Impaired Hearing and Systolic Blood Pressure as Potential Markers of Cerebral Infarction After Eclampsia: A...

Eclampsia is associated with short- and long-term neurological deficits. Identifying which women may be at risk is important. Magnetic resonance imaging shows an incidence of 30%-40% of subclinical cerebral infarcts among women with eclampsia. A simple screening tool would be useful to identify at-risk women. The objective of this study was to explore clinical markers to identify women at highest risk for silent cerebral infarcts in women who have experienced eclampsia.

This was a prospective observational study with cross-sectional MRI ascertainment conducted at Tygerberg Hospital, a tertiary referral centre in Cape Town, South Africa. Women were prospectively assessed for symptoms and signs known to be associated with eclampsia. Cerebral infarcts were identified using brain magnetic resonance imaging. Associations between clinical variables and the presence of cerebral infarcts were evaluated using logistic regression, with variables significant at the 20% level considered for inclusion in multivariable analyses using stepwise selection.

A total of 49 women with eclampsia were included in the analysis, of whom 33% (n = 16) had cerebral infarcts detected on MRI. Highest systolic blood pressure and impaired hearing prior to the eclamptic seizure were the clinical variables most strongly associated with the presence of silent cerebral infarcts, with an area under the receiver operating characteristic curve of 0.72 (95% CI 0.56-0.88). At a risk threshold of 43%, sensitivity was 60% (95% CI 36%-80%) and specificity was 84% (95% CI 67%-93%).

Higher systolic blood pressure and impaired hearing were the clinical features most strongly associated with silent cerebral infarcts in women with eclampsia. These findings highlight potentially useful clinical markers that, following external validation, may support triage decisions regarding neuroimaging and neurological follow up.