Preeclampsia is characterized by hypertension, abnormal peripheral edema, and proteinuria that can progress to eclampsia, which also involves seizures. Although CNS changes in severe preeclampsia and eclampsia represent a form of hypertensive en-cephalopathy, they also occur in normotensive individuals. The precise pathogenesis remains unclear. However, endothelial dysfunction due to circulating endothelial toxins or antibodies against the endothe-
lium can be the primary cause . MR findings in patients with severe preeclampsia/eclampsia are often similar to those with hypertensive encephalopa-thy. However,intracranial hemorrhage and infarction (Fig. 7.16) are common . Bilateral external capsule or basal ganglia lesions are also common . DW imaging can discriminate a cytotoxic edema from vasogenic edema .
Hemolysis, elevated liver enzymes and low platelets (HELLP syndrome) is a thrombotic mi-croangiopathic vasculopathy in pregnancy. Fatalities are attributable to intracranial hemorrhage, which may occur either in isolation or as part of the HELLP syndrome. The DW imaging findings are similar to those in eclampsia/preeclampsia.
Hypertensive encephalopathy in a 41-year-old woman with hypertensive crisis with pheochromocytoma. A T2-weight-ed image shows hyperintense lesions in the right frontal lobe and left temporo-parieto-occipital area (arrows). b Coronal FLAIR image shows multiple hyperintense lesions in the subcortical white matter (arrows) and slightly hyperintense lesions (arrowheads) in the left parieto-occipital area.c DW image shows the lesion in the left side as hyperintense (arrows) and the subcortical lesions as isointense.d ADC map reveals decreased ADC of the lesion in the left side, representing acute infarcts (arrows). Subcortical lesions show slightly increased or normal ADC, representing vasogenic edema (arrowhead). e Three-month follow-up MRI shows hyperintense lesions in the left parieto-occipital area, representing old infarcts (arrows).The lesion in the right frontal lobe is not detected. (From )
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