MRI study links eclampsia to cerebral infarcts, edema, and vasospasm

MRI study links eclampsia to cerebral infarcts, edema, and vasospasm | Image Credit: © merydolla - © merydolla - stock.adobe.com.

There is a link between eclampsia and cerebral infarcts, vasogenic cerebral edema, vasospasm, and decreased perfusion, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Link between eclampsia and neurologic complications

Eclampsia is a common complication of preeclampsia, leading to cerebral edema in 71% to 80% of cases.² Traditionally, magnetic resonance imaging (MRI) is used to visualize cerebral edema, which presents as increased brain water content.¹ This allows clinicians to identify decreased perfusion, which indicates insufficient blood flow to a region.

“Cerebral diffusion, perfusion, and vasospasm have not been studied in preeclampsia and eclampsia. If affected, it may explain the occurrence of neurologic signs and symptoms in women with preeclampsia and eclampsia who do not have evidence of pathology on conventional MRI,” wrote investigators.

Study criteria and diagnosing preeclampsia

The cross-sectional prospective study was conducted to evaluate MRI results in women with preeclampsia and eclampsia. Participants received an MRI after delivery but before discharge. Exclusion criteria included neurologic or cardiac disease, diabetes mellitus, and chronic hypertension.

Both the American College of Obstetricians and Gynecologists Practice Bulletin criteria and the presence of significant proteinuria were used to identify preeclampsia cases. Women with preeclampsia and generalized tonic-clonic seizures were classified as having eclampsia.

Clinical assessments and imaging methods

Worsening dyspnea, fine bibasal inspiratory crackles on auscultation, and x-ray features were identified to determine pulmonary edema. Cerebral edema was reported as the primary outcome, identified using MRI performed at 1.5T. High-intensity lesions on the diffusion-weighted imaging indicated acute cerebral infarcts.

Vasogenic cerebral edema was also reported based on high-intensity white matter lesions. The areas of edema in individual slices were added, then multiplied by slice thickness to calculate edema volume.

Investigators defined cerebral diffusion as the diffusion coefficient. This variable was considered a sign of subclinical edema. Finally, vessel segments with a diameter reduction over 50% vs adjacent normal-appearing vessels indicated vasospasm.

MRI timing and participant characteristics

A median of 3 days was reported between delivery and MRI among patients with preeclampsia vs 1 day for those with eclampsia. An MRI performed over 48 hours after delivery was reported in 60% of preeclampsia patients and 10% of eclampsia patients. The final analysis included 41 patients with eclampsia, 20 preeclampsia without eclampsia, and 10 normotensive pregnancies.

Nulliparity, antenatal care attendance, and stillbirth rates were increased in women with preeclampsia and eclampsia vs a normotensive pregnancy. Alcohol and cigarette use during pregnancy were also more common in women with eclampsia. At least 1 severe feature was reported in all women with preeclampsia.

Findings on cerebral infarcts and diffusion

Cerebral infarcts were reported in 34% of women with eclampsia, 5% with preeclampsia, and 0% with a normotensive pregnancy. Vasogenic cerebral edema rates were 80%, 20%, and 0%, respectively. A higher volume of edema was also reported in women with eclampsia vs those with preeclampsia when vasogenic cerebral edema was present, with a fold change of 12.20.

Diffusion was increased in the frontal white matter, parieto-occipital white matter, and caudate nucleus of women with eclampsia vs normotensive pregnancy, with mean differences of 0.07 × 10⁻³ mm²/s, 0.05 × 10−3 mm²/s, and 0.04 × 10⁻³ mm²/s, respectively. For preeclampsia vs normotensive pregnancy, these differences were 0.07 × 10⁻³ mm²/s, 0.02 × 10⁻³ mm²/s, and 0.02 × 10⁻³ mm²/s, respectively.

Eclampsia was also linked to increased parieto-occipital white matter and caudate nucleus diffusion vs preeclampsia. Similarly, perfusion in the caudate nucleus was decreased among this population. Vasospasm rates were 18% and 5.6%, respectively, vs 0% in the normotensive pregnancy group.

Clinical implications of imaging findings

These results indicated an increased presence of cerebral infarcts among women with eclampsia. Additionally, these women and those with preeclampsia may experience increased diffusion.

“This may explain neurologic signs and symptoms in these women when there is no clinically evident cerebral edema on conventional MRI,” wrote investigators.

References:

1. Bergman L, Hannsberger D, Schell S, et al. Cerebral infarcts, edema, hypoperfusion, and vasospasm in preeclampsia and eclampsia. Am J Obstet Gynecol. 2025;232:550.e1-14. doi:10.1016/j.ajog.2024.10.034
2. Verma AK, Garg RK, Pradeep Y, et al. Posterior encephalopathy syndrome in women with eclampsia: Predictors and outcome. Pregnancy Hypertens. 2017;10:74-82. doi:10.1016/j.preghy.2017.06.004