Diffusion-weighted Imaging Shows Cytotoxic and Vasogenic Edema in Eclampsia

24-year-old woman, 38 weeks' pregnant, with proteinuria, pedal edema, and a blood pressure of 160/110 mm Hg.

A, T2-weighted MR image (4000/96/1) shows hyperintense abnormalities in the cortical and subcortical regions of the occipital lobes.

B, Diffusion-weighted MR image (8000/100/1) shows the T2 abnormalities in A to have a predominantly low signal, suggestive of vasogenic edema (arrowheads). However, the two hyperintense areas (arrows) are consistent with cytotoxic edema.

C, ADC map shows predominantly hyperintense areas of free motion of water, as seen in vasogenic edema (arrowheads). Two areas of restricted motion of water (arrows) correspond to the diffusion-weighted hyperintensities in B. These are suggestive of ischemic injury.

D, FLAIR sequence (6000/128/1) obtained 3 months later shows tissue loss in the areas that were hypointense on the ADC map (arrowheads).