Cerebral hemodynamics in preeclampsia and eclampsia

A. I. Qureshi, M. R. Frankel, J. R. Ottenlips and B. J. Stern
Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.

OBJECTIVE: To test further the hypothesis that preeclampsia and eclampsia are associated with cerebral vasospasm. DESIGN: Prospective case study. SETTING: Inpatient obstetrics service of an urban public hospital. PATIENTS AND METHODS: Eleven women with eclampsia (mean gestational age, 32 weeks), preeclampsia (mean gestational age, 36 weeks), or normotensive pregnancy (mean gestational age, 35 weeks). Middle cerebral artery (MCA) velocity was measured bilaterally in all patients by means of transcranial Doppler ultrasonography. RESULTS: Eclamptic patients (n = 3) had significantly higher mean flow velocities and lower average pulsatility indexes than did normotensive patients (n = 4) (average MCA-mean flow velocity, 165 vs 79 cm/s [P = .007]; average MCA pulsatility index, 0.51 vs 1.1 [P < .001]). Compared with normotensive pregnant women, preeclamptic patients (n = 4) had lower average pulsatility indexes (0.76, P = .003), but similar mean flow velocities (average MCA-mean flow velocity, 82 cm/s; P = .8). CONCLUSION: Significantly higher MCA velocities in eclamptic, but not preeclamptic, women compared with those in normotensive pregnant women suggests that moderate to severe vasospasm is associated with eclampsia.