| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 1997;28:1082-1085.)
© 1997 American Heart Association, Inc.
Articles |
Diffusion-Weighted Imaging Discriminates Between Cytotoxic and Vasogenic Edema in a Patient With Eclampsia
From the Departments of Radiology (P.W.S., R.G.G.) and Neurology (F.S.B., L.H.S.), Massachusetts General Hospital, Boston.
Correspondence to Pamela W. Schaefer, MD, Gray 285, Massachusetts General Hospital, Fruit St, Boston, MA 02114.
Background The pathophysiology of eclampsia remains unclear. While the majority of patients develop reversible T2 hyperintense signal abnormalities on MR scans and reversible neurological deficits, some patients do develop infarctions (permanent T2 hyperintense abnormalities) and permanent neurological impairment. Routine MRI cannot prospectively differentiate between these two patient groups. Echo-planar diffusion-weighted imaging, however, is a new technique that clearly differentiates between cytotoxic and vasogenic edema.
Case Description A 30-year-old woman developed symptoms consistent with eclampsia 24 hours after delivering premature twins. An MRI demonstrated extensive, diffuse T2 hyperintense signal abnormalities involving subcortical white matter and adjacent gray matter with a posterior predominance, consistent with either infarction or hypertensive ischemic encephalopathy. Diffusion-weighted images demonstrated increased diffusion, consistent with vasogenic edema and hypertensive ischemic encephalopathy.
Conclusions Unlike routine MRI, diffusion-weighted imaging reliably differentiates between vasogenic edema and cytotoxic edema. Consequently, in eclamptic patients diffusion-weighted imaging can afford clear differentiation between hypertensive ischemic encephalopathy and infarction, two very different entities with very different treatment protocols. Diffusion-weighted imaging should be performed in all eclamptic patients and should greatly affect their management.
Key Words: brain edema • eclampsia • hypertension • magnetic resonance imaging
This article has been cited by other articles:
 |
|
 |
|
  F. Dicuonzo, A. Salvati, M. Palma, V. Lefons, G. Lasalandra, F. De Leonardis, and N. Santoro Posterior Reversible Encephalopathy Syndrome Associated With Methotrexate Neurotoxicity: Conventional Magnetic Resonance and Diffusion-Weighted Imaging Findings J Child Neurol, August 1, 2009; 24(8): 1013 - 1018. [Abstract] [PDF]
|
|
|
|
 |
|
 W.S. Bartynski Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1036 - 1042. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.S. Bartynski, H.P. Tan, J.F. Boardman, R. Shapiro, and J.W. Marsh Posterior Reversible Encephalopathy Syndrome after Solid Organ Transplantation AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 924 - 930. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C GURSES, A DURUKAN, S SENCER, S AKCA, B BAYKAN, and A GOKYIGIT A severe neurological sequela in acute intermittent porphryria: presentation of a case from encephalopathy to quadriparesis Br. J. Radiol., May 1, 2008; 81(965): e135 - e140. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Mukherjee, J.I. Berman, S.W. Chung, C.P. Hess, and R.G. Henry Diffusion Tensor MR Imaging and Fiber Tractography: Theoretic Underpinnings AJNR Am. J. Neuroradiol., April 1, 2008; 29(4): 632 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C A Davie and P O'Brien Stroke and pregnancy J. Neurol. Neurosurg. Psychiatry, March 1, 2008; 79(3): 240 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.S. Bartynski and J.F. Boardman Catheter Angiography, MR Angiography, and MR Perfusion in Posterior Reversible Encephalopathy Syndrome AJNR Am. J. Neuroradiol., March 1, 2008; 29(3): 447 - 455. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. H. Lee, E. F. M. Wijdicks, E. M. Manno, and A. A. Rabinstein Clinical Spectrum of Reversible Posterior Leukoencephalopathy Syndrome Arch Neurol, February 1, 2008; 65(2): 205 - 210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. McKinney, J. Short, C. L. Truwit, Z. J. McKinney, O. S. Kozak, K. S. SantaCruz, and M. Teksam Posterior Reversible Encephalopathy Syndrome: Incidence of Atypical Regions of Involvement and Imaging Findings Am. J. Roentgenol., October 1, 2007; 189(4): 904 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Cipolla Cerebrovascular Function in Pregnancy and Eclampsia Hypertension, July 1, 2007; 50(1): 14 - 24. [Full Text] [PDF]
|
|
|
|
 |
|
 M.L. Ishimori, B.D. Pressman, D.J. Wallace, and M.H. Weisman Posterior reversible encephalopathy syndrome: another manifestation of CNS SLE? Lupus, June 1, 2007; 16(6): 436 - 443. [Abstract] [PDF]
|
|
|
|
 |
|
 I. T. Zak, H. S. Dulai, and K. K. Kish Imaging of Neurologic Disorders Associated with Pregnancy and the Postpartum Period RadioGraphics, January 1, 2007; 27(1): 95 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Noguchi, F. Mihara, T. Yoshiura, O. Togao, K. Atsumi, T. Matsuura, T. Kuroiwa, and H. Honda MR Imaging of Human Herpesvirus-6 Encephalopathy after Hematopoietic Stem Cell Transplantation in Adults AJNR Am. J. Neuroradiol., November 1, 2006; 27(10): 2191 - 2195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Aeby, P. David, C. Fricx, P. Jissendi, S. Blecic, and P. Van Bogaert Posterior Reversible Encephalopathy Syndrome Revealing Acute Post-Streptococcal Glomerulonephritis J Child Neurol, March 1, 2006; 21(3): 250 - 251. [Abstract] [PDF]
|
|
|
|
|
|
H. Ozyurek, G. Oguz, S. Ozen, C. Akyuz, K. K. Oguz, B. Anlar, and S. Aysun Reversible Posterior Leukoencephalopathy Syndrome: Report of Three Cases J Child Neurol, December 1, 2005; 20(12): 990 - 993. [Abstract] [PDF]
|
|
|
|
 |
|
 C. C. Leite, U. C. Reed, M. C. G. Otaduy, M. T. C. Lacerda, M. O. R. Costa, L. G. Ferreira, M. S. Carvalho, M. B. D. Resende, S. K. N. Marie, and G. G. Cerri Congenital Muscular Dystrophy with Merosin Deficiency: 1H MR Spectroscopy and Diffusion-weighted MR Imaging Radiology, April 1, 2005; 235(1): 190 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Quick and M. J. Cipolla Pregnancy-induced up-regulation of aquaporin-4 protein in brain and its role in eclampsia FASEB J, February 1, 2005; 19(2): 170 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Soltes, I. M. Schmalfuss, and M. T. Bhatti Cortical Blindness Due to Reversible Posterior Leukoencephalopathy Syndrome in a Patient With Thrombotic Thrombocytopenic Purpura and Preeclampsia Arch Ophthalmol, December 1, 2004; 122(12): 1885 - 1887. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Cipolla, L. Vitullo, and J. McKinnon Cerebral artery reactivity changes during pregnancy and the postpartum period: a role in eclampsia? Am J Physiol Heart Circ Physiol, June 1, 2004; 286(6): H2127 - H2132. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Cruz-Flores, F. de Assis Aquino Gondim, and E. C. Leira Brainstem involvement in hypertensive encephalopathy: Clinical and radiological findings Neurology, April 27, 2004; 62(8): 1417 - 1419. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-T. Lin, S.-J. Wang, J.-L. Fuh, L.-T. Hsiao, J.-F. Lirng, and P.-M. Chen Prolonged Reversible Vasospasm in Cyclosporin A-Induced Encephalopathy AJNR Am. J. Neuroradiol., January 1, 2003; 24(1): 102 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. W. Stadnik, P. Demaerel, R. R Luypaert, C. Chaskis, K. L. Van Rompaey, A. Michotte, and M. J. Osteaux Imaging Tutorial: Differential Diagnosis of Bright Lesions on Diffusion-weighted MR Images RadioGraphics, January 1, 2003; 23(1): e7 - e7. [Abstract] [Full Text]
|
|
|
|
|
|
S C Keswani and R Wityk Don't throw in the towel! A case of reversible coma J. Neurol. Neurosurg. Psychiatry, July 1, 2002; 73(1): 83 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. Byun, S. O. Shin, Y. Chang, S. J. Lee, J. Finsterbusch, and J. Frahm Diffusion-Weighted MR Imaging of Metastatic Disease of the Spine: Assessment of Response to Therapy AJNR Am. J. Neuroradiol., June 1, 2002; 23(6): 906 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Covarrubias, P. H. Luetmer, and N. G. Campeau Posterior Reversible Encephalopathy Syndrome: Prognostic Utility of Quantitative Diffusion-Weighted MR Images AJNR Am. J. Neuroradiol., June 1, 2002; 23(6): 1038 - 1048. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Mader, M. Schoning, U. Klose, and W. Kuker Neonatal Cerebral Infarction Diagnosed by Diffusion-Weighted MRI: Pseudonormalization Occurs Early Stroke, April 1, 2002; 33(4): 1142 - 1145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Melhem, S. Mori, G. Mukundan, M. A. Kraut, M. G. Pomper, and P. C. M. van Zijl Diffusion Tensor MR Imaging of the Brain and White Matter Tractography Am. J. Roentgenol., January 1, 2002; 178(1): 3 - 16. [Full Text] [PDF]
|
|
|
|
|
|
W. S. Bartynski, Z. Zeigler, M. P. Spearman, L. Lin, R. K. Shadduck, and J. Lister Etiology of Cortical and White Matter Lesions in Cyclosporin-A and FK-506 Neurotoxicity AJNR Am. J. Neuroradiol., November 1, 2001; 22(10): 1901 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Provenzale, J. R. Petrella, L. C. H. Cruz Jr, J. C. Wong, S. Engelter, and D. P. Barboriak Quantitative Assessment of Diffusion Abnormalities in Posterior Reversible Encephalopathy Syndrome AJNR Am. J. Neuroradiol., September 1, 2001; 22(8): 1455 - 1461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rabinstein, S. Falcone, A. Forteza, and A. Forteza Diffusion-weighted Imaging Shows Cytotoxic and Vasogenic Edema in Eclampsia AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1068 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Mukherjee and R. C. McKinstry Reversible Posterior Leukoencephalopathy Syndrome: Evaluation with Diffusion-Tensor MR Imaging Radiology, June 1, 2001; 219(3): 756 - 765. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Ducreux, C. Oppenheim, X. Vandamme, D. Dormont, Y. Samson, G. Rancurel, G. Cosnard, and C. Marsault Diffusion-weighted Imaging Patterns of Brain Damage Associated with Cerebral Venous Thrombosis AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 261 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R K Garg Posterior leukoencephalopathy syndrome Postgrad. Med. J., January 1, 2001; 77(903): 24 - 24. [Abstract] [Full Text]
|
|
|
|
|
|
R Veltkamp, A Kupsch, J Polasek, T A Yousry, and H W Pfister Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients J. Neurol. Neurosurg. Psychiatry, December 1, 2000; 69(6): 824 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Holder, R. Muthupillai, S. Mukundan Jr, J. D. Eastwood, and P. A. Hudgins Diffusion-weighted MR Imaging of the Normal Human Spinal Cord in Vivo AJNR Am. J. Neuroradiol., November 1, 2000; 21(10): 1799 - 1806. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. B. Schwartz, S. K. Feske, J. F. Polak, U. DeGirolami, A. Iaia, K. M. Beckner, S. M. Bravo, R. A. Klufas, R. Y. C. Chai, and J. T. Repke Preeclampsia-Eclampsia: Clinical and Neuroradiographic Correlates and Insights into the Pathogenesis of Hypertensive Encephalopathy Radiology, November 1, 2000; 217(2): 371 - 376. [Abstract] [Full Text]
|
|
|
|
|
|
C Oppenheim, D Galanaud, Y Samson, M Sahel, D Dormont, B Wechsler, and C Marsault Can diffusion weighted magnetic resonance imaging help differentiate stroke from stroke-like events in MELAS? J. Neurol. Neurosurg. Psychiatry, August 1, 2000; 69(2): 248 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Albers, M. G. Lansberg, A. M. Norbash, D. C. Tong, M. W. O'Brien, A. R. Woolfenden, M. P. Marks, and M. E. Moseley Yield of diffusion-weighted MRI for detection of potentially relevant findings in stroke patients Neurology, April 25, 2000; 54(8): 1562 - 1567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Carhuapoma, P. Y. Wang, N. J. Beauchamp, P. M. Keyl, D. F. Hanley, and P. B. Barker Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage Stroke, March 1, 2000; 31(3): 726 - 732. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Cooney, W. G. Bradley, S. C. Symko, S. T. Patel, and P. K. Groncy Hypertensive Encephalopathy: Complication in Children Treated for Myeloproliferative Disorders-Report of Three Cases Radiology, March 1, 2000; 214(3): 711 - 716. [Abstract] [Full Text]
|
|
|
|
|
|
K.-O. Lovblad and C. Basssetti Diffusion-Weighted Magnetic Resonance Imaging in Brain Death Stroke, February 1, 2000; 31(2): 539 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Provenzale CT and MR Imaging of Nontraumatic Neurologic Emergencies Am. J. Roentgenol., February 1, 2000; 174(2): 289 - 299. [Full Text] [PDF]
|
|
|
|
|
|
M. Yoneda, M. Maeda, H. Kimura, A. Fujii, K. Katayama, and M. Kuriyama Vasogenic edema on MELAS: A serial study with diffusion-weighted MR imaging Neurology, December 1, 1999; 53(9): 2182 - 2182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Robertson, L. Ben-Sira, P. D. Barnes, R. V. Mulkern, C. D. Robson, S. E. Maier, M. J. Rivkin, and A. J. d. Plessis MR Line-Scan Diffusion-Weighted Imaging of Term Neonates with Perinatal Brain Ischemia AJNR Am. J. Neuroradiol., October 1, 1999; 20(9): 1658 - 1670. [Abstract] [Full Text]
|
|
|
|
|
|
S. G. Pavlakis, Y. Frank, and R. Chusid Topical Review: Hypertensive Encephalopathy, Reversible Occipitoparietal Encephalopathy, or Reversible Posterior Leukoencephalopathy: Three Names for an Old Syndrome J Child Neurol, May 1, 1999; 14(5): 277 - 281. [Abstract] [PDF]
|
|
|
|
|
|
E. Keller, S. Flacke, H. Urbach, and H. H. Schild Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging in Deep Cerebral Venous Thrombosis Stroke, May 1, 1999; 30(5): 1144 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Robertson, S. E. Maier, C. D. Robson, R. V. Mulkern, P. M. Karas, and P. D. Barnes MR Line Scan Diffusion Imaging of the Brain in Children AJNR Am. J. Neuroradiol., March 1, 1999; 20(3): 419 - 425. [Abstract] [Full Text]
|
|
|
|
|
|
A. R. Woolfenden, M. W. O'Brien, R. E. Schwartzberg, A. M. Norbash, and D. C. Tong Diffusion-Weighted MRI in Transient Global Amnesia Precipitated by Cerebral Angiography Stroke, November 1, 1997; 28(11): 2311 - 2314. [Abstract] [Full Text]
|
|