From the Research
CT scanning is recommended for patients with eclampsia who have persistent neurological deficits, atypical presentations, or symptoms that don't resolve within 24 hours after seizure control, as evidenced by a study published in 2015 1. The primary purpose of CT scanning in these patients is to rule out intracranial hemorrhage, cerebral edema, or other structural abnormalities that may mimic or complicate eclampsia. When ordering a CT scan, non-contrast imaging should be performed first, followed by contrast-enhanced imaging if necessary and if renal function permits. While obtaining neuroimaging, management of eclampsia should continue with magnesium sulfate (4-6g IV loading dose over 15-20 minutes, followed by 1-2g/hour maintenance), blood pressure control (targeting <160/110 mmHg using labetalol, hydralazine, or nifedipine), and delivery planning. Some key points to consider when interpreting CT findings in eclampsia include:
- Posterior reversible encephalopathy syndrome (PRES), characterized by white matter edema in the occipital and parietal lobes, which is typically reversible with proper management of the underlying condition 1.
- Cerebral edema, which was found in 45.72% of patients with eclampsia in one study 1.
- Cerebral infarct, which was found in 37.14% of patients with eclampsia in the same study 1.
- Intracerebral hemorrhage, which was found in 2.86% of patients with eclampsia 1. It's also important to note that MRI is more sensitive than CT for detecting subtle brain abnormalities in eclampsia, but may not be immediately available in emergency situations 2. In terms of patient outcomes, a study published in 2004 found that neurological recovery was complete in all survivors, and that critical care back-up is essential at tertiary referral centers for a large proportion of neurological abnormalities in eclampsia 3. Overall, the use of CT scanning in patients with eclampsia should be guided by clinical judgment and a thorough understanding of the potential benefits and limitations of this diagnostic tool.