Role of Neuroimaging in Patients with Atypical Eclampsia

Abstract

Need

Despite availability of intensive care units and improved antenatal care, some women still die from Eclampsia. Eclampsia is associated with increased risk of maternal death varying from 1.8 % in developed countries to 14 % in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/ischemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various CNS pathological conditions amenable to the medical treatment.

Aims and Objectives

(1) To study the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it. (2) To study the role of neuroimaging in patients with atypical eclampsia.

Methodology

Prospective study design included 30 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO₄ therapy and antihypertensives. The patients who are refractory to the treatment such as having recurrent convulsions despite therapy MgSO₄ were selected for neuroimaging with CT scan. Neuroimaging is done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the transaxial plane. Abdomen shielding is done with lead shield to prevent radiation hazard.

Result

S. No.	Findings	Number of patients	Percentage
1	Cerebral oedema	20
	Mild to moderate	17	56
	Severe	03	10
2	Hypertensive encephalopathy	05	16
3	Posterior reversible encephalopathy syndrome	11	36
4	Cerebral infarction	04	13
5	Cortical venous sinus thrombosis	02	16
6	Tuberculomas	02	06
7	Meningitis	01	03
8	Hydrocephalus	01	03
9	Normal	04	13

Conclusion

Eclampsia patients who were refractory to the treatment with MgSO₄ and antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuroimaging in these patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which had definitely improved patient's condition and have reduced morbidity.