mai H, Zheng Z, Guo K, Morse AN, Liu H. Neuroimaging findings in women who develop neurologic symptoms in severe preeclampsia with or without eclampsia. Hypertens Res 2018;41(8):598–604.
Dong X, Nao J. Neurological manifestations and neuroimaging presentations in patients with severe preeclampsia: predisposing factors and clinical implications. Neurol Sci 2019;40(6):1245–53.
Saxena R, Joshi K, Saxena G, Sharma G, Yadav K. A cross-sectional study to evaluate the cranial magnetic resonance imaging findings in eclampsia and severe pre-eclampsia patients and its clinical correlation. Adv Hum Biol 2018;8(1):41–5.
Osmanağaoğlu MA, Dinç G, Osmanağaoğlu S, Dinç H, Bozkaya H. Comparison of cerebral magnetic resonance and electroencephalogram findings in pre-eclamptic and eclamptic women. Aust N Z J Obstet Gynaecol 2005;45(5):384–90.
Portelli M, Baron B. Clinical Presentation of Preeclampsia and the Diagnostic Value of Proteins and Their Methylation Products as Biomarkers in Pregnant Women with Preeclampsia and Their Newborns. J Pregnancy 2018;2018:2632637.
Postma IR, Slager S, Kremer HP, de Groot JC, Zeeman GG. Long-term consequences of the posterior reversible encephalopathy syndrome in eclampsia and preeclampsia: a review of the obstetric and nonobstetric literature. Obstet Gynecol Surv 2014;69(5):287–300.
Soomro S, Kumar R, Lakhan H, Shaukat F. Risk Factors for Pre-eclampsia and Eclampsia Disorders in Tertiary Care Center in Sukkur, Pakistan. Cureus 2019;11(11):e6115.
Ahmad I, Zubair UB, Mumtaz H, Yousaf MA, Muhammad WW. Posterior reversible encephalopathy syndrome in our setup. Pak Armed Forces Med J 2013;63(3):365–68.
Hellmeyer L, Iwinska-Zelder J, Gerken L, Kühnert M, Schmidt S. MR-tomografische Veränderungen bei Präeklampsie und Eklampsie [Changes in MR images in pre-eclampsia and eclampsia]. Z Geburtshilfe Neonatol 2009;213(1):27–31.
Dong XY, Bai CB, Nao JF. Clinical and radiological features of posterior reversible encephalopathy syndrome in patients with pre-eclampsia and eclampsia. Clin Radiol 2017;72(10):887–95.
Rijal JP, Giri S, Dawadi S, Dahal KV. Posterior reversible encephalopathy syndrome (PRES) in a patient with late postpartum eclampsia. BMJ Case Rep 2014;2014(1):bcr2013203162.
Dong X, Nao J. Influential factors and clinical significance of an atypical presentation of posterior reversible encephalopathy syndrome in patients with eclampsia. Neurol Sci 2019;40(2):377–84.