Cerebral Manifestations of Preeclampsia

This thesis intends to describe and explain the course of clinical neurophysiological and neuropsychological parameters in patients with hypertensive disorders in pregnancy. We aimed to improve knowledge on cerebral pathophysiological mechanisms of preeclampsia related to signs and symptoms and to explore whether measuring features of these mechanisms with neurophysiological techniques can help to optimize timing of delivery in order to minimize maternal morbidity and maximize neonatal outcome. We compared EEG findings during pregnancy and postpartum in women with normotensive pregnancies and pregnancies complicated by hypertensive disorders. We concluded that women with severe PE show more EEG abnormalities and have impaired mental wellbeing postpartum. We present a study on visual evoked potentials (VEPs). The objective of this study was to compare neurophysiological changes in women with hypertensive disorders of pregnancy using VEPs. We defined reference values for normotensive pregnant women. We concluded in this study that normotensive pregnant women show neurophysiological adaptation to pregnancy of their visual cortex, which seemed to be absent in women with hypertensive disorders of pregnancy. Using Doppler ultrasound we estimated zero flow pressure (ZFP) and cerebral perfusion pressure (CPP) using simultaneously obtained arterial blood pressure and middle cerebral artery blood flow velocity in women with preeclampsia and healthy pregnant controls. Mean ± SD ZFP was lower in patients than in controls whereas CPP was considerably higher, as was the cerebral flow index. In normotensive pregnant women the patellar reflex was cross-sectionally recorded using surface electromyography at four time points during pregnancy and 6-8 weeks postpartum. Latency and amplitude of the compound muscle action potential during normotensive pregnancies showed no changes compared to the non-pregnant state during reproductive age. Latency of the compound muscle action potential was increased in pregnancies with severe preeclampsia compared to normotensive pregnancies. Postpartum these differences had disappeared. Women after PE more often complain of cognitive disturbances compared to women after uncomplicated pregnancies. We performed a study with a neuropsychological test battery in women who have had severe PE and women after uncomplicated normotensive pregnancies. The control group was matched for age, educational level and mode of anesthesia. The formerly pre-eclamptic women had significantly lower scores on most indices of the auditory-verbal memory test. Formerly pre-eclamptic women learned considerably fewer words than controls and recalled less after interference. No persistent differences were observed in tests for attention/concentration and executive functioning. There were no significant differences on depression and anxiety scales. The general discussion reflects on limitations in our studies. It relates findings to clinical perspectives and suggestions for future studies are made.

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