Cerebral blood flow in severe pre-eclampsia and eclampsia


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Abstract

Aim. To investigate the characteristics of cerebral blood flow in patients with preeclampsia and eclampsia and evaluate the feasibility of predicting and early diagnosis of cerebrovascular disorders Materials and methods. The present study included 174 women aged 17-44 with preeclampsia (n=117), pregnancy with chronic arterial hypertension (n=13), healthy pregnancy (n=34), and 10 non-pregnant women. Clinical evaluation included measurement of blood pressure, Doppler ultrasound of blood flow in major neck and brain arteries, as well as the venous trunks and meningeal venous sinuses. The blood flow assessment involved measurements of velocity and vascular resistance, arterial reactivity in both major territories, and combined cerebral blood flow and intracranial pressure indicators. Results. During preeclampsia, cerebral blood flow changes in the vertebra-basilar and carotid systems increased in a wavelike and non-synchronous manner. Moderate preeclampsia was characterized by large artery spasm and small-caliber artery dilation. In severe preeclampsia, there was a marked dilation of cerebral arteries with total cerebral hyper-perfusion and a progressive decrease in the cerebral vascular autoregulation reserve, which was more pronounced in vertebrobasilar arteries. After eclamptic seizures, the degree of vascular disorders reached a maximum, manifested by a sharp drop in cerebral blood flow, the development of cerebral edema, and an increase in intracranial pressure. Conclusion. Assessment of cerebral blood flow using transcranial Doppler ultrasound provides essential information about the condition of a patient with increasing preeclampsia severity.

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About the authors

Iraida S. Sidorova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: sidorovais@yandex.ru
Dr.Med.Sci., Professor, Academician of the RAS, Merited Scholar of the Russian Federation, Merited Doctor of the Russian Federation, Professor at the Department of Obstetrics and Gynecology № 1, Medical Faculty, Institute of Clinical Medicine

Natalya A. Nikitina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: natnikitina@list.ru
Dr.Med.Sci., Professor at the Department of Obstetrics and Gynecology № 1, Medical Faculty

Mikhail V. Tardov

L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Health Department

Email: mvtardov@rambler.ru
Dr.Med.Sci., Leading Researcher at the Research Department of the Inner Ear Audiology and Pathology

Igor D. Stulin

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

Dr.Med.Sci., Professor, Head of the Neurology department, Faculty of Medicine

References

  1. Lee Y.J., Lee S., Jo H.N., Kim J.M., Kwon B.S., Joo J.K. et al. Alterations in transcranial Doppler indices of pregnant women with complicated preeclampsia. Pregnancy Hypertens. 2019; 15: 189-94. https://dx.doi.org/10.1016/ j.preghy.2019.01.009.
  2. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin. Perinatol. 2012; 36(1): 56-9. https://dx.doi.org 10.1053/j.semperi.2011.09.011.
  3. Филиппов О.С., Гусева Е.В., Сидорова И.С., Никитина Н.А. Результаты конфиденциального аудита материнской смертности в Российской Федерации в 2014 году. Методическое письмо Министерства здравоохранения Российской Федерации № 15-4/10/2-5993 от 09.10.2015. 50с. [Filippov O.S., Guseva E.V., Sidorova I.S., Nikitina N.A. Results of a confidential audit of maternal mortality in the Russian Federation in 2014. Methodological letter of the Ministry of Health of the Russian Federation No 15-4/10/2-5993 from 09.10.2015. 50 p. (in Russian)].
  4. Филиппов О.С., Гусева Е.В., Сидорова И.С., Никитина Н.А. Результаты конфиденциального аудита материнской смертности в Российской Федерации в 2015 году. Методическое письмо Министерства здравоохранения Российской Федерации № 15-4/10/2-7955 от 14.12.2016. 61с. [Filippov O.S., Guseva E.V., Sidorova I.S., Nikitina N.A. Results of a confidential audit of maternal mortality in the Russian Federation in 2015. Methodological letter of the Ministry of Health of the Russian Federation No 15-4/10/2-7955 from 14.12.2016. 61 p. (in Russian)].
  5. Сидорова И.С., Никитина Н.А., Гусева Е.В. Результаты конфиденциального аудита материнской смертности от преэклампсии и эклампсии в России в 2017-2018 гг. Акушерство и гинекология. 2020; 1: 119-27. https:// dx.doi.org/10.18565/aig.2020.l.119-127. [Sidorova I.S., Nikitina N.A., Guseva E.V. Results of a confidential audit of maternal mortality from preeclampsia and eclampsia in Russia in 2017-2018. Obstetrics and gynecology. 2020; 1: 119-27 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.1.119-127.
  6. Basit S., Wohlfahrt J., Boyd H.A. Pre-eclampsia and risk of dementia later in life: nationwide cohort study. BMJ. 2018; 363: k4109. https://dx.doi.org/10.1136/ bmj.k4109.
  7. Siepmann T., Boar dm an H., Bilderbeck A., Griff anti L., Kenworthy Y., Zwager C. et al. Long-term cerebral white and gray matter changes after preeclampsia. Neurology. 2017; 88(13): 1256-64. https://dx.doi.org/10.1212/ WNL.0000000000003765.
  8. Ijomone O.K., Shallie P., Naicker T. Changes in the structure and function of the brain years after pre-eclampsia. Ageing Res. Rev. 2018; 47: 49-54. https://dx.doi. org/10.1016/j.arr.2018.06.006.
  9. Miller E.C., Gatollari H.J., Too G., Boehme A.K., Leffert L., Marshall R.S. et al. Risk factors for pregnancy-associated stroke in women with preeclampsia. Stroke. 2017; 48(7): 1752-9. https://dx.doi.org/10.1161/STR0KEAHA.117.017374.
  10. Kutlesic M.S., Kutlesic R.M., Koratevic G.P. Posterior reversible encephalopathy syndrome in eclamptic patients: neuroradiological manifestation, pathogenesis and management. Med. Pregl. 2015; 68(1-2): 53-8. https://dx.doi.org/10.2298/ mpns1502053k.
  11. Jones-Muhammad M., Warrington J.P. Cerebral blood flow regulation in pregnancy, hypertension, and hypertensive disorders of pregnancy. Brain Sci. 2019; 9(9): 224. https://dx.doi.org/10.3390/brainsci9090224.
  12. van Veen T.R., Panerai R.B., Haeri S., Griffioen A.C., Zeeman G.G., Belfort M.A. Cerebral autoregulation in normal pregnancy and preeclampsia. Obstet. Gynecol. 2013; 122(5): 1064-9. https://dx.doi.org/10.1097/AOG.0b013e3182a93fb5.
  13. Belfort M.A., Varner M.W., Dizon-Townson D.S., Grunewald C., Nisell H. Cerebral perfusion pressure, and not cerebral blood flow, may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis. Am. J. Obstet. Gynecol. 2002; 187(3): 626-34. https://dx.doi.org/10.1067/ mob.2002.125241.
  14. Sonneveld M.J., Brusse I.A., Duvekot J.J., Steegers E.A., Grune F., Visser G.H. Cerebral perfusion pressure in women with preeclampsia is elevated even after treatment of elevated blood pressure. Acta Obstet. Gynecol. Scand. 2014; 93(5): 508-11. https://dx.doi.org/10.1111/aogs.12358.
  15. Williams K., Galerneau F. Maternal transcranial Doppler in pre-eclampsia and eclampsia. Ultrasound Obstet. Gynecol. 2003; 21(5): 507-13. https://dx.doi. org /10.1002/uog.83.
  16. Hammer E.S., Cipolla M.J. Cerebrovascular dysfunction in preeclamptic pregnancies. Curr. Hypertens. Rep. 2015; 17(8): 64. https://dx.doi.org/10.1007/ s11906-015-0575-8.
  17. Warrington J.P., Fan F., Murphy S.R., Roman R.J., Drummond H.A., Granger J.P. et al. Placental ischemia in pregnant rats impairs cerebral blood flow autoregulation and increases blood-brain barrier permeability. Physiol. Rep. 2014; 2(8): e12134. https://dx.doi.org/10.14814/phy2.12134.
  18. Williams K., Wilson S. Maternal middle cerebral artery blood flow velocity variation with gestational age. Obstet. Gynecol. 1994; 84(3): 445-8.
  19. Trommer B.L., Homer D., Mikhael M.A. Cerebral vasospasm and eclampsia. Stroke. 1988; 19(3): 326-9. https://dx.doi.org/10.1161/01.str.19.3.326.
  20. Bergman L., Torres-Vergara P., Penny J., Wikstrom J., Nelander M., Leon J. et al. Investigating maternal brain alterations in preeclampsia: the need for a multidisciplinary effort. Curr. Hypertens. Rep. 2019; 21(9): 72. https://dx.doi. org/10.1007/s11906-019-0977-0.
  21. Fischer M., Schmutzhard E. Posterior reversible encephalopathy syndrome. J. Neurol. 2017; 264(8): 1608-16. https://dx.doi.org/10.1007/s00415-016-8377-8.
  22. Сидорова И.С. Преэклампсия. М.: МИА; 2016. 528с. [Sidorova I.S. Preeclampsia. M.: MIA; 2016. 528 p. (in Russian)].
  23. Сидорова И.С., Никитина Н.А. Преэклампсия как гестационный имму-нокомплексный комплементопосредованный эндотелиоз. Российский вестник акушера-гинеколога. 2019; 19(1): 5-11. [Sidorova I.S., Nikitina N.A. Preeclampsia as gestational immunocomplex endotheliosis. Russian Bulletin of obstetrician-gynecologist. 2019; 19(1): 5-11. (in Russian)]. https://dx.doi. org/10.17116/rosakush2019190115.
  24. Vorstrup S., Andersen A., Blegvad N., Paulson O.B. Calcium antagonist (PY 108-068) treatment may further decrease flow in ischemic areas in acute stroke. J. Cereb. Blood Flow Metab. 1986; 6(2): 222-9. https://dx.doi.org/10.1038/ jcbfm.1986.35.
  25. Zhang J., Liu J., Li D., Zhang C., Liu M. Calcium antagonists for acute ischemic stroke. Cochrane Database Syst. Rev. 2019; 2(2): CD001928. https://dx.doi. org/10.1002/14651858.CD001928.pub3.
  26. Loh K.Y., Wang Z., Liao P. Oncotic cell death in stroke. Rev. Physiol. Biochem. Pharmacol. 2019; 176: 37-64. https://dx.doi.org/10.1007/112_2018_13.
  27. Fricker M., Tolkovsky A.M., Borutaite V., Coleman M., Brown G.C. Neuronal cell death. Physiol. Rev. 2018; 98(2): 813-80. https://dx.doi.org/10.1152/ physrev.00011.2017.
  28. Dorhout Mees S.M., Rinkel G.J.E., Feigin V.L., Algra A., van den Bergh W.M., Vermeulen M. et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst. Rev. 2007; (3): CD000277. https:// dx.doi.org/10.1002/14651858.CD000277.pub3.

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