Assessment of Transcranial Doppler (TCD)-based Cerebral Hemodynamics in Preeclamptic Women.

Abstract

Introduction: Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with endothelial dysfunction and neurological complications such as posterior reversible encephalopathy syndrome (PRES). Conventional laboratory tests do not adequately capture cerebral involvement. Transcranial Doppler (TCD) offers a non-invasive method to assess cerebral hemodynamics. This study aimed to characterize cerebral flow dynamics in Indian women with PE.

Methods: A cross-sectional observational study was conducted including 44 pregnant women (25 with PE, 19 normotensives). PE was diagnosed using ISSHP criteria. TCD insonation of middle, anterior, and posterior cerebral arteries was performed with a 2 MHz probe via transtemporal windows. Parameters measured were peak systolic velocity (PSV), end-diastolic velocity (EDV), cerebral perfusion pressure (CPP), and resistance-area product (RAP). Data were analyzed using SPSS v20.0 with Student's t-test and Kruskal-Wallis tests.

Results: PE participants demonstrated significantly higher systolic, diastolic, and mean arterial pressures (p 0.001). TCD revealed increased PSV in bilateral MCA, reduced EDV, and elevated CPP across MCA, ACA, and PCA compared to controls. RAP was markedly raised in the PCA, suggesting impaired autoregulation and posterior circulation vulnerability to hyperperfusion.

Discussion: The study revealed significantly elevated peak systolic velocities (PSV), raised cerebral perfusion pressures (CPP) in the middle and posterior cerebral arteries (MCA and PCA) of preeclamptics, with concurrent reductions in end-diastolic velocity (EDV). Resistance Area Product (RAP) was increased in the PCA, suggesting impaired autoregulation and increased susceptibility to hyperperfusionrelated injury. These hemodynamic disturbances, particularly in the posterior circulation, may serve as early indicators of PRES risk. TCD provides a feasible bedside tool for antenatal neurovascular risk stratification. Larger, multicenter studies are warranted to establish predictive thresholds for clinical use.