Impaired Cerebral Glucose Metabolism in Eclampsia: A New Finding in Two Cases

Abstract

The pathophysiology of the reversible neurological manifestation in eclamptic women remains unclear. We report on 2 women with eclampsia who were repetitively examined by (1) transcranial Doppler (TCD), (2) magnetic resonance imaging (MRI) including T1- and T2-weighted images, fluid attenuated inversion recovery sequence, dynamic susceptibility-weighted perfusion imaging and magnetic resonance angiography (MRA), and (3) ¹⁸fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET). In both cases repetitive TCD revealed no signs of vasospasm; the same was true for MRA. MRI perfusion imaging showed completely homogenous cerebral blood flow in both cases. In the initial phase T2-weighted images revealed hyperintensities in both patients (predominantly bilateral frontal and parietal in 1 and in the temporo-occipital subcortex and the basal ganglia in the other). FDG-PET showed inhomogeneous glucose metabolism (GM) in both patients. Primary increased glucose utilization in the hyperintense T2-weighted areas as well as an attenuated GM parieto-occipital were observed in the 1st case; a high GM was found bilaterally in the basal ganglia and an attenuated one in the occipital cortex in the 2nd. In both cases MRI, and FDG-PET normalized within 3 weeks. These case reports document an altered cerebral GM in the presence of homogenous perfusion in eclamptic women. The high GM may be explained by a decoupling of cerebral perfusion and GM, possibly indicating an increased neuronal activity. The attenuation of the GM is most probably due to a deafferentation of cortical neurons.

Cerebral Blood Flow Regulation in Pregnancy, Hypertension, and Hypertensive Disorders of Pregnancy

“…Other studies have shown that compared to patients with severe preeclampsia, patients with eclampsia had increased CBF velocities and further increases in CBF velocities in the post-seizure phase [44]. Another study of two eclampsia cases found no sign of cerebral vasospasm but increased cerebral glucose metabolism suggesting increased neuronal activity in eclampsia patients [45]. Taken together, these studies demonstrate that in majority of cases, CBF velocities increase in eclampsia patients.…”

Pathophysiology of Preeclampsia-Induced Vascular Dysfunction and Implications for Subclinical Myocardial Damage and Heart Failure

“…Cerebral and visual symptoms (eg, seizures) are hallmarks of eclampsia, occurring in ∼1% of pregnancies. 44 With eclampsia, cerebral blood flow velocities increase 45 with reduced cerebral blood flow when compared to normotensive women. 46 In preeclampsia, higher velocities against the thin walls of cerebral vessels increase susceptibility to micro-bleeds and potentially cerebral edema.…”

Zerebrale Perfusionsbildgebung mittels Mehrschichtspiral-CT

“…Wenngleich diese Technik neue Einblicke in die Pathophysiologie einer Vielzahl neurologischer Krankeitsbilder einschließlich neurodegenerativer Prozesse ermöglichte [10,65,75,93,96], so blieb sie aufgrund hoher Kosten und logistischer Anforderungen doch schwerpunktmäßig ein Instrument der Forschung.…”