First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
Hypertens Res. 2018 Aug;41(8):598-604. doi: 10.1038/s41440-018-0051-3. Epub 2018 May 29.
Eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide, and its pathogenesis remains elusive. Our objective was to investigate neuroimaging findings in women who developed neurologic symptoms in severe preeclampsia with or without eclampsia to further understand the relationship between neuroimaging findings and the pathogenesis of eclamptic seizures. This retrospective study included 79 women with severe preeclampsia/eclampsia who underwent brain MRI/CT examination between 2005 and 2017. We analyzed imaging findings, clinical data, and laboratory data in order to compare patients with severe preeclampsia to those with eclampsia and patients with abnormal imaging findings to those with normal CT or MRI. A total of 41 of 79 women were diagnosed with eclampsia, 36 (88.80%) of which had abnormal neuroimaging findings, including cerebral edema (19 cases), infarction (5 cases), cerebral venous thrombosis (5 cases), and cerebral hemorrhage (7 cases). Five patients died of cerebral hemorrhage. Of the 38 cases of severe preeclampsia, 21 (55.26%) cases had abnormal imaging findings, including cerebral edema (20 cases), and 1 case had cerebral hemorrhage. Serum uric acid was significantly higher in patients with abnormal imaging findings than in patients without them (P = 0.004). The imaging findings in women with neurologic symptoms were similar between the severe preeclampsia and eclampsia groups. Our results suggest that eclampsia may not be a diagnosis with a unique pathogenesis; rather, it may be best considered a severe symptom of the intracranial pathophysiology of preeclampsia. We suggest that cranial imaging should be performed early in the management of patients with severe preeclampsia who develop new neurologic symptoms.
子痫前期是全球孕产妇和围产儿发病率和死亡率的主要原因，但其发病机制仍不清楚。我们的目的是研究在重度子痫前期伴或不伴子痫中出现神经系统症状的女性的神经影像学表现，以进一步了解神经影像学表现与子痫发作发病机制之间的关系。这项回顾性研究纳入了 2005 年至 2017 年间接受脑 MRI/CT 检查的 79 例重度子痫前期/子痫患者。我们分析了影像学表现、临床资料和实验室数据，以便比较重度子痫前期患者与子痫患者，以及影像学异常患者与 CT 或 MRI 正常患者。79 例患者中共有 41 例诊断为子痫，其中 36 例（88.80%）存在神经影像学异常，包括脑水肿（19 例）、脑梗死（5 例）、脑静脉血栓形成（5 例）和脑出血（7 例）。5 例患者死于脑出血。38 例重度子痫前期患者中，21 例（55.26%）存在影像学异常，包括脑水肿（20 例），1 例存在脑出血。影像学异常患者的血清尿酸明显高于无影像学异常患者（P = 0.004）。有神经系统症状的女性在重度子痫前期和子痫组中的影像学表现相似。我们的结果表明，子痫可能不是一种具有独特发病机制的疾病，而最好被认为是子痫前期颅内病理生理学的严重症状。我们建议在出现新的神经系统症状的重度子痫前期患者的管理中尽早进行头颅影像学检查。
