title: Incidence of posterior reversible encephalopathy syndrome in eclamptic and patients with preeclampsia with neurologic symptoms.
abstract: Posterior reversible encephalopathy syndrome is observed frequently in patients with eclampsia; however, it has also been reported in some patients with preeclampsia.
  
  
  
  The aim of this study was to determine the incidence of posterior reversible encephalopathy syndrome in patients with preeclampsia and eclampsia and to assess whether these 2 patient groups share similar pathophysiologic backgrounds by comparing clinical and radiologic characteristics.
  
  
  
  This was a retrospective cohort study of 4849 pregnant patients. A total of 49 patients with eclampsia and preeclampsia and with neurologic symptoms underwent magnetic resonance imaging and magnetic resonance angiography; 10 patients were excluded from further analysis because of a history of epilepsy or dissociative disorder. The age, parity, blood pressure, and routine laboratory data at the onset of symptoms were also recorded.
  
  
  
  Among 39 patients with neurologic symptoms, 12 of 13 patients with eclampsia (92.3%) and 5 of 26 patients with preeclampsia (19.2%) experienced the development of posterior reversible encephalopathy syndrome. Whereas age and blood pressure at onset were not significantly different between patients with and without encephalopathy, hematocrit, serum creatinine, aspartate transaminase, alanine transaminase, and lactate dehydrogenase values were significantly higher in patients with posterior reversible encephalopathy syndrome than in those without magnetic resonance imaging abnormalities. In contrast, patients with eclampsia with posterior reversible encephalopathy syndrome did not show any significant differences in clinical and laboratory data compared with patients with preeclampsia with posterior reversible encephalopathy syndrome. In addition to the parietooccipital regions, atypical regions (such as the frontal and temporal lobes), and basal ganglia were also involved in patients with eclampsia and patients with preeclampsia with posterior reversible encephalopathy syndrome. Finally, intraparenchymal hemorrhage was detected in 1 patient with eclampsia, and subarachnoid hemorrhage was observed in 1 patient with preeclampsia.
  
  
  
  Although the incidence of posterior reversible encephalopathy syndrome was high in patients with eclampsia, nearly 20% of the patients with preeclampsia with neurologic symptoms also experienced posterior reversible encephalopathy syndrome. The similarities in clinical and radiologic findings of posterior reversible encephalopathy syndrome between the 2 groups support the hypothesis that these 2 patient groups have a shared pathophysiologic background. Thus, magnetic resonance imaging studies should be considered for patients with the recent onset of neurologic symptoms, regardless of the development of eclampsia.
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Toyota, Aichi, Japan. Electronic address: marimo.mayama@gmail.com.
authors.forename: Michinori
authors.initials: M
authors.lastname: Mayama
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Kaname
authors.initials: K
authors.lastname: Uno
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Tano
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshihara
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Mayu
authors.initials: M
authors.lastname: Ukai
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kishigami
authors.affiliation: Department of Neurology, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Toyota, Aichi, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Oguchi
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D015897:Comorbidity; D004461:Eclampsia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies
keywords: cerebral vasoconstriction; eclampsia; magnetic resonance imaging; posterior reversible encephalopathy syndrome; preeclampsia