Pathophysiology of Pre-eclampsia/eclampsia Syndrome

Zunker, P.; Hohenstein, Christian; Deuschl, Günther

doi:10.1007/s004150170193

Cited by 7 publications

(8 citation statements)

References 14 publications

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“…This condition is characterized by abnormal vascular response to placentation and by endothelial cell dysfunction which represents common response leading to instability of vascular tone with vasospasm in various organs and activation of the coagulation system with microthrombi formation [24, 28, 29] with the consequence of ischemic damage in many organs. …”

Section: Pregnancy-specific Causes Of Ischemic Strokementioning

confidence: 99%

Ischemic Stroke during Pregnancy and Puerperium

Zotto

Giossi²,

Volonghi³

et al. 2011

Stroke Research and Treatment

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Ischemic stroke during pregnancy and puerperium represents a rare occurrence but it could be a serious and stressful event for mothers, infants, and also families. Whenever it does occur, many concerns arise about the safety of the mother and the fetus in relation to common diagnostic tests and therapies leading to a more conservative approach. The physiological adaptations in the cardiovascular system and in the coagulability that accompany the pregnant state, which are more significant around delivery and in the postpartum period, likely contribute to increasing the risk of an ischemic stroke. Most of the causes of an ischemic stroke in the young may also occur in pregnant patients. Despite this, there are specific conditions related to pregnancy which may be considered when assessing this particular group of patients such as pre-eclampsia-eclampsia, choriocarcinoma, peripartum cardiomiopathy, amniotic fluid embolization, and postpartum cerebral angiopathy. This article will consider several questions related to pregnancy-associated ischemic stroke, dwelling on epidemiological and specific etiological aspects, diagnostic issue concerning the use of neuroimaging, and the related potential risks to the embryo and fetus. Therapeutic issues surrounding the use of anticoagulant and antiplatelets agents will be discussed along with the few available reports regarding the use of thrombolytic therapy during pregnancy.

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Section: Pregnancy-specific Causes Of Ischemic Strokementioning

confidence: 99%

Ischemic Stroke during Pregnancy and Puerperium

Zotto

Giossi²,

Volonghi³

et al. 2011

Stroke Research and Treatment

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“…8 Women with preeclampsia have increased vascular tone and sensitivity to mediators of vasoconstriction underlying the hypertension, vasospasm, and organ hypoperfusion characteristic of it. [9][10][11][12][13] In addition, there is much evidence that endothelial dysfunction plays a major role in its pathogenesis. 10,11,14 In addition to promoting edema, endothelial dysfunction may cause instability of vascular tone, platelet activation, and local thrombosis.…”

Section: Pre-eclampsia-eclampsiamentioning

confidence: 99%

Stroke in Pregnancy

Feske

2007

Semin Neurol

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Although pregnancy-associated stroke is uncommon, the risk of stroke is greatly increased above the low baseline rate in young patients during late pregnancy and, even more so, during the puerperium. Stroke is a major contributor to the serious morbidity and mortality of pregnancy. The physiological hormonally mediated changes in circulation, vascular tissue structure, and coagulability, and the pathological state of pre-eclampsia-eclampsia contribute to this increased risk of stroke. Pregnancy-associated strokes are roughly evenly divided among hemorrhagic strokes, mainly from rupture of aneurysms and arteriovenous malformations (AVMs); ischemic strokes, mainly from late pregnancy and postpartum cerebral venous thrombosis; and strokes associated with pre-eclampsia-eclampsia, with a contribution from cardioembolism, especially in populations at risk from a high rate of underlying rheumatic valvular heart disease. Awareness of the types of stroke to expect during pregnancy will facilitate early diagnosis. This article discusses the pathogenesis of pregnancy-associated stroke, its epidemiology, and some diagnostic and therapeutic issues unique to pregnancy.

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“…As shown in patient 2, there can be a temporal 'dissociation' between the vasogenic edema and the elevated flow velocities, by which the edema antedates the peak flow velocities by days [20,22]. It appears possible that the vasogenic edema is in part caused by high levels of atrial natriuretic peptide which selectively opens BBB for water but not for amino acids [23,24].…”

Section: Discussionmentioning

confidence: 99%

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

Zunker

Georgiadis²,

Czech³

et al. 2003

Fetal Diagn Ther

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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.

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Pathophysiology of Pre-eclampsia/eclampsia Syndrome

Cited by 7 publications

References 14 publications

Ischemic Stroke during Pregnancy and Puerperium

Ischemic Stroke during Pregnancy and Puerperium

Stroke in Pregnancy

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

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