Cerebral edema complicating eclampsia

OBJECTIVE: This study was undertaken to describe and correlate clinical findings with computed tomographic and magnetic resonance imaging scan results in 10 women with eclampsia and widespread cerebral edema. STUDY DESIGN: This was a clinical descriptive study of 10 women with eclampsia and symptomatic cerebral edema who were encountered at Parkland Hospital from 1986 through 1998. During this 13-year period nearly 175 women had eclampsia from a total of >160,000 women delivered. The clinical courses of these 10 women with eclampsia and symptomatic cerebral edema are described, along with findings from computed tomographic and magnetic resonance imaging scans. RESULTS: In 3 cases symptoms followed an acute and severe elevation of blood pressure while the patient was being treated for eclampsia. All 3 of these women had severe generalized edema with radiographic findings of impending transtentorial herniation. Herniation did occur in 1 of these women, and she died. The other 7 women had central nervous system symptoms that persisted after an initial eclamptic convulsion. Symptoms ranged from lethargy, confusion, and blurred vision to obtundation and blindness. Five of these women had multiple areas of edema mostly apparent at the gray matter-white matter junction. Two women demonstrated extensive unilateral brain involvement; however, their symptoms were similar to those of the women with multifocal areas of cerebral edema. CONCLUSION: Symptomatic cerebral edema developed in almost 6% of women with eclampsia. Its genesis probably represents a continuum of central nervous system lesions that result from eclampsia. We postulate that women with symptoms of extensive cerebral edema have a cytotoxic edema caused by ischemia that is intensified by a vasogenic edema associated with sudden or severe hypertension.