The neurologic consequences of eclampsia

Toxemia of pregnancy (preeclampsia/eclampsia) is a syndrome characterized by pregnancy-induced hypertension, edema, and proteinuria, although it is often associated with more generalized multisystem abnormalities that affect the nervous system, the liver, kidneys, and coagulation. For the most part, preeclampsia/eclampsia is a reversible process that almost always improves after delivery of the baby. Despite recent advances in diagnosis and management, eclampsia remains the second most common cause of maternal death in the United States. Because of the often severe repercussions on the nervous system, neurologists can make important contributions to the management of patients with eclampsia. Although preeclampsia is largely under the purview of obstetrics, neurologists can provide input to the management of intracranial vascular problems, seizures, and raised intracranial pressure. Input on the severity and nature of neurologic problems will enable the obstetrician to determine whether to expedite or to delay child birth.

There is an increasing body of evidence on the associated endothelial dysfunction, breakdown of the blood-brain barrier, and failure of cerebrovascular autoregulation with vasospasm, ischemia, and cerebral edema. Therapy is directed at controlling blood pressure, giving magnesium sulfate to treat the preeclamptic/eclamptic process itself, and instituting antiseizure medicines (e.g., diazepam or phenytoin) when uncontrolled seizures or status epilepticus supervene.

Cerebrovascular accidents occur more frequently in young women during pregnancy and the puerperium, and there is an unmet need for basic and clinical research directed at the pathophysiology of the eclamptic process so as to provide more directed therapy.