Eclampsia, a severe complication of preeclampsia, is a life-threatening condition characterized by seizures in pregnant women with hypertension and proteinuria. It poses a significant risk to both maternal and fetal health, particularly in rural healthcare settings where early diagnosis and intervention are challenging1-2. Magnetic Resonance Imaging (MRI) of the brain plays a crucial role in identifying neurological complications, including posterior reversible encephalopathy syndrome (PRES), cerebral edema, infarctions, and hemorrhagic lesions, which are commonly associated with eclampsia3. This study aims to analyze the clinical and biochemical parameters of eclamptic patients and correlate them with MRI findings to improve diagnostic accuracy and patient management. Conducted in a rural tertiary referral center in the Darjeeling district, this research seeks to bridge the gap in understanding how biochemical markers and clinical presentations correspond with radiological abnormalities in eclampsia. By identifying patterns and associations, the study hopes to enhance early detection, guide therapeutic interventions, and reduce the morbidity and mortality associated with eclamptic complications in resource-limited settings3-5. Preeclampsia is a state of complicated multi-organ dysfunction with hypertension and proteinuria after 20 weeks of pregnancy. When a patient with Preeclampsia develops seizures (not associated with any other neurological abnormality) it is termed as Eclampsia. Onset may be before, during, or after delivery6. Most often it is during the second half of pregnancy. The seizures are of the tonic-clonic type and typically last about a minute. Following the seizure there is typically either a period of confusion or coma. Complications include aspiration pneumonia, cerebral hemorrhage, kidney failure, pulmonary oedema, HELLP syndrome, coagulopathy, abruptio placentae and cardiac arrest. The radiological findings of patients with Eclampsia are very similar to those with Hypertensive encephalopathy, Cerebral edema, gross and petechial hemorrhages, ischemic micro-infarcts are some of them7. With the recent advances in Magnetic Resonance Imaging and the ease of access to it has encouraged and helped us understand the neurological and anatomical variations associated with the disease. [4-6] In our study we aim to understand the correlation MRI findings and the biochemical changes along with the clinical findings of Eclampsia patients admitted in North Bengal Medical college over the study period of 1.5 year6-7. AIMS AND OBJECTIVES To study the biochemical clinical correlation with the MRI Brain findings of patients with Eclampsia admitted in North Bengal Medical College and Hospital.

This observational study was conducted to assess the clinical and biochemical correlation with different MRI brain findings in patients with eclampsia. A descriptive study design was used to analyze and describe various MRI abnormalities and their association with clinical and biochemical parameters in eclamptic patients. The study was conducted in the Department of Obstetrics & Gynaecology, North Bengal Medical College, Darjeeling District, West Bengal, over a total duration of 1.5 years, covering data collection, analysis, and interpretation. The study period was from 1st July 2021 to 1st December 2021. The study population included patients diagnosed with eclampsia, admitted either through the Labour Room, Outpatient Department (OPD), or Emergency Department in the Department of Gynaecology and Obstetrics at North Bengal Medical College and Hospital. Patients were included if they had at least one episode of seizure occurring after 20 weeks of gestation or within six weeks postpartum, with blood pressure ≥140 mmHg systolic and ≥90 mmHg diastolic, and urine albumin levels ≥ 0.3 g/L in both antepartum and postpartum cases. Exclusion criteria included pre-existing seizure disorders, metabolic seizures, space-occupying lesions (SOL), infections, presence of metallic implants contraindicating MRI, migraine, and claustrophobia. A total of 50 patients were included in the study, using a total enumeration sampling technique where all eligible patients admitted during the study period were considered. Data was collected from medical records and patient interviews, including socio-demographic details, clinical history, biochemical investigations, MRI findings, treatment interventions, and patient outcomes. The data was recorded in pre-designed information sheets and analyzed using MS Excel and appropriate statistical software to identify correlations between clinical, biochemical, and radiological findings. The study used a pre-designed and pre-tested semi-structured proforma to collect information, which included personal details, clinical history, investigations, imaging findings, and referral details. Additional medical records such as history and treatment sheets, Operation Theatre (OT) records, admission tickets, and statistical support from the Department of Community Medicine were utilized for data validation.

Table 1: Distribution according to age Age in years Number Percentage 18-20 12 24% 21-25 29 58% 26-35 9 18% Mean age in years 23.8 ± 4.2 The majority of patients (58%) were aged 21-25 years, followed by 24% in the 18-20 years group and 18% in the 26-35 years group, with a mean age of 23.8 ± 4.2 years. Table 2: Distribution according to gestational age Gestational Age at Presentation Number Percentage (%) 28-34 weeks 25 50% 34-40 weeks 20 40% <28 weeks or postpartum 5 10% Gestational age at presentation varied, with 50% of patients presenting between 28-34 weeks, 40% between 34-40 weeks, and 10% at less than 28 weeks or postpartum, indicating a higher prevalence in the third trimester. Table 3: Distribution according to mode of admission Mode of admission Number Percentage Emergency (Labour Room): 32 64% Referred from Peripheral Centers 14 28% OPD Admission 4 8% The majority of patients (64%) were admitted through the emergency labor room, while 28% were referred from peripheral centers, and 8% were admitted via the outpatient department (OPD), reflecting the diverse modes of hospital entry. Table 4: clinical features of patients Clinical Features Number Percentage Headache 44 88% Visual Disturbances 28 56% Altered Consciousness 15 30% Neurological Deficit 6 12% In our study, the most common clinical feature was headache, observed in 88% of patients, followed by visual disturbances in 56%. Altered consciousness was present in 30% of cases, while neurological deficits were noted in 12%, highlighting the varied neurological manifestations. Table 5: Seizure Episodes Before Admission Number of Seizures before admission Number Percentage 1-2 episodes 30 60% ≥3 episodes 20 40% Before admission, 60% of patients experienced 1-2 seizure episodes, while 40% had three or more episodes, indicating a higher seizure burden in a significant proportion of cases. Table 6: Biochemical Findings and Correlation with MRI Abnormalities Biochemical Parameter Number Patients (%) MRI Findings (%) Serum Creatinine >1.2 mg/dL 15 30% 70% had PRES Liver Enzyme Elevation (AST/ALT >70 IU/L) 23 45% 60% had edema in occipital lobes Thrombocytopenia (<1,00,000/mm³) 10 20% 50% had micro-haemorrhages Proteinuria (>0.3 g/L) 40 80% 72% had white matter hyperintensities Severe Hypertension (BP ≥160/110 mmHg) 29 58% 80% had significant MRI abnormalities In our study, biochemical abnormalities were associated with significant MRI findings, with 30% of patients having serum creatinine >1.2 mg/dL, of whom 70% had PRES. Liver enzyme elevation (AST/ALT >70 IU/L) was observed in 45% of patients, with 60% showing edema in the occipital lobes, while thrombocytopenia (<1,00,000/mm³) was present in 20%, with 50% exhibiting microhemorrhages. Proteinuria (>0.3 g/L) was noted in 80% of cases, with 72% displaying white matter hyperintensities, and severe hypertension (BP ≥160/110 mmHg) was seen in 58% of patients, of whom 80% had significant MRI abnormalities. Table 7: Management and Outcome Parameters Number Percentage ICU admission 20 40% Antihypertensive Therapy labetalol 46 92% for seizure control magnesium sulfate (MgSO₄) 29 58% Mode of Delivery: Cesarean Section 34 68% Vaginal Delivery 16 32% Maternal mortality 1 2% (1 patient due to intracerebral hemorrhage). Fetal Outcome: Preterm Births 21 42% Neonatal ICU Admission 15 30% Stillbirths 4 8% In our study, 40% of patients required ICU admission, 92% received labetalol, and 58% required magnesium sulfate for seizure control. Cesarean delivery was performed in 68% of cases, maternal mortality was 2%, and fetal outcomes included 42% preterm births, 30% neonatal ICU admissions, and 8% stillbirths.

Eclampsia is a severe and life-threatening complication of preeclampsia, characterized by the occurrence of seizures in hypertensive pregnant women with proteinuria. It remains a significant cause of maternal and fetal morbidity and mortality, especially in rural healthcare settings where timely diagnosis and intervention are often challenging. In this study, we explored the clinical and biochemical correlations of eclampsia with different MRI brain findings in patients admitted to a rural tertiary referral center. The findings emphasize the role of MRI in detecting neurological complications such as Posterior Reversible Encephalopathy Syndrome (PRES), cerebral edema, infarctions, and hemorrhagic lesions, which are frequently associated with eclampsia. Our results demonstrate that PRES was the most common MRI abnormality, observed in 68% of patients, predominantly affecting the parieto-occipital lobes. This aligns with existing literature, which describes PRES as a hallmark finding in hypertensive encephalopathy and eclampsia. The strong correlation between PRES and severe hypertension (BP ≥160/110 mmHg) in 80% of cases highlights the role of elevated blood pressure in the pathogenesis of cerebral edema. Vasogenic edema (56%) was the most frequent pattern observed, reinforcing the theory that endothelial dysfunction due to severe hypertension and systemic inflammation plays a critical role in eclampsia-related brain changes. Biochemical abnormalities were also significantly associated with MRI findings. Serum creatinine elevation (>1.2 mg/dL) was observed in 30% of patients, of which 70% had PRES, suggesting that renal dysfunction may contribute to cerebral autoregulation disturbances. Elevated liver enzymes (AST/ALT >70 IU/L) were found in 45% of cases, with 60% showing cerebral edema, which is consistent with multi-organ involvement in eclampsia. Thrombocytopenia (<1,00,000/mm³) was detected in 20% of patients, with 50% of these cases showing microhemorrhages on MRI, supporting the hypothesis that coagulopathy plays a role in the pathophysiology of cerebrovascular complications. The clinical presentation of patients in this study was also in line with previous reports. The most common symptoms were headache (88%), visual disturbances (56%), altered consciousness (30%), and neurological deficits (12%). Patients with multiple seizures (>3 episodes) before admission (40%) were more likely to have severe MRI abnormalities, indicating a possible link between prolonged seizure activity and the extent of cerebral involvement. The study also highlighted management and outcomes, emphasizing the importance of early diagnosis and aggressive treatment. 40% of patients required ICU admission, with 92% receiving antihypertensive therapy (primarily labetalol) and 58% requiring magnesium sulfate (MgSO₄) for seizure control. The mode of delivery was cesarean section in 68% of cases due to maternal or fetal distress, while 32% had vaginal deliveries. Maternal mortality was 2% (one patient due to intracerebral hemorrhage), and adverse fetal outcomes included preterm births (42%), NICU admissions (30%), and stillbirths (8%), reinforcing the devastating impact of eclampsia on both maternal and neonatal health. Comparative Analysis with Existing Studies Our study findings align with prior research on eclampsia-related MRI changes. Studies have consistently demonstrated a strong link between PRES and severe hypertension, along with a predilection for vasogenic edema and cortical involvement. Additionally, the association of thrombocytopenia and hemorrhagic lesions is well-documented, as low platelet counts increase the risk of microvascular bleeding in the brain. A study by Hinchey et al. (1996) first described PRES in eclampsia, emphasizing its reversible nature with timely blood pressure control and seizure management. Similar findings were reported by Fugate et al. (2010), who found that early MRI detection of PRES and aggressive treatment significantly reduced neurological complications. Our study supports these conclusions, highlighting that timely MRI assessment can guide targeted therapy and improve clinical outcomes. Strengths and Limitations The strength of this study lies in its comprehensive approach, incorporating clinical, biochemical, and radiological correlations in a rural tertiary care setting, an area where access to advanced neuroimaging is often limited. The total enumeration sampling technique ensured that all eligible patients were included, reducing selection bias. However, the study has some limitations. First, the sample size (50 patients) was relatively small, limiting the generalizability of the findings. Second, follow-up MRI scans were not performed, which could have provided insights into the reversibility of PRES and other lesions post-treatment. Third, the study was hospital-based, which may not reflect the true community prevalence of eclampsia-related neurological complications. Future studies with larger sample sizes, multi-center collaborations, and longitudinal follow-ups are needed to validate and expand upon these findings.

This study reinforces the importance of MRI brain imaging in eclamptic patients, with PRES emerging as the most common abnormality (68%), strongly correlating with severe hypertension, proteinuria, and biochemical abnormalities. Thrombocytopenia and elevated liver enzymes were associated with cerebral edema and hemorrhagic changes, suggesting a role of coagulation dysfunction and systemic inflammation in eclampsia-related brain pathology. Early diagnosis and timely intervention, including antihypertensive therapy and seizure control, significantly improved maternal and fetal outcomes. These findings highlight the need for increased access to neuroimaging in rural healthcare settings, where eclampsia remains a leading cause of maternal morbidity and mortality. Future research should focus on long-term neurological outcomes in eclamptic patients and strategies to improve early detection and management, particularly in resource-limited settings.

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