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Objective To define more clearly the neuropathophysiology of eclampsia utilising single-photon emission computed tomography (SPECT), cerebral computerised tomography (CT) and transcranial Doppler (TCD) ultrasonography. Design A prospective studySetting The obstetric unit in King Edward VIII Hospital, a large tertiary referral centre in Kwa-Zulu Natal, South Africa.Participants Sixty-five women with eclampsia.Interventions Imaging and ultrasonographic investigations were performed within 48 hours postpartum. Unenhanced cerebral CT scans were performed in all the women and SPECT scans were performed on 63 women using Technetium-99m-hexamethylpropyleneamineoxime (99mTc-J3MPAO) as a tracer of regional cerebral blood flow. Middle cerebral artery blood flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach.Main outcome measures Abnormalities in SPECT scan, CT scan and TCD ultrasound findings.Results SPECT scanning revealed perfusion deficits in the watershed areas in all women, 75% of whom had concomitant deficits in the parieto-occipital areas of the brain. Hypodensities (cerebral oedema) were reported in 38 CT scans (58-5%), with parieto-occipital involvement in 97.4% of cases. Increased flow velocity measurements in the middle and posterior cerebral arteries were recorded in 36 (85.7%) women in whom TCD ultrasound was performed. Conclusion The pathophysiological mechanism of eclamptic seizures is primary cerebral vasospasm with resultant ischaemia and cerebral oedema involving mainly the watershed areas and parietooccipital lobes of the brain. SPECT scanning has been shown to be superior to CT scanning and TCD ultrasonography in detecting neuropathophysiologic alterations in eclampsia. However, each of the three investigative tools provide its own unique information and all three are necessary research techniques to improve our understanding of the neuropathophysiological mechanism of eclamptic seizures.

A prospective study of 70 patients with life-threatening hemoptysis who had bronchial and systemic artery embolization with tris-acryl linked microspheres was performed over 15 months. The procedure was technically successful in 90% of patients and at 24 hr after the procedure (87%). Recurrent hemoptysis occurred in 13% of patients within the first week. Chest pain was experienced following embolization in 7% of patients. The mortality was 10% due to the inclusion of patients with pulmonary metastases. Bronchial artery embolization using microspheres is an effective and well-tolerated treatment for patients with life-threatening hemoptysis who are not surgical candidates.