Acute Neurological Issues in Pregnancy and the Peripartum

Abstract

Acute neurological diseases requiring hospitalization are relatively rare in women of childbearing age. However, during pregnancy and the postpartum period, several diseases increase in prevalence. Some are unique to the pregnant/postpartum state including preeclampsia and delivery-associated neuropathies. Others, although indirectly related to pregnancy, such as cerebral venous thrombosis, ischemic stroke, and intracerebral hemorrhage, increase in frequency and carry considerable risk of morbidity and mortality. In addition, treatment options are often limited. This review discusses the diseases more commonly seen during pregnancy and the postpartum period, with a focus on emergent neurological diseases and their management. Interventional therapies will also be discussed.

Maternal and Neonatal outcome in eclampsia in a tertiary care hospital in India

“…However, women in whom eclampsia develops exhibit a wide spectrum of signs, ranging from severe hypertension, severe proteinuria and generalized edema to absent or minimal hypertension, no proteinuria, and no edema [4] . Common signs and symptoms associated with eclampsia include persistent occipital or frontal headaches, blurred vision, photophobia, epigastric and/or right upperquadrant pain, and altered mental status [5] .…”

Postpartum vertebral artery dissection with posterior reversible encephalopathy syndrome

“…PRES is characterised by headaches, seizures and visual changes 3. Characteristic imaging features often include focal regions of symmetric oedema in the posterior brain parenchyma, as well as in other brain regions 3.…”

“…Characteristic imaging features often include focal regions of symmetric oedema in the posterior brain parenchyma, as well as in other brain regions 3. The pathogenesis is hypothesised to involve disorders of cerebral autoregulation and/or endothelial dysfunction with increased permeability of the blood–brain barrier 3. PRES generally develops in the setting of preeclampsia/eclampsia, but may also develop in the puerperium and as a presenting feature of late eclampsia 3.…”

“…We reached a diagnosis of postpartum eclampsia with PRES, based on the clinical course and previously reported MRI findings 3. RCVS is usually diagnosed from the presence of arterial narrowing on angiography.…”

Hemorragia intracraneal asociada a preeclampsia severa

“…En la HIC, la cefalea es el signo más común y en ocasiones, es muy difícil de diferenciar con la cefalea benigna, a menos que aparezcan graves complicaciones (14). También puede manifestarse con nauseas, vómitos, convulsiones, alteraciones de la consciencia, alteraciones visuales, parálisisaumento del hematoma en el control tomográfico, se decidió no realizar estudios adicionales.…”