Posterior reversible encephalopathy syndrome and eclampsia: Pressing the case for more aggressive blood pressure control

Steven J. Wagner, Letitia A. Acquah, E. Paul Lindell, Iasmina M. Craici, Majken T. Wingo, Carl H. Rose, Wendy M. White, Phyllis August, Vesna D Garovic

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Abstract

OBJECTIVE: To assess the prevalence, clinical presentations, and neuroimaging abnormalities in a series of patients treated for eclampsia at Mayo Clinic in Rochester, MN. PATIENTS AND METHODS: We reviewed the records of all pregnant patients diagnosed as having eclampsia at Mayo Clinic in Rochester, MN, between January 1, 2001, and December 31, 2008. All patients who underwent neuroimaging were identified, and all studies were reviewed by an independent neuroradiologist. Comparisons were made between groups who did and did not undergo imaging to identify differentiating clinical or laboratory variables. RESULTS: Thirteen cases of eclampsia were found, with neuroimaging studies available for 7: magnetic resonance imaging (n=6) and computed tomography (n=1). All 7 patients developed eclamptic seizures, and 2 of 7 patients had severe hypertension, with recorded systolic blood pressures exceeding 180 mm Hg. Neuroimaging showed characteristic changes of posterior reversible encephalopathy syndrome (PRES) in all patients. Follow-up imaging showed resolution in 2 of 3 patients; 1 patient had residual neuroimaging abnormalities. CONCLUSION: Our results suggest that the clinical syndrome of eclampsia is associated with an anatomical substrate that is recognizable by neuroimaging as PRES. The levels of blood pressure elevation are lower than those reported in cases of PRES because of hypertensive encephalopathy. Further studies are needed to determine whether more aggressive blood pressure control and early neuroimaging may have a role in the management of these patients.

Original languageEnglish (US)
Pages (from-to)851-856
Number of pages6
JournalMayo Clinic Proceedings
Volume86
Issue number9
DOIs
StatePublished - 2011

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Posterior Leukoencephalopathy Syndrome
Eclampsia
Neuroimaging
Blood Pressure
Hypertensive Encephalopathy
Seizures
Tomography
Magnetic Resonance Imaging
Hypertension

ASJC Scopus subject areas

  • Medicine(all)

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Posterior reversible encephalopathy syndrome and eclampsia : Pressing the case for more aggressive blood pressure control. / Wagner, Steven J.; Acquah, Letitia A.; Lindell, E. Paul; Craici, Iasmina M.; Wingo, Majken T.; Rose, Carl H.; White, Wendy M.; August, Phyllis; Garovic, Vesna D.

In: Mayo Clinic Proceedings, Vol. 86, No. 9, 2011, p. 851-856.

Research output: Contribution to journalArticle

Wagner, SJ, Acquah, LA, Lindell, EP, Craici, IM, Wingo, MT, Rose, CH, White, WM, August, P & Garovic, VD 2011, 'Posterior reversible encephalopathy syndrome and eclampsia: Pressing the case for more aggressive blood pressure control', Mayo Clinic Proceedings, vol. 86, no. 9, pp. 851-856. https://doi.org/10.4065/mcp.2011.0090
Wagner, Steven J. ; Acquah, Letitia A. ; Lindell, E. Paul ; Craici, Iasmina M. ; Wingo, Majken T. ; Rose, Carl H. ; White, Wendy M. ; August, Phyllis ; Garovic, Vesna D. / Posterior reversible encephalopathy syndrome and eclampsia : Pressing the case for more aggressive blood pressure control. In: Mayo Clinic Proceedings. 2011 ; Vol. 86, No. 9. pp. 851-856.
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