ABSTRACT
OBJECTIVES: To evaluate maternal cerebral hemodynamics in patients with preeclampsia (PE) from diagnosis to clinical resolution using transcranial Doppler (TCD) and compare these findings with those of healthy pregnant women. Furthermore, we sought to describe the prevalence of vasoconstriction (VC) and related clinical parameters in PE. STUDY DESIGN: Case-control study including consecutive patients with PE at diagnosis and healthy pregnant women at week 36 of pregnancy. We prospectively collected clinical and neuroimaging data. TCD was repeated at inclusion and on days 1, 7, and 30 postpartum. MAIN OUTCOME MEASURES: Evolution of intracranial arteries hemodynamics (mean velocities (MV), resistance index). VC diagnosis and related features are described. RESULTS: A total of 165 patients (80 with PE) underwent 467 TCD procedures. Patients with PE presented higher MAP. Intracranial arteries MV were significantly higher in patients with PE (at diagnosis and days 1 and 7 postpartum) but were normalized by day 30, without correlation with MAP evolution or treatment. VC was present in 32.5% of patients with PE (p < 0.001) and was mainly mild according to the Lindegaard index. Severe PE was associated with VC (50.0% vs. 22.6%; odds ratio 3.484; 95% confidence interval 1.425-8.520; p = 0.014). No other independent risk factors for reversible VC were identified. CONCLUSIONS: Patients with PE presented significantly higher MV in the anterior circulation compared to healthy controls, which worsened by day 7 and reverted by day 30 after delivery. VC was present in one-third of PE but was mainly mild and asymptomatic. Severe PE was associated with VC development.
Subject(s)
Cerebrovascular Circulation , Pre-Eclampsia/physiopathology , Vasoconstriction , Adult , Arterial Pressure , Case-Control Studies , Female , Humans , Postpartum Period , Pre-Eclampsia/diagnosis , Pregnancy , Prospective Studies , Severity of Illness Index , Ultrasonography, Doppler, TranscranialABSTRACT
We report the case of a 35-year-old woman who complained of a rapid enlargement of a pre-existing breast mass and yellowish nipple discharge. Clinical examination revealed a firm mass measuring 15 x 10 cm and "peau d'orange" phenomenon. Sonography revealed a well-defined mass with heterogeneous echotexture and hyperechoic trabecular structures that delineated hypoechoic areas, resulting in a honeycomb pattern. The patient underwent a surgical exploration and a biopsy of the mass and of the skin. The histopathologic examination revealed an atypical medullary carcinoma with high mitotic activity.
