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24: Cerebral white matter lesions in formerly (pre)-eclamptic women

      Objective

      The pathophysiologic mechanisms of the neurologic disturbances in (pre)-eclampsia are poorly understood. Particularly elusive is the association of hypertension with grand mal seizures and brain lesions characterized histopathologically by (sub)cortical edema, petechial hemorrhages and infarctions. This is made even more enigmatic because eclamptic women generally appear to have full clinical recovery. Previously we have shown that six weeks post partum approximately 25% of eclamptic women show persistent cerebral white matter lesions (WML) on MRI. The aim of the present study was to refute or confirm the persistence of such cerebral WML in the long term.

      Study design

      39 formerly eclamptic, 35 formerly preeclamptic and 31 normotensive parous women were matched for age and elapsed time since the index pregnancy. (Pre)-eclampsia was defined according to international standards. Participants underwent T1, Proton Density, Flair and T2-weighted MRI scans (3 Tesla). The scans were rated for presence of WML by a radiologist blinded for patient category. Presence of WML was tested with Chi-square, alpha was set at 0.05.

      Results

      Significantly more women in the formerly (pre)-eclamptic group demonstrated subcortical WML compared to the control group (35% vs. 19%, P<0.001). Average age in the control group was similar to formerly (pre)-eclamptic women (38±7 vs. 39±6 years, respectively, P=0.64). Elapsed time since the index pregnancy was also similar in both groups (5.4±4.2 control vs. 6.8±4.5 (pre)-eclampsia, P=0.12).

      Conclusion

      Several years after a pregnancy complicated by (pre)-eclampsia almost twice as many women show WML on MRI compared to women with a normotensive pregnancy. It is thought that the neurological disturbances in (pre)-eclampsia represent a form of Posterior Reversible Encephalopathy Syndrome. However, this entity seems a misnomer since such lesions are not necessarily reversible. The current belief that the neurological disturbances in (pre)-eclampsia represent a one-time event should be revised. Long-term clinical consequences need to be determined.