Cranial imaging spectrum in hypertensive disease of pregnancy

To determine cranial imaging findings in patients with severe preeclampsia, eclampsia and HELLP syndrome and the correlation between these findings and neurological symptoms.

CT or MRI findings of 120 patients diagnosed with severe preeclampsia, eclampsia and/or HELLP syndrome between January 1998 and December 2005 are presented.

Pathological imaging findings were observed in 28.1% (n = 32) of the severe preeclampsia group, in 43.3% (n = 30) of the HELLP group, in 51.35% (n = 27) of the eclampsia group and in 61.9% (n = 21) of the eclampsia + HELLP group and in 45% of all patients. Thirty-five patients had specific pathology defined as ischemic lesions, edema, and perivascular microhemorrhage. Infarcts were found in seven, intracranial hemorrhage in seven, hydrocephaly in two, dural sinus thrombosis in two and a pineal cyst in one patient. Specific lesions were generally located in the posterior parietal and occipital lobes. Five patients died due to intracranial hemorrhage and one patient due to septic shock.

A wide imaging spectrum from the ischemic lesion to severe intracranial hemorrhage can be detected in complicated cases of hypertensive diseases of pregnancy. It is essential to perform cranial imaging in patients with symptoms and neurological deficits.