title: Posterior reversible encephalopathy syndrome and eclampsia: pressing the case for more aggressive blood pressure control.
abstract: OBJECTIVE
  To assess the prevalence, clinical presentations, and neuroimaging abnormalities in a series of patients treated for eclampsia at Mayo Clinic in Rochester, MN.
  
  
  METHODS
  We reviewed the records of all pregnant patients diagnosed as having eclampsia at Mayo Clinic in Rochester, MN, between January 1, 2001, and December 31, 2008. All patients who underwent neuroimaging were identified, and all studies were reviewed by an independent neuroradiologist. Comparisons were made between groups who did and did not undergo imaging to identify differentiating clinical or laboratory variables.
  
  
  RESULTS
  Thirteen cases of eclampsia were found, with neuroimaging studies available for 7: magnetic resonance imaging (n=6) and computed tomography (n=1). All 7 patients developed eclamptic seizures, and 2 of 7 patients had severe hypertension, with recorded systolic blood pressures exceeding 180 mm Hg. Neuroimaging showed characteristic changes of posterior reversible encephalopathy syndrome (PRES) in all patients. Follow-up imaging showed resolution in 2 of 3 patients; 1 patient had residual neuroimaging abnormalities.
  
  
  CONCLUSIONS
  Our results suggest that the clinical syndrome of eclampsia is associated with an anatomical substrate that is recognizable by neuroimaging as PRES. The levels of blood pressure elevation are lower than those reported in cases of PRES because of hypertensive encephalopathy. Further studies are needed to determine whether more aggressive blood pressure control and early neuroimaging may have a role in the management of these patients.
authors: Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors: Steven J
authors: SJ
authors: Wagner
authors: Letitia A
authors: LA
authors: Acquah
authors: E Paul
authors: EP
authors: Lindell
authors: Iasmina M
authors: IM
authors: Craici
authors: Majken T
authors: MT
authors: Wingo
authors: Carl H
authors: CH
authors: Rose
authors: Wendy M
authors: WM
authors: White
authors: Phyllis
authors: P
authors: August
authors: Vesna D
authors: VD
authors: Garovic
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001931:Brain Mapping; D004461:Eclampsia / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008499:Medical Records / Q000706:statistics & numerical data; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome