Differences in cerebral blood flow patterns assessed by transcranial doppler in patients with severe pre-eclampsia and eclampsia

Abstract

Objective: To investigate cerebral perfusion variables derived from transcranial Doppler (TCD) in patients with severe hypertensive disorders of pregnancy and determine their association with the development of eclampsia. Methods: A cross-sectional study was conducted in an intensive care unit in Argentina. The study included 31 patients with severe pre-eclampsia (sPE), 35 with eclampsia (E), and 20 healthy pregnancies (HP). Doppler indices from the middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), and basilar artery (BA) were compared among the groups. Results: Compared to HP, patients with sPE and E exhibited higher values of cerebral flow index (CFI) (48 [42–57] and 51 [41–68] vs 34 [28–44], P= 0.001), higher cerebral perfusion pressure (CPP) (69 mmHg [56–77] and 68 mmHg [54–92] vs 49 mmHg [42–73], P= 0.044), and increased cerebral blood flow velocities (CBFV) with lower resistance in most examined territories. Patients with E demonstrated significantly higher CBFV values in MCA, PCA, and BA compared to those with sPE, along with a significant decrease in resistance index (RI) of the BA (P< 0.05). In multivariate analysis, the RI of the BA was the only Doppler variable independently associated with E. Conclusion: Increased cerebral flow velocities and lower resistance are characteristic findings in patients with sPE and E. While these changes are evident across all cerebral vascular territories, significant alterations in the Doppler indices of the basilar artery may provide insights into the mechanisms underlying the development of eclampsia.