Vasospasms Are Characteristic in Cases with Eclampsia/Preeclampsia and HELLP Syndrome: Proposal of an Angiospastic Syndrome of Pregnancy

Takao Kobayashi; Naoki Tokunaga; Haruo Isoda; Naohiro Kanayama; Toshihiko Terao

doi:10.1055/s-2001-14071

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2001; 27(2): 131-136
DOI: 10.1055/s-2001-14071

Vasospasms Are Characteristic in Cases with Eclampsia/Preeclampsia and HELLP Syndrome: Proposal of an Angiospastic Syndrome of Pregnancy

Takao Kobayashi¹ , Naoki Tokunaga¹ , Haruo Isoda² , Naohiro Kanayama¹ , Toshihiko Terao¹

¹Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan and
²Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan

Abstract

ABSTRACT

We attempted to prove the occurrence of generalized vasospasms in cases with eclampsia/preeclampsia and HELLP syndrome and to suggest the existence of an angiospastic syndrome of pregnancy. Sixteen cases with severe preeclampsia were evaluated. Among them, three cases were complicated by eclampsia and one case with HELLP syndrome. Cranial magnetic resonance angiography (MRA) was performed in 15 cases, and celiac angiography was performed in one case. Vasospasms were observed in 12 cases (75.0%), including all cases involving eclampsia and HELLP syndrome, and cerebral infarction was observed in one case. Typical vasospasms were found by MRA in the middle and posterior cerebral arteries with peripheral ischemic changes in cases with severe preeclampsia and eclampsia. Vasospasms of the hepatic arteries were observed by celiac angiography in a case with HELLP syndrome. Vasospasms are characteristic for patients with eclampsia/preeclampsia and HELLP syndrome, and the existence of an angiospastic syndrome of pregnancy is proposed.

KEYWORD

Preeclampsia - eclampsia - HELLP syndrome - vasospasms - magnetic resonance angiography (MRA)

Full Text

References

REFERENCES

1 Matsuda Y, Tomosugi T, Maeda Y. Cerebral magnetic resonance angiographic findings in severe preeclampsia. Gynecol Obstet Invest . 1995; 40 249-252
2 Kobayashi T, Terao T. Preeclampsia as chronic disseminated intravascular coagulation. Gynecol Obstet Invest . 1987; 24 170-178
3 Caritis S, Sibai B, Hauth J. Low-dose aspirin to prevent preeclampsia in women at high risk. N Engl J Med . 1998; 339 667-671
4 Sibai B M. Treatment of hypertension in pregnant women. N Engl J Med . 1996; 335 257-265
5 Khatun S, Kanayama N, Belayet H. Erratum to ``Increased concentrations of plasma epinephrine and norepinephrine in patients with eclampsia''. Eur J Obstet Gynecol Reprod Biol . 1997; 74 103-109
6 Belayet H, Kanayama N, Khatun S. Decreased renal and hepatic blood flow with preeclampsia-like histologic changes was obtained by stimulation of the celiac ganglion with LPS. Am J Perinatol . 1998; 15 109-114
7 Khatun S, Kanayama N, Sato E. Eclamptic plasma stimulates norepinephrine release in cultured sympathetic nerve. Hypertension . 1998; 31 1343-1349
8 Halim A, Kanayama N, El Maradny E. Correlated plasma elastase and sera cytotoxicity in eclampsia. A possible role of endothelin-1 induced neutrophil activation in preeclampsia-eclampsia. Am J Hypertens . 1996; 9 33-38
9 Kobayashi T, Sugimura M, Kanayama N. Coagulation/ fibrinolysis disorders in patients with severe preeclampsia. Semin Thromb Hemost . 1999; 25 451-454
10 Halim A, Kanayama N, El Maradny E. HELLP syndrome-like biochemical parameters obtained with endothelin-1 injection in rabbits. Gynecol Obstet Invest . 1993; 35 193-198
11 Halim A, Kanayama N, Maehara K. Eclampsia-like seizures and electroencephalographic changes in pregnant rabbits with endothelin-1 injection. Gynecol Obstet Invest . 1995; 39 1-7
12 Schobel H P, Fischer T, Heuszer K. Preeclampsia-a state of sympathetic overactivity. N Engl J Med . 1996; 335 1480-1485
13 Lee M I, Todd H M. Plasma catecholamines and angiotensin converting enzyme activity in hypertensive subjects with positive rollover test. Obstet Gynecol . 1984; 63 511-514
14 Kanayama N, She L, Maehara K. Induction of HELLP syndrome-like biochemical parameters by stimulation of the celiac ganglion in rats. J Hypertens . 1996; 14 453-459
15 Kanayama N, Tsujimura R, She L. Cold-induced stress stimulates the sympathetic nervous system, causing hypertension and proteinuria in rats. J Hypertens . 1997; 15 383-389
16 Ramos-Santos E, Devoe L D, Wakefield M L. The effects of epidural anesthesia on the Doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor. Obstet Gynecol . 1991; 77 20-26
17 Jouppila P, Jouppila R, Hollmen A, Koivula A. Lumbar epidural anesthesia to improve intervillous blood flow during labor in severe preeclampsia. Obstet Gynecol . 1982; 59 158-161
18 Kanayama N, Belayet H, Khatun S. A new treatment of severe pre-eclampsia by long-term epidural anaesthesia. J Hum Hypertens . 1999; 13 167-171