OS026. Study of neuroradiological and biochemical abnormalities in 100 women with preeclampsia-eclapmsia.

INTRODUCTION: The posterior reversible encephalopathy syndrome-PRES is recognised as the neuro radiologic abnormality in Eclampsia and with prompt treatment and delivery is usually reversible.

OBJECTIVES: To study neuro radiological and biochemical abnormalities in severe preeclampsia and eclampsia and their reversibility following delivery.

METHODS: 100 Women with severe pre-eclampsia and eclampsia admitted to High risk unit at Gandhi Hospital, Secunderabad were studied between September 2008 and September 2010. Preeclamptic women who presented with complications of pre eclampsia were included. Patients with convulsions in the absence of proteinuria and hypertension such as epileptics and other central nervous disorders and known intracranial pathology were excluded . All the women were investigated for laboratory parameters such as renal function tests, platelet counts, liver function tests, coagulation profile, fundoscopy, in antepartum period and abnormal results were re-evaluated one week after delivery and in cases with persistent abnormal results at one week postpartum were again evaluated at the end of two weeks. Fifty women with eclampsia among the study group underwent MR imaging of brain before delivery and thirty of these women who showed PRES underwent MR imaging postpartum. The different types images used are (i) T1 weighted image (ii) T2 weighted image - highly sensitive (iii) Flair image (iv) Diffusion Weighted image (DW) with Apparent Diffusion Co-efficient (ADC). MRI studies were performed in axial, coronal and sagittal axes in varying thickness of 5-10mm. The machine used was 1.5 Tesla Aves Siemens. The biochemical parameters and results of neuro imaging were studied antepartum and postpartum.

RESULTS: Thirty six out of 50 women showed abnormal MRI findings. In 30 women (83%) findings were consistent with PRES. 3 cases (8%) showed infarction, 1 case showed CSVT , 1 cerebral hemorrhage and 1 showed glioma undiagnosed in antenatal period . Out of 30 cases of PRES, 18(77%) cases showed reversal within 1 week postpartum, and 9(33%) cases within 2 weeks postpartum. 80-90% of the abnormal laboratory parameters reversed to normal within 1 week post partum. Abnormal persistent parameters reversed to normal in all cases at the end of 2 weeks.

CONCLUSION: Posterior Reversible Encephalopathy Syndrome (PRES) is a new clinico radiological entity resulting from vasogenic edema in almost all cases of eclampsia but rare with preeclampsia. In fact eclampsia may be considered as clinical manifestation of PRES. Though MRI brain is a valuable diagnostic tool in evaluation of eclampsia it is expensive, and less available. Repeat MRI investigations may not be necessary, as almost all cases of PRES are reversible. MRI brain in cases of eclampsia also help to identify rare pathologies in the brain other than PRES, wrongly attributed to eclampsia Though preeclampsia and eclampsia are reversible, duration required for reversal is 1-2week period, during which period pathology is resolving but not recovered completely and complications can still occur. Hence, close observation is required in the first 1-2week postpartum.