Multifocal cerebral hemorrhage in eclampsia and severe pre-eclampsia

Eclampsia and severe preeclampsia have often been associated with transient cortical blindness and with bilateral occipital CT hypodensities or increased T2-weighted signal abnormalities on MRI. Petechial hemorrhages have been reported pathologically and on MRI, but major hemorrhages have been infrequent. Symptoms and radiologic findings are usually reversible and the prognosis good. We reviewed the clinical and radiologic findings in four patients with eclampsia or severe pre-eclampsia who had multifocal cerebral hemorrhages found acutely on CT. Hemorrhages were usually bilateral and often in posterior areas. Two patients had hemorrhages discovered after earlier normal scans. One patient died, and others had prolonged neurologic residua including visuospatial and other cognitive deficits. The posterior CT and MRI abnormalities in eclampsia and severe pre-eclampsia are not always benign and reversible but may precede or include multifocal hemorrhages with long-term neurologic complications. The affected areas suggest an increased posterior circulation vulnerability to the hypertensive vascular disease of eclampsia.