Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Cerebral Hemodynamics in Preeclampsia and Eclampsia

Cerebral Hemodynamics in Preeclampsia and Eclampsia Abstract Objective: To test further the hypothesis that preeclampsia and eclampsia are associated with cerebral vasospasm. Design: Prospective case study. Setting: Inpatient obstetrics service of an urban public hospital. Patients and Methods: Eleven women with eclampsia (mean gestational age, 32 weeks), preeclampsia (meangestational age, 36 weeds), or normotensive pregnancy (mean gestational age, 35 weeks). Middle cerebral artery (MCA) velocity was measured bilaterally in all patients by means of transcranial Doppler ultrasonography. Results: Eclamptic patients (n=3) had significantly higher mean flow velocities and lower average pulsatility indexes than did normotensive patients (n=4) (average MCA-mean flow velocity, 165 vs 79 cm/s [P=.007]; average MCA pulsatility index, 0.51 vs 1.1 [P<.001]). Compared with normotensive pregnant women, preeclamptic patients (n=4) had lower average pulsatility indexes (0.76, P=.003), but similar mean flow velocities (average MCA—mean flow velocity, 82 cm/s; P=.8). Conclusion: Significantly higher MCA velocities in eclamptic, but not preeclamptic, women compared with those in normotensive pregnant women suggests that moderate to severe vasospasm is associated with eclampsia. References 1. Royburt M, Seidman DS, Serr DM, Mashiach S. Neurologic involvement in hypertensive disease of pregnancy . Obstet Gynecol Surv . 1991;46:656-664.Crossref 2. Usta IM, Sibai BM. Emergent management of puerperal eclampsia . Obstet Gynecol Clin North Am . 1995;22:315-335. 3. Sibai BM, McCubbin JH, Anderson GD, Lipshitz J, Dilts PV Jr. Eclampsia, I: observations from 67 recent cases . Obstet Gynecol . 1981;58:609-613. 4. Cunningham FG, Fernandez CO, Hernandez C. Blindness associated with preeclampsia and eclampsia . Am J Obstet Gynecol . 1995;172:1291-1298.Crossref 5. Glaser GH. Neurologic complications of internal diseases . In: Baker AB, Baker LH, ed. Clinical Neurology . New York, NY: Harper & Row Publishers Inc; 1977; 3:11-12. 6. Wiebers DO. Ischemic cerebrovascular complications of pregnancy . Arch Neurol . 1985;42:1106-1113.Crossref 7. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome . N Engl J Med . 1996;334:494-500.Crossref 8. Sibai BM, Schneider JM, Morrison JC, et al. The late postpartum eclampsia controversy . Obstet Gynecol . 1980;55:74-78. 9. Will AD, Lewis KL, Hinshaw DB, et al. Cerebral vasoconstriction in toxemia . Neurology . 1987;37:1555-1557.Crossref 10. Trommer BL, Homer D, Mikhael MA. Cerebral vasospasm and eclampsia . Stroke . 1988;19:326-329.Crossref 11. Bogousslavsky J, Despland PA, Regli F, Dubuis PY. Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds . Eur Neurol . 1989;29:102-105.Crossref 12. Williams K, McLean C. Maternal cerebral vasospasm in eclampsia assessed by transcranial Doppler . Am J Perinatol . 1993;10:243-244. 13. Kanayama N, Nakajima A, Maehara K, et al. Magnetic resonance imaging angiography in a case of eclampsia . Gynecol Obstet Invest . 1993;36:56-58.Crossref 14. Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited . Ann Neurol . 1993;33:222-225.Crossref 15. Ito T, Sakai T, Inagawa S, Utsu M, Bun T. MR angiography of cerebral vasospasm in preeclampsia . AJNR Am J Neuroradiol . 1995;16:1344-1346. 16. Lindheimer MD, Katz Al. Pathophysiology of preeclampsia . Annu Rev Med . 1981;32:273-289.Crossref 17. Steinmeier R, Laumer R, Bondar I, Priem R, Fahlbusch R. Cerebral hemodynamics in subarachnoid hemorrhage evaluated by transcranial Doppler sonography, II: pulsatility indices: normal reference values and characteristics in subarachnoid hemorrhage . Neurosurgery . 1993;33:10-18.Crossref 18. Sloan MA, Haley EC Jr, Kassell NF, et al. Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage . Neurology . 1989;39:1514-1518.Crossref 19. Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound . Proc R Soc Med . 1974;67:447-449. 20. Arnolds BJ, von Reutern GM. Transcranial Doppler sonography: examination technique and normal reference values . Ultrasound Med Biol . 1986;12:115-123.Crossref 21. Adams RJ, Nichols FT, Hess DC. Normal values and physiological variables . In: Newell DW, Aaslid R, eds. Transcranial Doppler . New York, NY: Raven Press; 1992:41-48. 22. Gant NF, Worley RJ, Everett RB, MacDonald PC. Control of vascular responsiveness during human pregnancy . Kidney Int . 1980;18:253-258.Crossref 23. Bauer TW, Moore GW, Hutchins GM. Morphologic evidence for coronary artery spasm in eclampsia . Circulation . 1982;65:255-259.Crossref 24. Oney T, Kaulhausen H. The value of the angiotensin sensitivity test in the early diagnosis of hypertensive disorders in pregnancy . Am J Obstet Gynecol . 1982; 142:17-20. 25. Pipkin FB, Hunter JC, Turner SR, O'Brien PM. Prostaglandin E2 attenuates the pressor response to angiotensin II in pregnant subjects but not in nonpregnant subjects . Am J Obstet Gynecol . 1982;142:168-176. 26. Zammit VC, Whitworth JA, Brown MA. Endothelium-derived prostacyclin: effect of serum from women with normal and hypertensive pregnancy . Clin Sci (Colch) . 1992;82:383-388. 27. Zahradnik HP, Schafer W, Wetzka B, Beckwoldt M. Hypertensive disorders in pregnancy: the role of eicosanoids . Eicosanoids . 1991;4:123-136. 28. MacKenzie ET, Strandgaard S, Graham DI, Jones JV, Harper AM, Farrar JK. Effects of acutely induced hypertension in cats on pial arteriolar caliber, local cerebral blood flow, and the blood-brain barrier . Circ Res . 1976;39:33-41.Crossref 29. Byrom FB. The calibre of the cerebral arteries in experimental hypertension . Proc R Soc Med . 1968;61:605-606. 30. Armstrong FS, Hayes GJ. Segmental cerebral arterial constriction associated with pheochromocytoma . J Neurosurg . 1961;18:643-646.Crossref 31. Konzen JP, Levine SR, Garcia JH. Vasospasm and thrombus formation as possible mechanisms of stroke related to alkaloidal cocaine . Stroke . 1995;26:1114-1118.Crossref 32. Levine SR, Washington JM, Jefferson MF, et al. 'Crack' cocaine associated stroke . Neurology . 1987;37:1849-1853.Crossref 33. Donaldson JO. Eclampsia . Adv Neurol . 1994;64:25-33. 34. Dahmus MA, Barton JR, Sibai BM. Cerebral imaging in eclampsia: magnetic resonance imaging versus computed tomography . Am J Obstet Gynecol . 1992; 167:935-941.Crossref 35. Crawford S, Varner MW, Digre KB, Servais G, Corbett JJ. Cranial magnetic resonance imaging in eclampsia . Obstet Gynecol . 1987;70:474-477. 36. Brown CE, Purdy P, Cunningham FG. Head computed tomographic scans in women with eclampsia . Am J Obstet Gynecol . 1985;159:915-920.Crossref 37. Digre KB, Varner MW, Osborn AG, Crawford S. Cranial magnetic resonance imaging in severe preeclampsia vs eclampsia . Arch Neurol . 1993;50:399-406.Crossref 38. Schwaighofer BW, Hesselink JR, Healy ME. MR demonstration of reversible brain abnormalities in eclampsia . J Comput Assist Tomogr . 1989;13:310-312.Crossref 39. Duncan R, Hadley D, Bone I, Symonds EM, Worthington BS, Rubin PC. Blindness in eclampsia: CT and MR imaging . J Neurol Neurosurg Psychiatry . 1989; 52:899-902.Crossref 40. Edvinsson L, Owman C, Sjoberg N-O. Autonomic nerves, mast cells, and amine receptors in human brain vessels: a histochemical and pharmacologic study . Brain Res . 1976;115:377-393.Crossref 41. Schwartz RB, Jones KM, Kalina P, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases . AJR Am J Roentgenol . 1992;159:379-383.Crossref 42. Dorsch NW. Cerebral arterial spasm—a clinical review . Br J Neurosurg . 1995; 9:403-412.Crossref 43. Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulphate with phenytoin for the prevention of eclampsia . N Engl J Med . 1995;333:201-205.Crossref 44. Pritchard JA, Pritchard SA. Standardized treatment of 154 consecutive cases of eclampsia . Am J Obstet Gynecol . 1975;123:543-552. 45. Zaret GM. Possible treatment of pre-eclampsia with calcium channel blocking agents . Med Hypotheses . 1983;12:303-319.Crossref 46. Kemp PA, Gardiner SM, Bennett T, Rubin PC. Magnesium sulphate reverses the carotid vasoconstriction caused by endothelin-I, angiotensin II and neuropeptide-Y, but not that caused by NG-nitro-L-arginine methyl ester, in conscious rats . Clin Sci (Colch) . 1993;85:175-181. 47. Belfort MA. The effect of magnesium sulphate on blood flow in the maternal retina in mild pre-eclampsia: a preliminary colour flow Doppler study . Br J Obstet Gynaecol . 1992;99:641-645.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Cerebral Hemodynamics in Preeclampsia and Eclampsia

Loading next page...
 
/lp/american-medical-association/cerebral-hemodynamics-in-preeclampsia-and-eclampsia-myZMzywlg6
Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1996.00550120034013
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To test further the hypothesis that preeclampsia and eclampsia are associated with cerebral vasospasm. Design: Prospective case study. Setting: Inpatient obstetrics service of an urban public hospital. Patients and Methods: Eleven women with eclampsia (mean gestational age, 32 weeks), preeclampsia (meangestational age, 36 weeds), or normotensive pregnancy (mean gestational age, 35 weeks). Middle cerebral artery (MCA) velocity was measured bilaterally in all patients by means of transcranial Doppler ultrasonography. Results: Eclamptic patients (n=3) had significantly higher mean flow velocities and lower average pulsatility indexes than did normotensive patients (n=4) (average MCA-mean flow velocity, 165 vs 79 cm/s [P=.007]; average MCA pulsatility index, 0.51 vs 1.1 [P<.001]). Compared with normotensive pregnant women, preeclamptic patients (n=4) had lower average pulsatility indexes (0.76, P=.003), but similar mean flow velocities (average MCA—mean flow velocity, 82 cm/s; P=.8). Conclusion: Significantly higher MCA velocities in eclamptic, but not preeclamptic, women compared with those in normotensive pregnant women suggests that moderate to severe vasospasm is associated with eclampsia. References 1. Royburt M, Seidman DS, Serr DM, Mashiach S. Neurologic involvement in hypertensive disease of pregnancy . Obstet Gynecol Surv . 1991;46:656-664.Crossref 2. Usta IM, Sibai BM. Emergent management of puerperal eclampsia . Obstet Gynecol Clin North Am . 1995;22:315-335. 3. Sibai BM, McCubbin JH, Anderson GD, Lipshitz J, Dilts PV Jr. Eclampsia, I: observations from 67 recent cases . Obstet Gynecol . 1981;58:609-613. 4. Cunningham FG, Fernandez CO, Hernandez C. Blindness associated with preeclampsia and eclampsia . Am J Obstet Gynecol . 1995;172:1291-1298.Crossref 5. Glaser GH. Neurologic complications of internal diseases . In: Baker AB, Baker LH, ed. Clinical Neurology . New York, NY: Harper & Row Publishers Inc; 1977; 3:11-12. 6. Wiebers DO. Ischemic cerebrovascular complications of pregnancy . Arch Neurol . 1985;42:1106-1113.Crossref 7. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome . N Engl J Med . 1996;334:494-500.Crossref 8. Sibai BM, Schneider JM, Morrison JC, et al. The late postpartum eclampsia controversy . Obstet Gynecol . 1980;55:74-78. 9. Will AD, Lewis KL, Hinshaw DB, et al. Cerebral vasoconstriction in toxemia . Neurology . 1987;37:1555-1557.Crossref 10. Trommer BL, Homer D, Mikhael MA. Cerebral vasospasm and eclampsia . Stroke . 1988;19:326-329.Crossref 11. Bogousslavsky J, Despland PA, Regli F, Dubuis PY. Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds . Eur Neurol . 1989;29:102-105.Crossref 12. Williams K, McLean C. Maternal cerebral vasospasm in eclampsia assessed by transcranial Doppler . Am J Perinatol . 1993;10:243-244. 13. Kanayama N, Nakajima A, Maehara K, et al. Magnetic resonance imaging angiography in a case of eclampsia . Gynecol Obstet Invest . 1993;36:56-58.Crossref 14. Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited . Ann Neurol . 1993;33:222-225.Crossref 15. Ito T, Sakai T, Inagawa S, Utsu M, Bun T. MR angiography of cerebral vasospasm in preeclampsia . AJNR Am J Neuroradiol . 1995;16:1344-1346. 16. Lindheimer MD, Katz Al. Pathophysiology of preeclampsia . Annu Rev Med . 1981;32:273-289.Crossref 17. Steinmeier R, Laumer R, Bondar I, Priem R, Fahlbusch R. Cerebral hemodynamics in subarachnoid hemorrhage evaluated by transcranial Doppler sonography, II: pulsatility indices: normal reference values and characteristics in subarachnoid hemorrhage . Neurosurgery . 1993;33:10-18.Crossref 18. Sloan MA, Haley EC Jr, Kassell NF, et al. Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage . Neurology . 1989;39:1514-1518.Crossref 19. Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound . Proc R Soc Med . 1974;67:447-449. 20. Arnolds BJ, von Reutern GM. Transcranial Doppler sonography: examination technique and normal reference values . Ultrasound Med Biol . 1986;12:115-123.Crossref 21. Adams RJ, Nichols FT, Hess DC. Normal values and physiological variables . In: Newell DW, Aaslid R, eds. Transcranial Doppler . New York, NY: Raven Press; 1992:41-48. 22. Gant NF, Worley RJ, Everett RB, MacDonald PC. Control of vascular responsiveness during human pregnancy . Kidney Int . 1980;18:253-258.Crossref 23. Bauer TW, Moore GW, Hutchins GM. Morphologic evidence for coronary artery spasm in eclampsia . Circulation . 1982;65:255-259.Crossref 24. Oney T, Kaulhausen H. The value of the angiotensin sensitivity test in the early diagnosis of hypertensive disorders in pregnancy . Am J Obstet Gynecol . 1982; 142:17-20. 25. Pipkin FB, Hunter JC, Turner SR, O'Brien PM. Prostaglandin E2 attenuates the pressor response to angiotensin II in pregnant subjects but not in nonpregnant subjects . Am J Obstet Gynecol . 1982;142:168-176. 26. Zammit VC, Whitworth JA, Brown MA. Endothelium-derived prostacyclin: effect of serum from women with normal and hypertensive pregnancy . Clin Sci (Colch) . 1992;82:383-388. 27. Zahradnik HP, Schafer W, Wetzka B, Beckwoldt M. Hypertensive disorders in pregnancy: the role of eicosanoids . Eicosanoids . 1991;4:123-136. 28. MacKenzie ET, Strandgaard S, Graham DI, Jones JV, Harper AM, Farrar JK. Effects of acutely induced hypertension in cats on pial arteriolar caliber, local cerebral blood flow, and the blood-brain barrier . Circ Res . 1976;39:33-41.Crossref 29. Byrom FB. The calibre of the cerebral arteries in experimental hypertension . Proc R Soc Med . 1968;61:605-606. 30. Armstrong FS, Hayes GJ. Segmental cerebral arterial constriction associated with pheochromocytoma . J Neurosurg . 1961;18:643-646.Crossref 31. Konzen JP, Levine SR, Garcia JH. Vasospasm and thrombus formation as possible mechanisms of stroke related to alkaloidal cocaine . Stroke . 1995;26:1114-1118.Crossref 32. Levine SR, Washington JM, Jefferson MF, et al. 'Crack' cocaine associated stroke . Neurology . 1987;37:1849-1853.Crossref 33. Donaldson JO. Eclampsia . Adv Neurol . 1994;64:25-33. 34. Dahmus MA, Barton JR, Sibai BM. Cerebral imaging in eclampsia: magnetic resonance imaging versus computed tomography . Am J Obstet Gynecol . 1992; 167:935-941.Crossref 35. Crawford S, Varner MW, Digre KB, Servais G, Corbett JJ. Cranial magnetic resonance imaging in eclampsia . Obstet Gynecol . 1987;70:474-477. 36. Brown CE, Purdy P, Cunningham FG. Head computed tomographic scans in women with eclampsia . Am J Obstet Gynecol . 1985;159:915-920.Crossref 37. Digre KB, Varner MW, Osborn AG, Crawford S. Cranial magnetic resonance imaging in severe preeclampsia vs eclampsia . Arch Neurol . 1993;50:399-406.Crossref 38. Schwaighofer BW, Hesselink JR, Healy ME. MR demonstration of reversible brain abnormalities in eclampsia . J Comput Assist Tomogr . 1989;13:310-312.Crossref 39. Duncan R, Hadley D, Bone I, Symonds EM, Worthington BS, Rubin PC. Blindness in eclampsia: CT and MR imaging . J Neurol Neurosurg Psychiatry . 1989; 52:899-902.Crossref 40. Edvinsson L, Owman C, Sjoberg N-O. Autonomic nerves, mast cells, and amine receptors in human brain vessels: a histochemical and pharmacologic study . Brain Res . 1976;115:377-393.Crossref 41. Schwartz RB, Jones KM, Kalina P, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases . AJR Am J Roentgenol . 1992;159:379-383.Crossref 42. Dorsch NW. Cerebral arterial spasm—a clinical review . Br J Neurosurg . 1995; 9:403-412.Crossref 43. Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulphate with phenytoin for the prevention of eclampsia . N Engl J Med . 1995;333:201-205.Crossref 44. Pritchard JA, Pritchard SA. Standardized treatment of 154 consecutive cases of eclampsia . Am J Obstet Gynecol . 1975;123:543-552. 45. Zaret GM. Possible treatment of pre-eclampsia with calcium channel blocking agents . Med Hypotheses . 1983;12:303-319.Crossref 46. Kemp PA, Gardiner SM, Bennett T, Rubin PC. Magnesium sulphate reverses the carotid vasoconstriction caused by endothelin-I, angiotensin II and neuropeptide-Y, but not that caused by NG-nitro-L-arginine methyl ester, in conscious rats . Clin Sci (Colch) . 1993;85:175-181. 47. Belfort MA. The effect of magnesium sulphate on blood flow in the maternal retina in mild pre-eclampsia: a preliminary colour flow Doppler study . Br J Obstet Gynaecol . 1992;99:641-645.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Dec 1, 1996

References