BACKGROUND Eclampsia, a serious pregnancy complication, is associated with cerebral edema and infarctions but the underlying pathophysiology remains largely unexplored. OBJECTIVES To assess the pathophysiology of eclampsia using specialized magnetic resonance imaging that measures diffusion, perfusion, and vasospasm. STUDY DESIGN This was a cross-sectional study recruiting consecutive pregnant women between April 2018 to November 2021 at Tygerberg Hospital, Cape Town, South Africa. We recruited women with eclampsia, preeclampsia, and normotensive pregnancies who underwent magnetic resonance imaging after birth. Main outcome measures were cerebral infarcts, edema, and perfusion using intravoxel incoherent motion imaging and vasospasm using magnetic resonance imaging angiography. The imaging protocol was established before inclusion. RESULTS Forty-nine women with eclampsia, 20 with preeclampsia and 10 normotensive women were included. Cerebral infarcts were identified in 34% of eclamptic, 5% of preeclamptic (risk difference (RD) 0.29; 95% confidence interval (CI) 0.06 to 0.52, p=0.012) and in no normotensive controls. Eclamptic women were more likely to have vasogenic cerebral edema compared to preeclamptic (80% vs 20%, RD 0.60; CI 0.34 to 0.85, p<.001) and normotensive women (RD 0.80; CI 0.47 to 1.00, p<.001). Diffusion was increased in eclampsia in the parietooccipital white matter (mean difference (MD) 0.02 x10-3 mm2/s, CI 0.00 to 0.05, p=0.045) and the caudate nucleus (MD 0.02 x10-3 mm2/s, CI 0.00 to 0.04, p=0.033) when compared to preeclamptic women. Diffusion was also increased in eclamptic women in the frontal (MD 0.07 x10-3 mm2/s, CI 0.02 to 0.12, p=0.012) and parietooccipital white matter (MD 0.05 x10-3 mm2/s, CI 0.02 to 0.07, p=0.03) and the caudate nucleus (MD 0.04 x10-3 mm2/s, CI 0.00 to 0.07, p=0.028) when compared to normotensive women. Perfusion was decreased in edematous regions. Hypoperfusion was present in the caudate nucleus in eclampsia (MD -0.17 x10-3 mm2/s, CI -0.27 to -0.06, p=0.003) when compared to preeclampsia. There were no signs of hyperperfusion. Vasospasm was present in 18% of eclamptic, 6% of preeclamptic and none of the controls. CONCLUSIONS Eclampsia is associated with cerebral infarcts, vasogenic cerebral edema, vasospasm and decreased perfusion, all not usually evident on standard clinical imaging. This may explain why some have cerebral symptoms and signs despite having normal conventional imaging.

中文翻译：

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子痫前期和子痫中的脑梗塞、水肿、灌注不足和血管痉挛。


背景 子痫是一种严重的妊娠并发症，与脑水肿和梗死有关，但潜在的病理生理学在很大程度上仍未得到探索。目的 使用测量弥散、灌注和血管痉挛的专用磁共振成像评估子痫的病理生理学。研究设计 这是一项横断面研究，于 2018 年 4 月至 2021 年 11 月期间在南非开普敦泰格堡医院连续招募孕妇。我们招募了患有子痫、子痫前期和血压正常的妊娠，她们在出生后接受了磁共振成像。主要结局指标是脑梗死、水肿和使用体素内不连贯运动成像的灌注以及使用磁共振成像血管造影的血管痉挛。成像方案是在纳入前建立的。结果 纳入 49 例子痫女性、20 例子痫前期女性和 10 例血压正常的女性。在 34% 的子痫患者中发现脑梗死，在 5% 的先兆子痫中发现 （风险差 （RD） 0.29;95% 置信区间 （CI） 0.06 至 0.52，p=0.012），并且在无血压正常的对照中。与子痫前期相比，子痫女性更容易发生血管源性脑水肿 （80% vs 20%，RD 0.60;CI 0.34 至 0.85，p<.001）和血压正常的女性 （RD 0.80;CI 0.47 至 1.00，p<.001）。与子痫前期妇女相比，子痫中顶枕叶白质 （平均差 （MD） 0.02 x10-3 mm2/s，CI 0.00 至 0.05，p = 0.045）和尾状核 （MD 0.02 x10-3 mm2/s，CI 0.00 至 0.04，p = 0.033） 的子痫弥散增加。子痫女性额叶 （MD 0.07 x10-3 mm2/s，CI 0.02 至 0.12，p=0.012） 和顶枕白质 （MD 0.05 x10-3 mm2/s，CI 0.02 至 0.07，p=0） 的弥散量也有所增加。03） 和尾状核 （MD 0.04 x10-3 mm2/s，CI 0.00 至 0.07，p=0.028） 与正常血压女性相比。水肿区域的灌注减少。与子痫前期相比，子痫尾状核中存在低灌注 （MD -0.17 x10-3 mm2/s，CI -0.27 至 -0.06，p=0.003）。没有过度灌注的迹象。血管痉挛见于 18% 的子痫药，6% 的先兆子痫药，无对照组。结论 子痫与脑梗死、血管源性脑水肿、血管痉挛和灌注减少有关，这些在标准临床影像学检查中通常不明显。这可能解释了为什么有些人尽管常规影像学检查正常，但仍会出现脑部症状和体征。