Neurological Emergencies During Pregnancy

 

PRES
RCVS
CVT
Eclampsia
Mode of onset
Rapid, postpartum
Abrupt, postpartum
Third trimester or later, gradual
Antepartum, intrapartum or postpartum
Key findings
Seizures. May be accompanied by stupor, visual loss or hallucinations. Headache dull and throbbing
Thunderclap headache. Seizures are less common. Transient focal deficits
Headache is universal, progressive and diffuse. Seizures in 40 %
Seizures, frequent visual symptoms, abdominal pain, hyperreflexia, hypertension and proteinuria
Evolution over time
If BP is controlled, resolves within short period
Changes over time. ICH, second week; ischaemic complications, third week
Evolves over several days, non-arterial territorial infarcts and haemorrhages might develop
Can evolve (from pre-eclampsia) gradually or abruptly
CSF findings
Usually normal
Often normal. Fifty per cent of cases have pleocytosis and raised proteins
Pressure raised in 80 %; 30–50 % have raised proteins and cell counts
Usually normal unless complicated by haemorrhage
Imaging
CT positive in about 50 % of patients; MRI shows prominent T2-weighted and FLAIR abnormalities nearly always in parieto-occipital lobes, but can involve other brain regions; intracerebral haemorrhage in about 15 % of patients

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Sep 23, 2016 | Posted by in OBSTETRICS | Comments Off on Neurological Emergencies During Pregnancy

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