Unusual computed tomographic scan in eclampsia

Cerebral infarction during hypertensive encephalopathy: Case report with pathologic and atypical radiographic findings

Neuroimaging of patients with hypertensive encephalopathy frequently reveals white matter changes that reverse with control of blood pressure. We report a young woman who presented with hypertensive encephalopathy but with unusual radiographic findings. Her course and atypical appearance on magnetic resonance imaging raised suspicion for encephalitis, but autopsy disclosed a large cerebral infarction, an uncommon complication during this clinical syndrome. The discovery of a pheochromocytoma at autopsy was also unexpected and may be associated with the unusual features of this case. The clinical, pathologic, and radiographic descriptions of this case may offer further insight into the pathophysiology of hypertensive encephalopathy.

[Reversible cerebral changes in hemolytic-uremic syndrome]

The hemolytic-uremic syndrome is a pathology characterized by a triad consisting of acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia, with complications of the central nervous system arising in a considerable number of cases. Altered cranial computerized tomography examinations usually reveal cerebral infarctions. We present here two cases in which diffuse hypodensity was observed in the white matter in addition to the infarcts. This hypodensity was reversible after resolution of the acute phase of the disease, as is also the case for the alterations described in uremic encephalopathy and in hypertensive encephalopathy of other etiologies.

Occipital lobe epilepsy: a chronic condition related to transient occipital lobe involvement in eclampsia

Eleven hours and 6 days, respectively, after childbirth 2 women exhibited hypertension and paroxysmal visual disturbances followed by tonic-clonic seizures and no other preeclamptic signs. Both developed partial epilepsy with occipital lobe seizures with no other neurologic defects. Neuroimaging showed no lesion during either the acute episode or 3-5 year follow-up. Selective vulnerability of the occipital lobes during eclamptic hypertensive encephalopathy was the probable pathophysiologic mechanism. Aggressive antihypertensive treatment during the acute phase may have exacerbated the risk of permanent cerebral damage.

Resolution of focal CT hypodense lesions in patients with subarachnoid hemorrhage

Cerebral infarction in the setting of vasospasm due to subarachnoid hemorrhage (SAH) is a known complication of aneurysmal rupture. Computed tomography (CT) has been instrumental in making this diagnosis; however, focal hypodense lesions on CT scan do not always represent infarcted tissue. Two patients are presented here who had CT hypodense lesions in regions of cerebral vasospasm following subarachnoid hemorrhage.

Magnesium sulfate reverses experimental delayed cerebral vasospasm after subarachnoid hemorrhage in rats

We induced experimental delayed cerebral vasospasm by the intracisternal injection of greater than 0.5 ml blood in 30 rats. Seventy-two hours later the basilar artery was exposed via the transclival approach and photographed at high-power magnification through an operating microscope. We then evaluated the effect of topical (n = 30) and intravenous (n = 20) magnesium sulfate on the spastic artery by computerized image analysis. A greater than 50% reduction in baseline diameter of the basilar artery was observed in the rats subjected to subarachnoid hemorrhage compared with the 10 controls (p less than 0.0001). Intravenous magnesium sulfate dilated the spastic artery to approximately 75% of the baseline diameter in control rats (p less than 0.0001). Topical magnesium sulfate caused dramatic dilation of the basilar artery in both the control and the subarachnoid hemorrhage groups to near 150% of the baseline diameter in the controls (p less than 0.001). All rats receiving intravenous magnesium sulfate reached therapeutic plasma levels of the ion. Hemodynamic effects were mild and immediately reversible upon cessation of magnesium sulfate administration. We suggest that magnesium has a role in the treatment of subarachnoid hemorrhage-induced vasospasm in humans.

Postpartum amaurosis

Blindness is a rare but dramatic complication of pregnancy and delivery. We present the case of a patient who developed toxemia at the time of delivery that with ineffective treatment resulted in cortical blindness without seizure activity. The pathogenesis as well as the diagnostic workup and treatment of this unusual complication are discussed.

Computed tomographic changes of the brain in toxaemia of pregnancy

Four cases of toxaemia of pregnancy examined with computed tomography scans of the brain are reported. A review of the literature reveals 19 other cases with previously reported CT brain scans. The review shows intracerebral oedema as the main finding. Haemorrhage, massive or punctate was noted in four cases. The pathogenesis of the CT changes and the clinico-radiological correlation of the visual disturbances are discussed.

Action of magnesium sulfate in the treatment of preeclampsia-eclampsia

Recent evidence supports the concept that cerebral vasospasm is involved in the pathogenesis of eclampsia. Magnesium, which has a beneficial effect in eclampsia, may act by opposing calcium-dependent arterial constriction, thereby relieving vasospasm. Magnesium may also antagonize the increase in intracellular calcium concentration caused by ischemia and thus prevent cell damage and death. Magnesium might have a role in the treatment of cerebral vasospasm and ischemia, such as occurs in subarachnoid hemorrhage, ischemic stroke, and brain trauma.

Repeated cranial computed tomographic and magnetic resonance imaging scans in two cases of eclampsia

In two cases of eclampsia with consumptive thrombocytopenia, the maximum increase in blood pressure and the lowest platelet count coincided with the maximum degree of neurologic and neuroradiologic abnormality. Computed tomograms showed decreased attenuation, and T2-weighted magnetic resonance images showed increased signal intensity focally in the cerebral cortex and the deep gray and white matter. Blood pressure, platelet count, clinical status, and roentgenograms normalized completely in both cases. Severe arterial hypertension and disseminated transitory microvascular occlusions presumably caused multiple small foci of brain edema that resolved without remaining detectable ischemic brain damage.

Eclampsia: a pediatric neurologic problem

Eclampsia is a syndrome of hypertension, proteinuria, edema, and neurologic manifestations such as seizures, focal deficits, or blindness occurring during pregnancy, mainly in primigravidas. Although it is not seen often in the pediatric population, it occurs with greater frequency among pregnant patients under the age of 15 than in the general population. Serious sequelae can be prevented with prompt and adequate treatment, including termination of pregnancy.

Cerebral vasospasm and eclampsia

We describe a patient who experienced focal cerebral and brainstem ischemia in the setting of postpartum eclampsia. Cerebral angiography showed spasm of large- and medium-caliber arteries. This case provides rare documentation that vasospasm may account for cerebral ischemia in eclamptic women with focal signs. This observation suggests that in such patients cerebral angiography may be informative and useful.

CT and angiographic correlation of severe neurological disease in toxemia of pregnancy

Two patients with severe cerebral symptoms of toxemia of pregnancy were examined using computed tomography (CT) and angiography. CT disclosed extensive areas of low attenuation within the cerebral hemispheres. Angiography revealed constriction and narrowing of proximal and peripheral vessels suggesting vasculitis with extensive areas of impaired regional cerebral blood flow. A review of the known pathology and the theories regarding the pathophysiology of the cerebral effects of toxemia is presented.

CT findings in eclampsia

Cranial CT was performed in five patients with eclampsia: densitometric modifications were present in all cases. Only one patient, who later died, displayed multiple foci of cerebral haemorrhage; all others presented bilateral, symmetrical, nonenhancing hypodensities with mass effect interpreted as cerebral oedema. At CT performed 7-14 days after interruption of the pregnancy, these characteristic hypodense lesions were no longer present while neurological symptoms disappeared.