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


METHODS
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.


RESULTS
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<.001, P<.001, P=.009, and P=.027, respectively).


CONCLUSIONS
Neuroimaging in eclampsia demonstrates a higher incidence of atypical distributions and cytotoxic edema than previously thought. Altered sensorium; visual disturbances; status epilepticus; and elevated serum uric acid, lactate dehydrogenase, and creatinine are associated with abnormal neuroimaging findings. Higher serum creatinine, uric acid, and lactate dehydrogenase levels and moderate and severe forms of posterior reversible encephalopathy syndrome are possible predictors of poor outcome.
From the Departments of Neurology (V.J., R.V., R.K.G., M.K.S., H.S.M., P.K.S.).
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V
Junewar
From the Departments of Neurology (V.J., R.V., R.K.G., M.K.S., H.S.M., P.K.S.) drrajeshverma32@yahoo.com.
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R
Verma
Obstetrics and Gynecology (P.L.S.).
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PL
Sankhwar
From the Departments of Neurology (V.J., R.V., R.K.G., M.K.S., H.S.M., P.K.S.).
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RK
Garg
From the Departments of Neurology (V.J., R.V., R.K.G., M.K.S., H.S.M., P.K.S.).
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MK
Singh
From the Departments of Neurology (V.J., R.V., R.K.G., M.K.S., H.S.M., P.K.S.).
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HS
Malhotra
From the Departments of Neurology (V.J., R.V., R.K.G., M.K.S., H.S.M., P.K.S.).
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PK
Sharma
Radiodiagnosis (A.P.), King George's Medical University, Lucknow, India.
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A
Parihar
D000328:Adult; D001921:Brain / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D004461:Eclampsia / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D059906:Neuroimaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies