Brain MRI in peripartum seizures: usefulness of combined T2 and diffusion weighted MR imaging
Section snippets
Materials and methods
We report three patients with a clinically definite diagnosis of eclampsia. They all presented with pregnancy induced hypertension associated with peripheral edema and proteinuria leading to the diagnosis of preeclampsia. All women then had seizures, thus fulfilling the diagnostic criteria for eclampsia. Routine MRI with T2 weighted images as well as DWI were obtained on a Simmens vision 1.5-T system. Diffusion weighted images (DWI) were obtained with a b value of 1000 s/mm2, with repetition
Case 1
A 34-year-old African American primigravida was admitted for worsening of pregnancy induced hypertension at 34 weeks of gestation. She also had developed ankle edema for the preceding week. On admission, she received an intravenous bolus of 6 gm MgSO4, followed by continuous infusion at rate of 2 gm/h. Labor was induced with oxytocin and she delivered a healthy infant vaginally early the next day. Following the delivery her blood pressure remained high. While on MgSO4 therapy, she had a brief
Discussion
A seizure for the first time during the peripartum period presents a diagnostic dilemma. The underlying causes of such seizures vary. Some causes are associated with high immediate morbidity and mortality, but with benign long term prognosis. The common causes of new onset peripartum seizure are eclampsia, dural sinus thrombosis, arterial or venous stroke without sinus thrombosis, intracranial hemorrhage, and sleep deprivation with unmasking of epilepsy. Eclampsia and cerebral infarction are
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Cited by (32)
Cerebrovascular Pathophysiology in Preeclampsia and Eclampsia
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2017, American Journal of Emergency MedicineCerebrovascular pathophysiology in preeclampsia and eclampsia
2014, Chesley's Hypertensive Disorders in Pregnancy, Fourth EditionCerebrovascular (Patho)Physiology in Preeclampsia/Eclampsia
2009, Chesley's Hypertensive Disorders in PregnancyEclampsia: A neurological perspective
2008, Journal of the Neurological SciencesDiffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: Initial experience
2003, American Journal of Obstetrics and GynecologyCitation Excerpt :In clinical practice, reversal of lesions with restricted diffusion, such as cytotoxic edema, is absolutely rare, with an estimated 0.2%-0.4% probability.7,19 Some reported cases of DW-MRI have suggested a mechanism of microvascular dilatation that leads to vasogenic edema as the pathophysiologic condition of BE in eclampsia/preeclampsia,4,10,20 and DW-MRI can distinguish between irreversible (cytotoxic/ischemic) and reversible (vasogenic) edema.4,6 Our data strongly support this hypothesis (Figs 3 and 4).