Severe pre-eclamptic women with headache: is posterior rever
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A high incidence of posterior reversible encephalopathy syndrome (PRES) has been observed in women with eclampsia on imaging. However this association was documented mostly after convulsions occurred. This study aimed to detect the development of PRES using magnetic resonance imaging (MRI) in women with severe preeclampsia and headache, and evaluate the clinical and radiological findings in obstetric outcomes.

Patients were enrolled at a mean gestational age of 32?weeks (range 29–38?weeks). Of the 18 MRI scans, 15 (83%) revealed abnormal findings, the brain stem, and the cerebellum being affected. Two patients had abnormal susceptibility-weighted imaging (SWI) findings, indicating micro-hemorrhages. The majority (12 cases, 66%) of the patients had abnormal cortical hyperintensities in the occipital and temporal lobes. Only three patients had normal MRI pictures. None of the women had eclampsia occurred during the peripartum period, and only one unrelated neonatal death due to congenital anomalies.

This study revealed two significant findings.
-First, advanced neuroimaging techniques such as MRI indicated the changes in subcortical regions were comparable to those of PRES in most of patients (?80%) having severe pre-eclampsia combined with headache.

-Second, SWI could identify microhemorrhage in patients, and prompt management could prevent deterioration into eclampsia or stroke.

A high incidence of abnormal cortical hyperintensity changes at locations typical for PRES on MRI was noted in women with severe pre-eclampsia and headache. These early hypertensive neurological signs allowed prompt and efficient obstetrical management, to prevent the development of eclampsia and PRES.
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