Cerebral Infarcts, Edema, Hypoperfusion, and Vasospasm in Preeclampsia and Eclampsia

Abstract

( Am J Obstet Gynecol . 2025;232:550.e1-14. doi: 10.1016/j.ajog.2024.10.034.) When hypertension and end-organ injury develop after 20 weeks of gestation, it is known as preeclampsia (PEC), and this condition is life-threatening. One of the most common complications secondary to PEC is eclampsia (EC), when tonic-clonic seizures occur, and cerebral edema is present in 71% to 80% of cases. There is no direct treatment for EC, and the etiology is unknown. Cerebral edema is typically visualized and diagnosed using computerized tomography and conventional magnetic resonance imaging (MRI), with common etiologies being cytotoxic, vasogenic, osmotic, and interstitial. Diffusion-weighted imaging (DWI) can allow for distinguishing vasogenic from cytotoxic edema. Another technique that can provide more detail in cerebral edema is intravoxel incoherent imaging (IVIM), an advanced DWI technique. To date, cerebral perfusion, diffusion, and vasospasm have not been studied in patients with PEC and EC. This study was designed to use advanced MRI techniques to evaluate women with EC, PEC, and normotensive controls to potentially explain the origin of neurologic symptoms in both conditions.