Advertisement

Neurological Emergencies in Pregnant Patients

  • Jason SiegelEmail author
Chapter

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.

Keywords

Pregnancy Preeclampsia Eclampsia PRES RCVS Amniotic fluid embolism Stroke Status epilepticus 

References

  1. 1.
    Frontera JA, Ahmed W. Neurocritical care complications of pregnancy and puerperum. J Crit Care. 2014;29(6):1069–81.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Aromaa M, Rautava P, Helenius H, Sillanpaa ML. Prepregnancy headache and the well-being of mother and newborn. Headache. 1996;36(7):409–15.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Singhal AB. Postpartum angiopathy with reversible posterior leukoencephalopathy. Arch Neurol. 2004;61(3):411–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Roth C, Ferbert A. The posterior reversible encephalopathy syndrome: what’s certain, what’s new? Pract Neurol. 2011;11(3):136–44.PubMedCrossRefGoogle Scholar
  9. 9.
    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 13PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29(6):1036–42.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol. 1993;33(2):222–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995;345(8963):1455–63.Google Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.Google Scholar
  16. 16.
    Koellhoffer EC, McCullough LD. The effects of estrogen in ischemic stroke. Transl Stroke Res. 2013;4(4):390–401.PubMedCrossRefGoogle Scholar
  17. 17.
    Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785–99.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Sibai BM. Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol. 2012;206(6):470–5.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Stam J, De Bruijn SF, DeVeber G. Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev. 2002;(4):CD002005.Google Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    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 71–2PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar
  33. 33.
    Dias MS, Sekhar LN. Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery. 1990;27(6):855–65.. discussion 65–6PubMedCrossRefGoogle Scholar
  34. 34.
    Rajiv KR, Radhakrishnan A. Status epilepticus in pregnancy: etiology, management, and clinical outcomes. Epilepsy Behav. 2017;76:114–9.PubMedCrossRefGoogle Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar
  37. 37.
    Chan LY, Tsui MH, Leung TN. Guillain-Barre syndrome in pregnancy. Acta Obstet Gynecol Scand. 2004;83(4):319–25.PubMedGoogle Scholar
  38. 38.
    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.PubMedCrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    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.PubMedCrossRefGoogle Scholar
  41. 41.
    Committee on Obstetric P. Committee opinion no. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210–e6.CrossRefGoogle Scholar
  42. 42.
    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.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Radiology ACo. ACR manual on contrast media. Version 10.3. 2017.Google Scholar
  44. 44.
    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.PubMedCrossRefGoogle Scholar
  45. 45.
    Osei EK, Faulkner K. Fetal doses from radiological examinations. Br J Radiol. 1999;72(860):773–80.PubMedCrossRefGoogle Scholar
  46. 46.
    Wakeford R, Little MP. Risk coefficients for childhood cancer after intrauterine irradiation: a review. Int J Radiat Biol. 2003;79(5):293–309.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Departments of Neurology, Neurosurgery, and Critical Care MedicineMayo Clinic FloridaJacksonvilleUSA

Personalised recommendations