Abstract
Neurological emergencies occur rarely in pregnant patients, but clinicians need an acute awareness of these diseases and a low threshold to investigate symptoms. Like nonpregnant patients, pregnant patients can experience ischemic stroke, hemorrhagic stroke, autoimmune neuromuscular weakness, seizures, and flare-ups of chronic neurological problems. Special considerations must be taken, however, in investigating the pathological etiology, investigational workup, and treatment options as these aspects can differ greatly from the general patient. In order to prevent iatrogenic complications, clinicians should also have knowledge of radiation limitations and teratogenic medications.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Frontera JA, Ahmed W. Neurocritical care complications of pregnancy and puerperum. J Crit Care. 2014;29(6):1069–81.
Cripe SM, Frederick IO, Qiu C, Williams MA. Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy. Paediatr Perinat Epidemiol. 2011;25(2):116–23.
Lynch KM, Brett F. Headaches that kill: a retrospective study of incidence, etiology and clinical features in cases of sudden death. Cephalalgia. 2012;32(13):972–8.
Aromaa M, Rautava P, Helenius H, Sillanpaa ML. Prepregnancy headache and the well-being of mother and newborn. Headache. 1996;36(7):409–15.
Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987–2004. Am J Hypertens. 2008;21(5):521–6.
Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545–88.
Singhal AB. Postpartum angiopathy with reversible posterior leukoencephalopathy. Arch Neurol. 2004;61(3):411–6.
Roth C, Ferbert A. The posterior reversible encephalopathy syndrome: what’s certain, what’s new? Pract Neurol. 2011;11(3):136–44.
Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914–25. Epub 2015 Jul 13
Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29(6):1036–42.
Fugate JE, Wijdicks EF, Parisi JE, Kallmes DF, Cloft HJ, Flemming KD, Giraldo EA, Rabinstein AA. Fulminant postpartum cerebral vasoconstriction syndrome. Arch Neurol. 2012;69(1):111–7.
Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol. 1993;33(2):222–5.
Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995;345(8963):1455–63.
Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med. 1995;333(4):201–5.
Hull AD, Long DM, Longo LD, Pearce WJ. Pregnancy-induced changes in ovine cerebral arteries. Am J Phys. 1992;262(1 Pt 2):R137–43.
Koellhoffer EC, McCullough LD. The effects of estrogen in ischemic stroke. Transl Stroke Res. 2013;4(4):390–401.
Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785–99.
Sibai BM. Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol. 2012;206(6):470–5.
Wiese KM, Talkad A, Mathews M, Wang D. Intravenous recombinant tissue plasminogen activator in a pregnant woman with cardioembolic stroke. Stroke. 2006;37(8):2168–9.
Murugappan A, Coplin WM, Al-Sadat AN, McAllen KJ, Schwamm LH, Wechsler LR, et al. Thrombolytic therapy of acute ischemic stroke during pregnancy. Neurology. 2006;66(5):768–70.
Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21.
Aaron S, Shyamkumar NK, Alexander S, Babu PS, Prabhakar AT, Moses V, et al. Mechanical thrombectomy for acute ischemic stroke in pregnancy using the penumbra system. Ann Indian Acad Neurol. 2016;19(2):261–3.
Zhu F, Gory B, Mione G, Humbertjean L, Derelle AL, Richard S. Combined reperfusion therapy to treat cryptogenic acute ischemic stroke during the first trimester of pregnancy: case report and literature review. Ther Clin Risk Manag. 2018;14:1677–83.
Watanabe TT, Ichijo M, Kamata T. Uneventful pregnancy and delivery after thrombolysis plus thrombectomy for acute ischemic stroke: case study and literature review. J Stroke Cerebrovasc Dis. 2019;28:70–5.
Shah SS, Snelling BM, Brunet MC, Sur S, McCarthy D, Stein A, et al. Transradial mechanical thrombectomy for proximal Mca occlusion in a first trimester pregnancy: case report and literature review. World Neurosurg. 2018;120:415.
Bhogal P, Aguilar M, AlMatter M, Karck U, Bazner H, Henkes H. Mechanical thrombectomy in pregnancy: report of 2 cases and review of the literature. Interv Neurol. 2017;6(1–2):49–56.
Stam J, De Bruijn SF, DeVeber G. Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev. 2002;(4):CD002005.
Kashkoush AI, Ma H, Agarwal N, Panczykowski D, Tonetti D, Weiner GM, et al. Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review. J Clin Neurosci. 2017;39:9–15.
Horton JC, Chambers WA, Lyons SL, Adams RD, Kjellberg RN. Pregnancy and the risk of hemorrhage from cerebral arteriovenous malformations. Neurosurgery. 1990;27(6):867–71.. discussion 71–2
Porras JL, Yang W, Philadelphia E, Law J, Garzon-Muvdi T, Caplan JM, et al. Hemorrhage risk of brain arteriovenous malformations during pregnancy and puerperium in a North American Cohort. Stroke. 2017;48(6):1507–13.
Ogilvy CS, Stieg PE, Awad I, Brown RD Jr, Kondziolka D, Rosenwasser R, et al. Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Circulation. 2001;103(21):2644–57.
Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, et al. Management of Brain Arteriovenous Malformations: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017;48(8):e200–e24.
Dias MS, Sekhar LN. Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery. 1990;27(6):855–65.. discussion 65–6
Rajiv KR, Radhakrishnan A. Status epilepticus in pregnancy: etiology, management, and clinical outcomes. Epilepsy Behav. 2017;76:114–9.
Lu YT, Hsu CW, Tsai WC, Cheng MY, Shih FY, Fu TY, et al. Status epilepticus associated with pregnancy: a cohort study. Epilepsy Behav. 2016;59:92–7.
Wu M, Hao N, Yan B, Chi X, Zhou D. Status epilepticus in pregnant women with epilepsy after valproate adjustment: a case series. Seizure. 2016;43:39–41.
Chan LY, Tsui MH, Leung TN. Guillain-Barre syndrome in pregnancy. Acta Obstet Gynecol Scand. 2004;83(4):319–25.
Djelmis J, Sostarko M, Mayer D, Ivanisevic M. Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol. 2002;104(1):21–5.
Batocchi AP, Majolini L, Evoli A, Lino MM, Minisci C, Tonali P. Course and treatment of myasthenia gravis during pregnancy. Neurology. 1999;52(3):447–52.
Atwell TD, Lteif AN, Brown DL, McCann M, Townsend JE, Leroy AJ. Neonatal thyroid function after administration of IV iodinated contrast agent to 21 pregnant patients. AJR Am J Roentgenol. 2008;191(1):268–71.
Committee on Obstetric P. Committee opinion no. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210–e6.
Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316(9):952–61.
Radiology ACo. ACR manual on contrast media. Version 10.3. 2017.
Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23.
Osei EK, Faulkner K. Fetal doses from radiological examinations. Br J Radiol. 1999;72(860):773–80.
Wakeford R, Little MP. Risk coefficients for childhood cancer after intrauterine irradiation: a review. Int J Radiat Biol. 2003;79(5):293–309.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Siegel, J. (2020). Neurological Emergencies in Pregnant Patients. In: Rabinstein, A. (eds) Neurological Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-030-28072-7_20
Download citation
DOI: https://doi.org/10.1007/978-3-030-28072-7_20
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-28071-0
Online ISBN: 978-3-030-28072-7
eBook Packages: MedicineMedicine (R0)