Is high cerebral perfusion pressure and cerebral flow predictive of impending seizures in preeclampsia? A case report.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah, Salt Lake City 84132, USA.
Hypertension in Pregnancy (Impact Factor: 1.19). 02/2005; 24(1):59-63. DOI: 10.1081/PRG-45776
Source: PubMed

ABSTRACT Transcranial Doppler ultrasound was used to demonstrate elevated estimated cerebral perfusion pressure (CPP) and cerebral flow index (CFI) in a preeclamptic patient. She subsequently developed eclampsia. After magnesium sulfate therapy her CPP and CFI were within the normal range and she did not experience further seizures. This finding suggests that cerebral overperfusion may be at least one of the etiologies involved in the pathogenesis of eclampsia.

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    ABSTRACT: Thesis (Ph. D. )--University of Vermont, 2007. Includes bibliographical references (leaves 191-240).
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    ABSTRACT: To determine the cerebral hemodynamic effect of magnesium sulfate (MgSO4) in preeclampsia. Prospective observational study. Tertiary Care Medical Center. Preeclamptic patients (systolic < 160, diastolic < 110 mmHg). Transcranial Doppler (TCD) of the middle cerebral arteries (MCA) of 15 preeclamptics, before and after IV MgSO4. No vasoactive drugs other than MgSO4 were given. 11 patients with mild range BP (140/90-160/110 mmHg) had measurements at baseline, 30 and 120 minutes after MgSO4, and 7 patients with elevated CPP had baseline and 30 minute measurements. Hemodynamic parameters were compared with normative curves. Mean arterial pressure (MAP), heart rate (HR), cerebral perfusion pressure (CPP), resistance index (RI), resistance area product (RAP), and cerebral flow index (CFI). Eight women had normal baseline CPP, and 11 had normal CFI. 11 had mild preeclampsia range blood pressure and MgSO4 had no significant effect on CPP, CFI, HR, MCA velocities, or RAP but did decrease the MAP in the first 30 minutes (107 +/- 8 to 100 +/- 9 mmHg; p = 0.035), mainly due to a drop in diastolic pressure (87 +/- 10 to 82 +/- 9 mmHg; p = 0.004). 7 patients with elevated baseline CPP had a significant reduction in CPP, but no change in CFI, after MgSO4. MgSO4 does not significantly effect CPP or CFI in preeclamptics with baseline blood pressure in the mild range, but does significantly reduce CPP in those with high baseline CPP. This may be important in the prevention of hypertensive encephalopathy.
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