THE DILEMMA OF THE UNUSUAL DISTRIBUTION OF MR ENCEPHALOPATHY IN PRE-ECLAMPTIC/ECLAMPTIC FEMALE PATIENTS : DETECTION AND PITFALLS

Abstract

To evaluate the MRI findings in pre-eclamptic/ eclamptic encephalopathy and to evaluate the usefulness of diffusion weighted MRI (DW-MRI) as an imaging tool and its prognostic implication in changing treatment protocol. Patients & methods: Prospective study included24 patients, diagnosed clinically as preeclampsia (14 cases) and eclampsia in (10 cases). Their ages ranged from 25 to 45 years with mean age of 35.6 years. They examined on a standard 1.5 Tesla MR unit. Initially conventional T2 and FLAIRimages were done followed by Diffusion weighted imaging . Results: All 24 patients were acutely hypertensive at presentation. All patients develop abnormal increased signal on T2 and FLAIR sequences predominantly involving the posterior circulation. 20 ofthese patients demonstrate increased SI on diffusion weighted images denoting vasogenic edema while only 4 patients showed corresponding low signal on DW-MRI (cytotoxic edema). Follow up study confirmed the resolution of the lesions (in 20 patients) successfully with reversible neurologic impairment while those 4 patients with cytotoxic edema pattern,they develop permanent T2 / FLAIR hyper intense signal and neurological impairment. Conclusion: Involvement of the parietal and occipital lobes is common in patients with eclampsia, and the signal abnormalities on MRI are reversible if recognized and treated early.DWI can correlates well with the patient's outcome, and should be performed in all eclamptic patients and that may affect greatly their management.