Investigating Maternal Brain Alterations in Preeclampsia: the Need for a Multidisciplinary Effort

Abstract

Porpuose of Review: To provide insight into the mechanisms underlying cerebral pathophysiology in preeclampsia and to highlight possible methods for evaluation, screening and surveillance of cerebral complications in the condition. Recent Findings: Every 12 minutes, a woman dies as a consequence of preeclampsia with cerebral complications, such as eclampsia, among the most common causes. The incidence of eclampsia has been estimated to vary from one in 100 to one in 2000 deliveries, with the highest incidences in low-income countries. The pathophysiology of eclampsia remains enigmatic. The increased blood pressure cannot be the only underlying cause, since some cases of eclampsia arise without simultaneous hypertension. Evaluation of brain alterations in preeclampsia and eclampsia is challenging and demands a multidisciplinary collaboration, since no single method can accurately and fully describe how preeclampsia affects the brain. Summary: Cerebral complications of preeclampsia are a significant factor in maternal morbidity and mortality worldwide. No single method can accurately describe the full picture of how preeclampsia affects the brain vasculature and parenchyma. We recommend a multinational effort to overcome, not only the issue of limited sample availability, but also, to optimize the quality of research.

Clinical and Imaging Data-Based Model for Predicting Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in Pregnant Women With Severe Preeclampsia or Eclampsia and Analysis of Perinatal Outcomes

“…Headache is a high-risk factor for RPLS and a precursor of eclampsia. Cortical blindness is also a unique manifestation of RPLS [ 11 , 14 , 15 ]. This study found that in preeclampsia, neurological symptoms such as headache ( P < 0.05) was independent risk factors for RPLS, but the blurred vision is also a potential factor that cannot be ignored (The p value 0.072 is close to 0.05).…”

Patient with Preeclampsia in ICU: Usefulness of the Transcranial Doppler (TCD/TCCS) to Monitor and Predict the Most Common Neurological Complications

“…Recurrent seizures can lead to hypoxia, maternal injury, aspiration pneumonia, and status epilepticus. While the incidence of eclampsia is 1 in 2000 in high-income countries, it is estimated to be 1 in 100 to 1 in 1700 deliveries in low-and middle-income countries [11].…”

“…Recent studies show promising results on the detection of cerebral biomarkers (S100B, neuron-specific enolase (NSE), neurofilament light chain (NfL), and tua) to diagnose cerebral complications at onset or before onset of preeclampsia [11].…”

“…Another application for TCD/TCCS might be the evaluation of dynamic cerebral autoregulation to predict short-and long-term cerebral complications (as has been studied in stroke patients [64]), such as eclampsia, neurological complications, impaired cognitive function, and stroke [11].…”

Cerebral perfusion pressure and autoregulation in eclampsia—a case control study

“…Endothelial dysfunction at the bloodbrain barrier level along with or resulting in cerebral blood flow alteration is a leading theory. 7 Studies using transcranial Doppler (TCD) ultrasound have consistently shown increased cerebral perfusion pressure (CPP) in PE, although with large variances within groups. 8e11 Dynamic cerebral autoregulation (DCA) is a physiological process that maintains cerebral blood flow relatively constant despite changes in blood pressure (BP).…”