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Overlapping Features of Eclampsia and Postpartum Angiopathy

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Abstract

Introduction

Postpartum cerebral angiopathy (PPA) is considered one of a diverse group of rare conditions termed “reversible cerebral vasoconstriction syndromes”. Existing literature suggest considerable overlap in the manifestations of eclampsia and PPA.

Methods

Retrospective case series review of PPA and eclampsia from a single neurosciences intensive care unit patient log identified over a consecutive 18-month period. A MEDLINE search (using OVID) of the English literature from 1950 through October 2008 was also performed.

Results

Four patients who meet the obstetrical criteria for eclampsia and four patients whose clinical and radiographic features were consistent with PPA were identified. Twenty-eight patients with PPA were identified from the literature and showed significant clinical and radiographic overlap without cohort.

Conclusion

Given the overlapping clinical, laboratory, and radiographical features of eclampsia and PPA, it is probable they share a similar underlying pathophysiological mechanism and represent different clinical expressions of the same pregnancy-related disorder. The obstetrical definition of eclampsia may be to strict when applied in the neurosciences intensive care unit.

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References

  1. Kittner SJ, Stern BJ, Feeser BR, et al. Pregnancy and the risk of stroke. N Engl J Med. 1996;335:768–74. doi:10.1056/NEJM199609123351102.

    Article  PubMed  CAS  Google Scholar 

  2. Sharshar T, Larry C, Mas JL. Incidence and causes of strokes associated with pregnancy and puerperium. A study in public hospitals of Ile de France. Stroke. 1995;26:930–6.

    PubMed  CAS  Google Scholar 

  3. ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsoa and eclampsia. Int J Gynaecol Obstet. 2002;77(1):67–75. doi: 10.1016/S0020-7292(02)80002-9.

    Google Scholar 

  4. Gifford RW, August PA, Cunningham G, et al. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183:S1–22. doi:10.1067/mob.2000.107928.

    Article  Google Scholar 

  5. Singhal AB, Koroshetz WJ, Caplan LR. Cerebral vasoconstriction syndromes. In: Bogousslavsky J, Caplan LR, editors. Uncommon causes of stroke. Cambridge, UK: Cambridge University Press; 2001. p. 114–23.

    Google Scholar 

  6. Singhal AB. Postpartum angiopathy with reversible posterior leukoencephalopathy. Arch Neurol. 2004;61(3):411–6. doi:10.1001/archneur.61.3.411.

    Article  PubMed  Google Scholar 

  7. Neudecker S, Stock K, Krasnianski M. Call-Fleming postpartum angiopathy in the puerperium: a reversible cerebral vasoconstriction syndrome. Obstet Gynecol. 2006;107(2):446–9.

    PubMed  Google Scholar 

  8. Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146(1):34–44.

    PubMed  Google Scholar 

  9. Williams TL, Lukovits TG, Harris BT, Harker RC. A fatal case of postpartum cerebral angiopathy with literature review. Arch Gynecol Obstet. 2007;275(1):67–77. doi:10.1007/s00404-006-0194-3.

    Article  PubMed  Google Scholar 

  10. Will AD, Lewis KL, Hinshaw DB Jr, et al. Cerebral vasoconstriction in toxemia. Neurology. 1987;37(9):1555–7.

    PubMed  CAS  Google Scholar 

  11. Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol. 1993;33(2):222–5. doi:10.1002/ana.410330215.

    Article  PubMed  CAS  Google Scholar 

  12. Matthys LA, Coppage KH, Lambers DS, et al. Delayed postpartum preeclampsia: an experience of 151 cases. Am J Obstet Gynecol. 2004;190(5):1464–6. doi:10.1016/j.ajog.2004.02.037.

    Article  PubMed  Google Scholar 

  13. Chames MC, Livingston JC, Ivester TS, et al. Late postpartum eclampsia: a preventable disease? Am J Obstet Gynecol. 2002;186(6):1174–7. doi:10.1067/mob.2002.123824.

    Article  PubMed  Google Scholar 

  14. Leitch CR, Cameron AD, Walker JJ. The changing pattern of eclampsia over a 60-year period. Br J Obstet Gynaecol. 1997;104(8):917–22.

    PubMed  CAS  Google Scholar 

  15. Giller CA, Hodges K, Batjer HH. Transcranial Doppler pulsatility in vasodilation and stenosis. J Neurosurg. 1990;72:901–6.

    Article  PubMed  CAS  Google Scholar 

  16. Prokesch RC, Rimland D, Petrini JL, Fein AB. Cerebrospinal fluid pleocytosis after seizures. South Med J. 1983;76(3):322–7.

    PubMed  CAS  Google Scholar 

  17. Edlow B, Kasner S, Hurst R, et al. Reversible cerebral vasoconstriction syndrome associated with subarachnoid hemorrhage. Neurocrit Care. 2007;7:203–10. doi:10.1007/s12028-007-0058-0.

    Article  PubMed  Google Scholar 

  18. Atkins PT, Levy KJ, Cross AH, Goldberg MP, et al. Postpartum cerebral vasospasm treated with hypervolemic therapy. Am J Obstet Gynecol. 1996;175:1386–800. doi:10.1016/S0002-9378(96)70064-9.

    Article  Google Scholar 

  19. Singhal AB, Bernstein RA. Postpartum angiopathy and other cerebral vasoconstriction syndromes. Neurocrit Care. 2005;3(1):91–7. doi:10.1385/NCC:3:1:091.

    Article  PubMed  Google Scholar 

  20. Geocadin R, Razumovsky A, Wityk R, et al. Intracerebral hemorrhage and postpartum cerebral vasculopathy. J Neurol Sci. 2002;205(1):29–34. doi:10.1016/S0022-510X(02)00245-9.

    Article  PubMed  Google Scholar 

  21. Geraghty JJ, Hoch DB, Robert ME, Vinters HV. Fatal puerperal cerebral vasospasm and stroke in a young woman. Neurology. 1991;41:1145–7.

    PubMed  CAS  Google Scholar 

  22. Ursell MR, Marras CL, Farb R, et al. Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: implications for management. Stroke. 1998;29:1995–8.

    PubMed  CAS  Google Scholar 

  23. Lee K, Young S, Kim S, Sunwoo I. Basilar artery vasospasm in postpartum cerebral angiopathy. Neurology. 2000;54(10):2003–5.

    PubMed  CAS  Google Scholar 

  24. Zunker P, Ggolombeck K, Brossmann J, et al. Post-partum cerebral angiopathy: repetitive TCD, MRI, MRA and EEG examination. Neurol Res. 2002;24:570–2.

    Article  PubMed  Google Scholar 

  25. Song JK, Fisher S, Seifert TD, Cacayorin ED, et al. Postpartum cerebral angiopathy: atypical features and treatment with intracranial balloon angioplasty. Neuroradiology. 2004;46:1022–6. doi:10.1007/s00234-003-1129-3.

    Article  PubMed  CAS  Google Scholar 

  26. Sugiyama Y, Muroi A, Ishikawa M, Tsukamoto T. A benign form of isolated angiitis of the central nervous system in puerperium: an identical disorder to postpartum angiopathy? Intern Med. 1997;36:931–4. doi:10.2169/internalmedicine.36.931.

    Article  PubMed  CAS  Google Scholar 

  27. Yasuda Y, Matsuda I, Kang Y, et al. Isolated angiitis of the central nervous system first presenting as intracranial hemorrhage during cesarean section. Intern Med. 1993;32:745–8. doi:10.2169/internalmedicine.32.745.

    Article  PubMed  CAS  Google Scholar 

  28. Katzin LW, Levine M, Singhal AB. Dural puncture headache, postpartum angiopathy pre-eclampsia and cortical vein thrombosis after and uncomplicated pregnancy. Cephalalgia. 2007;27(5):461–5. doi:10.1111/j.1468-2982.2007.01285.x.

    Article  PubMed  CAS  Google Scholar 

  29. Ho CM, Chan KH. Posterior reversible encephalopathy syndrome with vasospasm in a postpartum woman after postural headache following spinal anesthesia. Anesth Analg. 2007;105(3):770–2. doi:10.1213/01.ane.0000278128.26896.b2.

    Article  PubMed  Google Scholar 

  30. Chandrashekaran S, Parikh S, Kapoor P, Subbarayan S. Postpartum reversible cerebral vasoconstriction syndrome. Am J Med Sci. 2007;334(3):222–4. doi:10.1097/MAJ.0b013e318141fc69.

    Article  PubMed  Google Scholar 

  31. Calado S, Vale-Santos J, Lima C, et al. Postpartum cerebral angiopathy: vasospasm, vasculitis of both? Cerebrovasc Dis. 2004;18(4):3401. doi:10.1159/000080976.

    Article  Google Scholar 

  32. Farine D, Andreyko J, Lysikiewicz A, et al. Isolated angitis of the brain in pregnancy and puerperium. Obstet Gynecol. 1994;4(63):586–7.

    Google Scholar 

  33. Ducros A, Boukobza M, Porcher R, et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain. 2007;130:3091–101. doi:10.1093/brain/awm256.

    Article  PubMed  Google Scholar 

  34. Buckle RM, Duboulay G, Smith B. Death due to cerebral vasospasm. J Neurol Neurosurg Psychiatry. 1964;27:440–4. doi:10.1136/jnnp.27.5.440.

    Article  PubMed  CAS  Google Scholar 

  35. Douglas K, Redman C. Eclampsia in the United Kingdom. BMJ. 1994;309:1395–400.

    PubMed  CAS  Google Scholar 

  36. Sibai B, Dekker G, Kupferminc M. Pre-eclpamsia. Lancet. 2005;365:785–99.

    PubMed  Google Scholar 

  37. Dineen R, Banks A, Lenthall R. Imaging of acute neurological conditions in pregnancy and the puerperium. Clin Radiol. 2005;60:1156–70. doi:10.1016/j.crad.2005.03.010.

    Article  PubMed  CAS  Google Scholar 

  38. Lewis LK, Hinshaw DB Jr, Will AD, et al. CT and angiographic correlation of severe neurological disease in toxemia of pregnancy. Neuroradiology. 1988;30:59–64. doi:10.1007/BF00341945.

    Article  PubMed  CAS  Google Scholar 

  39. Hansen WF, Burnham SJ, Svendsen TO, et al. Transcranial Doppler findings of cerebral vasospasm in pre-eclampsia. J Matern Fetal Med. 1996;5:194–200. doi:10.1002/(SICI)1520-6661(199607/08)5:4<194::AID-MFM6>3.0.CO;2-F.

    Article  PubMed  CAS  Google Scholar 

  40. Trommer BL, Homer D, Mikhael MA. Cerebral vasospasm and eclampsia. Stroke. 1988;19:326–9.

    PubMed  CAS  Google Scholar 

  41. Horn EH, Filshie M, Kerslake RW, et al. Widespread cerebral ischaemia treated with nimodipine in a patient with eclampsia. BMJ. 1990;301:794. doi:10.1136/bmj.301.6755.794.

    Article  PubMed  CAS  Google Scholar 

  42. Schwartz RB, Jones KM, Kalina P, et al. Hypertensive encephalopathy findings on CT, MR imaging and SPECT imaging in 14 cases. AJR. 1992;159:379–83.

    PubMed  CAS  Google Scholar 

  43. Brubaker LM, Smith JK, Lee YZ, et al. Hemodynamic and permeability changes in posterior reversible encephalopathy syndrome measured by dynamic susceptibility perfusion-weighted MR imaging. AJNR Am J Neuroradiol. 2005;26(4):825–30.

    PubMed  Google Scholar 

  44. Belfort M, Anthony J, Saade G, Allen J, Nimodipine Study Group. A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med. 2003;348(4):304–11. doi:10.1056/NEJMoa021180.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Michigan State University, Bronson Methodist Hospital, 601 John Street Suite M-124, Kalamazoo, MI, 49007, USA

    Jeffrey J. Fletcher

  2. Department of Neurology (Neurocritical Care), Michigan State University, Bronson Methodist Hospital, 601 John Street Suite M-124, Kalamazoo, MI, 49007, USA

    Jeffrey J. Fletcher

  3. Departments of Critical Care Medicine & Clinical Neurosciences, Foothills Medical Center, University of Calgary, Edmonton, AB, Canada

    Andreas H. Kramer

  4. Departments of Neurology, Neurosurgery and Medicine, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, #1109, Chicago, IL, 60611, USA

    Thomas P. Bleck

  5. University of Virginia Hospital, Box 800394, Charlottesville, VA, 29008, USA

    Nina J. Solenski

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  1. Jeffrey J. Fletcher
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Correspondence to Jeffrey J. Fletcher.

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Fletcher, J.J., Kramer, A.H., Bleck, T.P. et al. Overlapping Features of Eclampsia and Postpartum Angiopathy. Neurocrit Care 11, 199–209 (2009). https://doi.org/10.1007/s12028-009-9221-0

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  • DOI: https://doi.org/10.1007/s12028-009-9221-0

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