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Wesley SR, Vates GE, Thornburg LL. Neurologic Emergencies in Pregnancy. Obstet Gynecol 2024:00006250-990000000-01058. [PMID: 38626451 DOI: 10.1097/aog.0000000000005575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/29/2024] [Indexed: 04/18/2024]
Abstract
Neurologic emergencies in pregnancy require prompt evaluation and early, focused intervention to improve neurologic outcomes for the affected person and to avoid further injury. Neurologic events in pregnancy, although rare, present a time of extreme risk of permanent injury for the person who is pregnant. Therefore, obstetric clinicians should be well versed in the risk factors for potential neurologic events and understand the symptoms and events that should prompt evaluation for a neurologic event. In addition, they should support other specialties in aggressive and early neurologic care for the patient to improve outcomes while assessing fetal well-being and care optimization for the dyad. Obstetric clinicians can uniquely provide knowledge of changes in pregnancy physiology that can increase the risk of neurologic events, as well as change the treatment of these events. For all patients with neurologic events, "time is brain." Therefore, it is important to be aware of changes in common presenting pregnancy concerns that should prompt evaluation for other pathogeneses. Finally, pregnancy care teams should be prepared to begin the initial stabilization and management of acute neurologic emergencies, including seizure, stroke, and meningitis, while seeking aid from other medical and neurologic specialists who can support their care and interventions. Early and aggressive interventions for individuals with neurologic events during pregnancy and postpartum are critical to the overall well-being of the dyad.
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Affiliation(s)
- Shaun R Wesley
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Division of Neuroendocrine Disorders, Department of Neurosurgery, University of Rochester, Rochester, New York
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Joshi G, Gilyard SN, Sehi DA, Herr KD, Mellnick VM, Javidan C. Organ System Review of Nonobstetric Complications and Emergencies of Pregnancy. Radiographics 2023; 43:e220140. [PMID: 37410626 DOI: 10.1148/rg.220140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Gayatri Joshi
- From the Department of Radiology and Imaging Sciences (G.J., S.N.G., K.D.H.) and Department of Emergency Medicine (G.J., K.D.H.), Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308; Department of Radiology and Imaging Sciences, Grady Medical Hospital, Atlanta, Ga (G.J., K.D.H.); DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, Tenn (D.A.S.); and Mallinckrodt Institute of Radiology (V.M.M., C.J.) and Department of Pediatrics, Saint Louis Children's Hospital (C.J.), Washington University School of Medicine, St Louis, Mo
| | - Shenise N Gilyard
- From the Department of Radiology and Imaging Sciences (G.J., S.N.G., K.D.H.) and Department of Emergency Medicine (G.J., K.D.H.), Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308; Department of Radiology and Imaging Sciences, Grady Medical Hospital, Atlanta, Ga (G.J., K.D.H.); DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, Tenn (D.A.S.); and Mallinckrodt Institute of Radiology (V.M.M., C.J.) and Department of Pediatrics, Saint Louis Children's Hospital (C.J.), Washington University School of Medicine, St Louis, Mo
| | - Daniel A Sehi
- From the Department of Radiology and Imaging Sciences (G.J., S.N.G., K.D.H.) and Department of Emergency Medicine (G.J., K.D.H.), Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308; Department of Radiology and Imaging Sciences, Grady Medical Hospital, Atlanta, Ga (G.J., K.D.H.); DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, Tenn (D.A.S.); and Mallinckrodt Institute of Radiology (V.M.M., C.J.) and Department of Pediatrics, Saint Louis Children's Hospital (C.J.), Washington University School of Medicine, St Louis, Mo
| | - Keith D Herr
- From the Department of Radiology and Imaging Sciences (G.J., S.N.G., K.D.H.) and Department of Emergency Medicine (G.J., K.D.H.), Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308; Department of Radiology and Imaging Sciences, Grady Medical Hospital, Atlanta, Ga (G.J., K.D.H.); DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, Tenn (D.A.S.); and Mallinckrodt Institute of Radiology (V.M.M., C.J.) and Department of Pediatrics, Saint Louis Children's Hospital (C.J.), Washington University School of Medicine, St Louis, Mo
| | - Vincent M Mellnick
- From the Department of Radiology and Imaging Sciences (G.J., S.N.G., K.D.H.) and Department of Emergency Medicine (G.J., K.D.H.), Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308; Department of Radiology and Imaging Sciences, Grady Medical Hospital, Atlanta, Ga (G.J., K.D.H.); DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, Tenn (D.A.S.); and Mallinckrodt Institute of Radiology (V.M.M., C.J.) and Department of Pediatrics, Saint Louis Children's Hospital (C.J.), Washington University School of Medicine, St Louis, Mo
| | - Cylen Javidan
- From the Department of Radiology and Imaging Sciences (G.J., S.N.G., K.D.H.) and Department of Emergency Medicine (G.J., K.D.H.), Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308; Department of Radiology and Imaging Sciences, Grady Medical Hospital, Atlanta, Ga (G.J., K.D.H.); DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, Tenn (D.A.S.); and Mallinckrodt Institute of Radiology (V.M.M., C.J.) and Department of Pediatrics, Saint Louis Children's Hospital (C.J.), Washington University School of Medicine, St Louis, Mo
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Abstract
PURPOSE To provide updated evidence-based recommendations for the evaluation and treatment of primary and secondary headaches in pregnancy and postpartum. TARGET POPULATION Pregnant and postpartum patients with a history of or experiencing primary or new secondary headaches. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on interventions to prevent primary headache in individuals who are pregnant or attempting to become pregnant, postpartum, or breastfeeding; evaluation for symptomatic patients presenting with primary and secondary headaches during pregnancy; and treatment options for primary and secondary headaches during pregnancy and lactation. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Murthy JM, Jaiswal SK, Gaade KA. Posterior Reversible Encephalopathy Syndrome Is the Common Cause of New-Onset Seizures in the Peripartum Period: A Tertiary Hospital-Based Study in South India. J Epilepsy Res 2021; 11:49-55. [PMID: 34395223 PMCID: PMC8357549 DOI: 10.14581/jer.21007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose To study the aetiolgic spectrum of new-onset seizures in the peripartum period in south India. Methods This is a retrospective analysis of case records of women with new-onset seizures in the peripartum period admitted between 2005 and 2018 (13 years). Results Of the 41 women (mean age, 26.20 years; range, 19–35 years) admitted, 20 patients (48.7%) had hypertensive disorders of pregnancy (HDP). Generalized tonic-clonic seizure (88%) was the common seizure type. The aetiologies of new-onset seizures were: 1) pregnancy-related aetiologies in 33 (80.5%) and 2) non-pregnancy-related aetiologies in eight (19.5%). Of the pregnancy-related aetiologies, posterior reversible encephalopathy syndrome (PRES) was the commonest cause in 24 patients (58.5%). Seizure cluster presentation was common in patients with PRES (p=0.0087). Of the eight women with non-pregnancy-related aetiologies, endemic central nervous system (CNS) infections accounted for three (7.3%; brain tuberculoma in one and neurocystocercosis in two) of the aetiology. All the women had Glasgow outcome scale-5 outcome. Conclusions PRES was the common cause of new-onset seizures in peripartum period in this cohort. Endemic infections of CNS accounted for 7.3% of the total aetiological spectrum. This study suggests that the possibility of PRES should be considerd in woman with HDP and seizure cluster in peripartum period.
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Affiliation(s)
- Jagarlapudi Mk Murthy
- Department of Neurology, CARE Institute of Neurosciences, CARE Hospitals, Hyderabad, India
| | - Shyam K Jaiswal
- Department of Neurology, CARE Institute of Neurosciences, CARE Hospitals, Hyderabad, India
| | - Keshava Anand Gaade
- Department of Neurology, CARE Institute of Neurosciences, CARE Hospitals, Hyderabad, India
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