Neuro-imaging study in eclampsia

ABSTRACT

Background: Eclampsia is associated with increased risk of maternal death varying from 1.8 % in developed countries to 14 % in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/haemoorhage. Eclampsia patients have been found to have various CNS pathological conditions amenable to the medical treatment. The aim of the study is to know the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it.Methods: Prospective study design included 50 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and anti-hypertensive. Cranial CT scan examinations were performed for all patients within 24hours of last convulsion without intravenous contrast material injection. Time taken to recover from all the clinical symptoms like altered consciousness, defective vision, headache and seizure and the maternal outcome are compared.    Results: 62% of patients with eclampsia had detectable pathological changes in CT scan. Cerebral edema was the most common CT scan finding with parietal lobe was the most common site (90.32%) of pathological changes. Mortality rate was high among eclamptic patients with cerebral hemorrhage.Conclusions: CT scan was found to be effective in detecting cerebral pathology in more than half of the eclamptic patients. The most common pathological changes detected are cerebral edema and cerebral infarction. CT scan may not be required for the diagnosis of eclampsia, but it must be used in certain complicated patients to detect cerebral pathology at the earliest so that specific management could be provided to reduce the maternal mortality.