Preeclampsia-eclampsia: Clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy

PURPOSE: To investigate the clinical parameters that are associated with th e development of brain edema of hypertensive encephalopathy in patients wit h preeclampsia-eclampsia. MATERIALS AND METHODS: Twenty-eight patients with preeclampsia-eclampsia an d neurologic symptoms underwent magnetic resonance (MR) imaging. Clinical p arameters recorded at the time of MR imaging included serum electrolytes an d various indices of hematologic, renal, and hepatic function. Several data were available 1 week prior to the development of neurologic symptoms in 1 1 patients. Univariate analysis and multivariate logistic regression analys es were performed to study possible associations between these parameters a nd brain edema at MR imaging. RESULTS: The 20 patients with brain edema at MR imaging had a significantly greater incidence of abnormal red blood cell morphology (14 [82%] of 17 pa tients vs two [25%] of eight, P < .005) and higher levels of lactic dehydro genase (LDH) (339 U/L +/- 65 [SD] vs 258 U/L +/- 65, P = .007) than the eig ht with normal MR imaging findings; multivariate logistic regression analys is showed a strong association with red blood cell morphology only. Moreove r, LDH levels were elevated before the development of neurologic abnormalit ies (P < .05). Blood pressures were not significantly different between gro ups at any time. CONCLUSION: Brain edema at MR imaging in patients with preeclampsia-eclamps ia was associated with abnormalities in endothelial damage markers and not with hypertension level.