1
|
Wesley SR, Vates GE, Thornburg LL. Neurologic Emergencies in Pregnancy. Obstet Gynecol 2024; 144:25-39. [PMID: 38626451 DOI: 10.1097/aog.0000000000005575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
Collapse
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
| | | | | |
Collapse
|
2
|
Greige T, Edlow JA. Managing Acute Headache in Pregnant and Postpartum Women. Ann Emerg Med 2024; 84:51-59. [PMID: 38597849 DOI: 10.1016/j.annemergmed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Tatiana Greige
- Department of Neurology, Boston Medical Center, Boston, MA.
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
3
|
Pantbalekundri N, Mathurkar S, Acharya N, Kumar S, Acharya S. Choroidopathy and Retinal Detachment: A Rare Sighting in a Case of Postpartum Hemorrhage Presenting With Posterior Reversible Encephalopathy Syndrome. Cureus 2023; 15:e50731. [PMID: 38234958 PMCID: PMC10792348 DOI: 10.7759/cureus.50731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome characterized by convulsions, headache, fatigue, impaired mental status, and decreased vision. It is mainly accompanied by hypertension. Although the pathophysiology of PRES is unknown, some theories revolve around cerebral autoregulation, the ability to maintain cerebral blood flow, or the brain's ability to maintain steady cerebral blood flow over a varying range of blood pressures by cerebral vaso-constriction or dilation. The presence of subcortical vasogenic edema in the posterior brain and hyperintensity lesions in the occipital and parietal lobes on magnetic resonance imaging (MRI) of the brain is diagnostic. We present the case of a woman who acquired PRES after a postpartum hemorrhage with no underlying disease, eventually leading to a choroidopathy and sudden onset diminution of vision, early diagnosis of which saved the patient from the catastrophic complication of permanent blindness.
Collapse
Affiliation(s)
- Nikhil Pantbalekundri
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Swapneel Mathurkar
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health Education and Research, Wardha, IND
| |
Collapse
|
4
|
Kwon NY, Lee HY, Hwang SI, Sung SH, Cho SJ, Yoon YJ, Park JK. Herbal Medicine for Postpartum Pain: A Systematic Review of Puerperal Wind Syndrome (Sanhupung). Healthcare (Basel) 2023; 11:2743. [PMID: 37893817 PMCID: PMC10606538 DOI: 10.3390/healthcare11202743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Mothers in the postpartum period often experience musculoskeletal disorders and pain, impacting their ability to care for themselves and their infants. Conventional treatments have limitations, prompting interest in alternative options like herbal medicine. This systematic review aimed to confirm the effectiveness and safety of herbal medicine treatment to improve maternal health in patients with postpartum pain (puerperal wind syndrome). We searched eight electronic databases for randomized controlled trials (RCTs) to evaluate the effects of herbal medicines on puerperal wind syndrome. Nine RCTs, including 652 patients, were selected. Following a meta-analysis of RCTs, both herbal medicine and combination treatments improved the visual analog scale scores, total effective rate, scores of Traditional Chinese Medicine syndromes, Oswestry Disability Index, and quality of life in patients with role-emotional puerperal wind syndrome. All adverse events were minor, and the incidence rate was not high compared with that of the control group. In conclusion, herbal medicine supports the improvement in pain, other systemic symptoms, and the quality of life of patients with puerperal wind syndrome. Moreover, no serious side effects were observed; therefore, herbal medicines appear to be safe. It can be the preferred treatment option for puerperal wind syndrome, which is currently managed symptomatically.
Collapse
Affiliation(s)
- Na-Yoen Kwon
- Department of Obstetrics and Gynecology, College of Korean Medicine, Ga-Chon University, Seongnam-si 13120, Republic of Korea;
| | - Hee-Yoon Lee
- Department of Korean Medicine Obstetrics and Gynecology, Pusan National University Korean Medicine Hospital, Yangsan-si 50612, Republic of Korea; (H.-Y.L.); (Y.-J.Y.)
- Department of Korean Medicine Obstetrics and Gynecology, School of Korean Medicine, Pusan National University, Yangsan-si 50612, Republic of Korea;
| | - Su-In Hwang
- Department of Korean Medicine Obstetrics and Gynecology, School of Korean Medicine, Pusan National University, Yangsan-si 50612, Republic of Korea;
| | - Soo-Hyun Sung
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea;
| | - Su-Jin Cho
- Research Institute of Nursing Science, Pusan National University, Yangsan-si 50612, Republic of Korea;
| | - Young-Jin Yoon
- Department of Korean Medicine Obstetrics and Gynecology, Pusan National University Korean Medicine Hospital, Yangsan-si 50612, Republic of Korea; (H.-Y.L.); (Y.-J.Y.)
- Department of Korean Medicine Obstetrics and Gynecology, School of Korean Medicine, Pusan National University, Yangsan-si 50612, Republic of Korea;
| | - Jang-Kyung Park
- Department of Korean Medicine Obstetrics and Gynecology, Pusan National University Korean Medicine Hospital, Yangsan-si 50612, Republic of Korea; (H.-Y.L.); (Y.-J.Y.)
- Department of Korean Medicine Obstetrics and Gynecology, School of Korean Medicine, Pusan National University, Yangsan-si 50612, Republic of Korea;
| |
Collapse
|
5
|
Greige T, Bilello LA, Singleton JM, Edlow JA. Acute headache in pregnant and post-partum patients: A clinical review. Am J Emerg Med 2023; 72:16-19. [PMID: 37451065 DOI: 10.1016/j.ajem.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Headaches during pregnancy and the post-partum period may be due to either an exacerbation of a pre-existing neurological presentation, a new pregnancy-related process, or a non-pregnancy related condition. Key physiologic changes during pregnancy and the post-partum period contribute to the vulnerability of this patient population and the increased risk of complications. OBJECTIVE OF THE REVIEW Review causes of headaches in pregnant and post-partum patients as well as neuroimaging techniques performed. DISCUSSION Headaches are a common complaint for pregnant and post-partum patients. For pregnant patients, a range of serious causes must be considered including cerebral venous thrombosis, posterior reversible encephalopathy syndrome and stroke. Primary headaches are responsible for most post-partum headaches, however other causes also include pre-clampsia, cerebral venous thrombosis and post-dural headache. Determining the optimal imaging technique in this vulnerable population remains a challenge given the scarce guidelines. CONCLUSION The greatest difficulty while evaluating pregnant and post-partum patients presenting with an acute headache in an emergency setting is to determine whether the headache is due to a primary disorder such as migraines or is secondary to an underlying, sometimes serious pathology. The following review explores evidenced-based diagnosis of headache in this particular setting.
Collapse
Affiliation(s)
- Tatiana Greige
- Boston Medical Center, Department of Neurology, One Boston Medical Center Pl, Boston, MA 02118, United States of America.
| | - Leslie A Bilello
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, One Deaconess Rd, 2(nd) Floor, Boston, MA 02115, United States of America.
| | - Jennifer M Singleton
- University of Colorado Health Highlands Ranch Hospital, Department of Emergency Medicine, 1500 Park Central Drive, Highlands Ranch, CO 80129, United States of America.
| | - Jonathan A Edlow
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, One Deaconess Rd, 2(nd) Floor, Boston, MA 02115, United States of America.
| |
Collapse
|
6
|
Lucia M, Viviana M, Alba C, Giulia D, Carlo DR, Grazia PM, Luca T, Federica VM, Immacolata VA, Grazia PM. Neurological Complications in Pregnancy and the Puerperium: Methodology for a Clinical Diagnosis. J Clin Med 2023; 12:jcm12082994. [PMID: 37109329 PMCID: PMC10141482 DOI: 10.3390/jcm12082994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Neurological complications in pregnancy and the puerperium deserve particular attention from specialists due to the worsening of the clinical picture for both the mother and the fetus. This narrative review of existing data in the literature aims to analyze the most common "red flag symptoms" attributable to neurological complications such as pre-eclampsia (PE), eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), cerebral vasoconstriction syndrome (RCVS), stroke, CVS thrombosis, pituitary apoplexy, amniotic fluid embolism and cerebral aneurysm rupture, with the aim of providing a rapid diagnostic algorithm useful for the early diagnosis and treatment of these complications. The data were derived through the use of PubMed. The results and conclusions of our review are that neurological complications of a vascular nature in pregnancy and the puerperium are conditions that are often difficult to diagnose and manage clinically. For the obstetrics specialist who is faced with these situations, it is always important to have a guide in mind in order to be able to unravel the difficulties of clinical reasoning and promptly arrive at a diagnostic hypothesis.
Collapse
Affiliation(s)
- Merlino Lucia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Matys Viviana
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Crognale Alba
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - D'Ovidio Giulia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Della Rocca Carlo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, 04100 Latina, Italy
| | - Porpora Maria Grazia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Titi Luca
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Viscardi Maria Federica
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Volpicelli Agnese Immacolata
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| | - Piccioni Maria Grazia
- Department of Maternal, Infantile and Urological Sciences, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
7
|
Rosenow F, Mann C. Status epilepticus in pregnancy. Epilepsy Behav 2023; 138:109034. [PMID: 36525922 DOI: 10.1016/j.yebeh.2022.109034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Status epilepticus is a frequent neurological emergency associated with a case fatality of about 10-15% depending on age, cause, and other factors, and a high burden for patients, caregivers, and society. In pregnancy, it can occur in two different clinical constellations: (1) In women with a history of epilepsy and (2) as new onset status epilepticus in pregnancy (NOSEP). Both entities are relatively rare but differ in terms of etiology. Here we describe the epidemiology, etiologies, diagnosis, clinical course with the maternal and fetal outcome, and the suggested management strategies for either manifestation. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
Collapse
Affiliation(s)
- Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
8
|
Hang S, Dixit P, Alam D, Fatima S, Madhavan R. Reversible Cerebral Vasoconstriction Syndrome and Ischemic Stroke Secondary to Peripartum Cardiomyopathy - Report a Rare Case. Cureus 2022; 14:e29640. [PMID: 36320956 PMCID: PMC9606850 DOI: 10.7759/cureus.29640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Acute cardioembolic stroke is a rare presentation of peripartum cardiomyopathy. We present an unusual case of peripartum cardiomyopathy, that subsequently developed cardioembolic ischemic stroke and reversible cerebral vasospasms. A 26-year-old G1P1 caucasian woman presented to the emergency department 10 days after a spontaneous vaginal delivery with the clinical and physical presentation of acute heart failure. Brain natriuretic peptide (BNP) level was >8000 pg/mL. Transthoracic echocardiogram (TTE) demonstrated global left ventricular hypokinesis, reduced ejection fraction (EF) 22% with grade I diastolic dysfunction and apical thrombus. On hospital day two of her heart failure exacerbation admission, a code stroke was activated for aphasia and confusion. She received an IV tissue plasminogen activator (tPA) and underwent a mechanical thrombectomy. On hospital day three, she developed worsening of neurological symptoms, and a computed tomography (CT) angiogram revealed vasospasm in the region of the left middle cerebral artery (MCA), which subsequently resulted in nimodipine therapy. Furthermore, her hospital course was complicated by persistent hypotension, and with our concern for vasospasm that was noted in the CT angiogram instead of guideline-directed therapy for heart failure, digoxin was given to control heart rate and to improve cardiac output. Ultimately, her neurological symptoms improved, and she was discharged on hospital day 10. This case highlights the combination of rare presentations - postpartum cardiomyopathy, ischemic stroke, and reversible cerebral vasospasms, which suggests that the time and size of the stroke are of the essence in terms of promptness of aggressive treatment.
Collapse
|
9
|
Rehman MNU, Khan DU, Aslam A. Postpartum superior sagittal, left transverse sinus and right internal jugular vein thrombosis with left parietal infarct: A case report. Radiol Case Rep 2022; 17:1911-1915. [PMID: 35401902 PMCID: PMC8990037 DOI: 10.1016/j.radcr.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/21/2022] Open
Abstract
Cerebral venous sinus thrombosis is a rarely occurring condition. Pregnancy and postpartum are both known risk factors for cerebral venous sinus thrombosis. Early detection and treatment are critical, as CVST can be potentially life-threatening. Here, we present a case of a patient who developed left transverse and superior sagittal sinus thrombosis 15 days after normal vaginal delivery. The patient presented to the emergency department with complaints of irritability and an altered state of consciousness for two days. The patient also developed seizures extending from the lower limb to the upper body. Laboratory investigations revealed abnormalities in the complete blood count report and urine complete examination. The patient's coagulation profile was totally abnormal, indicating a presence of a thrombus. All the other diagnostic techniques, including Electrocardiogram, Carotid Doppler Scan, and Ultrasound abdomen, revealed no findings. However, Magnetic resonance venography + Magnetic resonance imaging showed partial superior sagittal sinus thrombosis in the anterior and upper parietal regions, right internal jugular vein thrombosis, and left transverse thrombosis with associated left parietal infarcts. The presence of thrombosis in sinuses and jugular vein resulted in seizures, altered state of consciousness, and other associated symptoms. The patient was treated with sodium valproate, heparin, and other medications accordingly. The above-mentioned case was unique due to the involvement of unusual sinuses (transverse sinus) as previous studies have only reported cases of thrombus presence in the superior sagittal sinus. This case study will discuss patient diagnosis and management with Heparin and Diazepam to stop altered state of consciousness and seizures in females.
Collapse
Affiliation(s)
| | - Dr. Ubaid Khan
- Department of Medicine, King Edward Medical University Lahore, Pakistan
- Corresponding author.
| | - Ayesha Aslam
- Department of Neurology, Mayo Hospital, Lahore, Pakistan
| |
Collapse
|
10
|
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.
Collapse
|
11
|
Zhou B, Huang SS, Huang C, Liu SY. Cerebral venous sinus thrombosis in pregnancy: A case report. World J Clin Cases 2022; 10:309-315. [PMID: 35071533 PMCID: PMC8727275 DOI: 10.12998/wjcc.v10.i1.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/09/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a rare but life-threatening disease in pregnant women. Anticoagulation is the first-line therapy for CVT management. However, some patients have poor outcomes despite anticoagulation. Currently, the endovascular treatment of CVT in pregnant women remains controversial. We report a rare case of CVT in a pregnant woman who was successfully treated with two stent retriever devices.
CASE SUMMARY The patient was a 29-year-old pregnant woman. She was first diagnosed with hyperemesis gravidarum due to severe nausea and vomiting for one week. As the disease progressed, she developed acute left hemiplegia. Imaging confirmed the diagnosis of superior sagittal sinus, right transverse sinus and sinus sigmoideus thrombosis. As anticoagulant therapy was ineffective, she underwent thrombectomy. After the mechanical thrombectomy, her headache diminished. Three weeks later, the patient was completely independent. At a 3-mo follow-up, no relapse of symptoms was observed.
CONCLUSION Mechanical thrombectomy may be an effective alternative therapy for CVT in pregnant women if anticoagulation therapy fails.
Collapse
Affiliation(s)
- Biao Zhou
- Department of Neurology, Dongguan Tungwah Hospital, Dongguan 523000, Guangdong Province, China
| | - Shan-Shan Huang
- Department of Intensive Care Unit, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518000, Guangdong Province, China
| | - Can Huang
- Department of Neurology, Dongguan Tungwah Hospital, Dongguan 523000, Guangdong Province, China
| | - Shu-Yun Liu
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen 518000, Guangdong Province, China
| |
Collapse
|
12
|
Rafiq S, Posh S, Jeelani B, Wani S. Spectrum of neurological complications of pregnancy on magnetic resonance imaging. MATRIX SCIENCE MEDICA 2022. [DOI: 10.4103/mtsm.mtsm_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Yang H, Fan Y, Zhu Z, Wu H, Chen Z, Hu X, Wu T, Zhang M. Strategies for the Emergency Treatment of Pregnant Women with Neurological Symptoms during the COVID-19 Pandemic. Aging Dis 2022; 14:290-298. [PMID: 37008058 PMCID: PMC10017149 DOI: 10.14336/ad.2022.0718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) has been spreading all over the world for more than two years. Though several kinds of vaccines are currently available, emergence of new variants, spike mutations and immune escape have raised new challenges. Pregnant women are vulnerable to respiratory infections due to their altered immune defence and surveillance functions. Besides, whether pregnant persons should receive a COVID-19 vaccine is still under debate because limited data are available on the efficacy and safety of receiving a vaccine during pregnancy. Physiological features and lack of effective protection making pregnant women at high risk of getting infected. Another concern is that pregnancy may trigger the onset of underlying existing neurological disease, which is highly similar to those neurological symptoms of pregnant women caused by COVID-19. These similarities interfere with diagnosis and delay timely and effective management. Therefore, providing efficient emergency support for pregnant women suffering from neurological symptoms caused by COVID-19 remains a challenge among neurologists and obstetricians. To improve the diagnosis and treatment efficiency of pregnant women with neurological symptoms, we propose an emergency management framework based on the clinicians' experience and available resources. This emergency care system aimed at addressing the conundrums faced by the emergency guarantee system under COVID-19 pandemic and could serve as a potential multisystem project for clinical practice and medical education.
Collapse
Affiliation(s)
- Haojun Yang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yishu Fan
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqing Zhu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Haiyue Wu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuohui Chen
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xinhang Hu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tong Wu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence should be addressed to: Dr. Mengqi Zhang, Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China. .
| |
Collapse
|
14
|
MRI in Pregnancy and Precision Medicine: A Review from Literature. J Pers Med 2021; 12:jpm12010009. [PMID: 35055324 PMCID: PMC8778056 DOI: 10.3390/jpm12010009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.
Collapse
|
15
|
Bonnet MP, Garnier M, Keita H, Compère V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Gonzalez Estevez M, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskiewicz L, Sénat MV, Schmitz T, Sentilhes L. [Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of Anesthesiology and Intensive Care (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021:S2468-7189(21)00246-4. [PMID: 34772654 DOI: 10.1016/j.gofs.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marie-Pierre Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - Marc Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Hawa Keita
- Université de Paris, Department of Anaesthesiology and Intensive Care, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Compère
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynaecology, Nantes University Hospital, Mother and Child Hospital, Nantes, France
| | - Tiphaine Raia-Barjat
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Saint Etienne University Hospital, Université de Saint Etienne Jean Monnet, INSERM, U 1059 SainBioSE, F-42023 Saint Etienne, France
| | - Paul Berveiller
- Department of Obstetrics and Gynaecology - Poissy Saint-Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France; Ecole Nationale Vétérinaire d'Alfort, BREED, Maison-Alfort, France
| | - Julien Burey
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Mother and Child Hospital, Hospices Civils de Lyon, Bron, France; Université de Lyon, Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie Bruyère
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin- Bicêtre, France
| | - Adeline Castel
- Department of Anaesthesiology and Intensive Care, Paule de Viguier University Hospital, Toulouse, France
| | - Elodie Clouqueur
- Department of Obstetrics and Gynaecology, Tourcoing Hospital, France
| | - Max Gonzalez Estevez
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Jeanne de Flandre Maternity Hospital, Lille University Hospital, Lille, France
| | - Valentina Faitot
- Department of Anaesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Catherine Fischer
- Department of Anaesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florent Fuchs
- Department of Obstetrics and Gynaecology, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), UMR INSERM - Université de Montpellier, Campus Santé, IURC, Montpellier, France
| | - Edouard Lecarpentier
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Université de Paris Est Créteil, CHIC of Créteil, Créteil, France; INSERM U955 Institut Biomédical Henri Mondor, Créteil, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Agnès Rigouzzo
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathias Rossignol
- Department of Anaesthesiology and Intensive Care and SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Emmanuel Simon
- Department of Gynaecology, Obstetrics and Reproductive Biology, Dijon Bourgogne University Hospital, France; UFR Sciences de santé Dijon, Université de Bourgogne, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Nancy University Hospital, Nancy, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynaecology, Antoine Béclère University Hospital, Université de Paris Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Université de Aix Marseille, France; Centre for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Université de Aix Marseille, Marseille, France
| | - Marie-Victoire Sénat
- Department of Gynaecology and Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University de Paris-Saclay, UVSQ, CESP, INSERM, Villejuif, France
| | - Thomas Schmitz
- Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France; Department of Gynaecology and Obstetrics, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Aliénor d'Aquitaine Maternity Hospital, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
16
|
Bonnet MP, Garnier M, Keita H, Compère V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Gonzalez Estevez M, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskiewicz L, Camilleri C, Sénat MV, Schmitz T, Sentilhes L. Guidelines for the management of women with severe pre-eclampsia. Anaesth Crit Care Pain Med 2021; 40:100901. [PMID: 34602381 DOI: 10.1016/j.accpm.2021.100901] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide national guidelines for the management of women with severe pre-eclampsia. DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The last SFAR and CNGOF guidelines on the management of women with severe pre-eclampsia were published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology. RESULTS The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1+/-), 9 have a moderate level of evidence (GRADE 2+/-), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations. CONCLUSIONS There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe pre-eclampsia.
Collapse
Affiliation(s)
- Marie-Pierre Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - Marc Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Hawa Keita
- Université de Paris, Department of Anaesthesiology and Intensive Care, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Compère
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynaecology, Nantes University Hospital, Mother and Child Hospital, Nantes, France
| | - Tiphaine Raia-Barjat
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Saint Etienne University Hospital, Université de Saint Etienne Jean Monnet, INSERM, U 1059 SainBioSE, F-42023 Saint Etienne, France
| | - Paul Berveiller
- Department of Obstetrics and Gynaecology - Poissy Saint-Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France; Ecole Nationale Vétérinaire d'Alfort, BREED, Maison-Alfort, France
| | - Julien Burey
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Mother and Child Hospital, Hospices Civils de Lyon, Bron, France; Université de Lyon, Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie Bruyère
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin- Bicêtre, France
| | - Adeline Castel
- Department of Anaesthesiology and Intensive Care, Paule de Viguier University Hospital, Toulouse, France
| | - Elodie Clouqueur
- Department of Obstetrics and Gynaecology, Tourcoing Hospital, France
| | - Max Gonzalez Estevez
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Jeanne de Flandre Maternity Hospital, Lille University Hospital, Lille, France
| | - Valentina Faitot
- Department of Anaesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Catherine Fischer
- Department of Anaesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florent Fuchs
- Department of Obstetrics and Gynaecology, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), UMR INSERM - Université de Montpellier, Campus Santé, IURC, Montpellier, France
| | - Edouard Lecarpentier
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Université de Paris Est Créteil, CHIC of Créteil, Créteil, France; INSERM U955 Institut Biomédical Henri Mondor, Créteil, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Agnès Rigouzzo
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathias Rossignol
- Department of Anaesthesiology and Intensive Care and SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Emmanuel Simon
- Department of Gynaecology, Obstetrics and Reproductive Biology, Dijon Bourgogne University Hospital, France; UFR Sciences de santé Dijon, Université de Bourgogne, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Nancy University Hospital, Nancy, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynaecology, Antoine Béclère University Hospital, Université de Paris Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Université de Aix Marseille, France; Centre for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Université de Aix Marseille, Marseille, France
| | - Céline Camilleri
- "Grossesse et Santé, Contre la Prééclampsie" Association, Paris, France
| | - Marie-Victoire Sénat
- Department of Gynaecology and Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University de Paris-Saclay, UVSQ, CESP, INSERM, Villejuif, France
| | - Thomas Schmitz
- Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France; Department of Gynaecology and Obstetrics, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Aliénor d'Aquitaine Maternity Hospital, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
17
|
Deck GM, Yarrington CD, Pennell PB. Factors associated with anti-seizure medication utilization for eclamptic seizures: 1995-2015. Epilepsy Behav 2021; 124:108299. [PMID: 34600278 DOI: 10.1016/j.yebeh.2021.108299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to ascertain the drivers of the use of anti-seizure medications (ASMs) other than magnesium sulfate (MgSO4) in seizure management in a cohort of pregnant and postpartum women with eclamptic seizure. METHODS Cases of seizure activity attributed to eclampsia from 1995-2015 at 2 large urban academic medical centers were identified and reviewed by a neurologist and an obstetrician. Analyses focused on patterns of ASM utilization among women according to timing, recurrence, posterior reversible encephalopathy syndrome, and specialty consultation with additional sub-analysis focusing on recurrent seizures only. RESULTS 93 cases of eclampsia were identified. 100% of subjects received MgSO4. 52% of women received an ASM in addition to MgSO4. Subjects with seizures occurring post-partum, with >1 seizure, or who had a formal neurology consult were more likely to receive an ASM in addition (risk ratio [RR] 3.05 [95% confidence interval [CI] [1.30-7.11], RR 3.01 [95% CI 1.29-7.02], and RR 6.29 [2.37, 16.71] respectively). Postpartum recurrent seizures or those receiving a neurology consult were also more likely to be treated with ASMs compared to recurrent or comanaged seizures occurring before delivery (RR 1.55 [1.02, 2.37] and 1.65 [1.02, 2.69]). CONCLUSIONS In this retrospective cohort, patients with atypical seizure presentation (e.g., postpartum and/or recurrent) and women who were comanaged with a neurologist were more likely to receive an ASM other than MgSO4.
Collapse
Affiliation(s)
- Gina M Deck
- Massachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA 02114, United States.
| | - Christina D Yarrington
- Brigham and Women's Hospital, Department of Obstetrics and Gynecology, 45 Francis Ave., Boston, MA 02115, United States.
| | - Page B Pennell
- Brigham and Women's Hospital, Department of Neurology, 45 Francis Ave., Boston, MA 02115, United States.
| |
Collapse
|
18
|
Ozdemir K, Sahin S, Sevimli Guler D, Unsal A. Headache and distress during pregnancy. Int J Gynaecol Obstet 2021; 157:686-693. [PMID: 34449878 DOI: 10.1002/ijgo.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/07/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the prevalence of headache, review variables believed to be associated, and assess distress levels in pregnant women. METHODS This is a cross-sectional study conducted on pregnant women who presented to a Training and Research Hospital in Sakarya, Turkey from June 1, 2020 to December 1, 2020. The study group consisted of 600 pregnant women who agreed to take part in the study. Chi-squared test and logistic regression analysis were used to analyze the data. Statistical significance level was accepted as P value of 0.05 or less. RESULTS The ages of pregnant women ranged from 19 to 44 years with a mean age of 29.01 ± 5.27 years. Prevalence of headache during pregnancy was found to be 55.7% (n = 334). The number of pregnant women at of distress was found to be 144 (24.0%). There was no difference between women with and without headache and between severity of headache and prevalence of distress (P > 0.05 for each). CONCLUSION Headache is an important health issue in pregnant women. There was no relationship between the presence and severity of headache and distress level.
Collapse
Affiliation(s)
- Kevser Ozdemir
- Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Sevil Sahin
- Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | | | - Alaattin Unsal
- Public Health Department, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin 2021; 39:649-670. [PMID: 33896537 DOI: 10.1016/j.ncl.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article serves as a comprehensive review of neurologic emergencies in pregnancy. Common initial presentations of neuroemergencies are reviewed with a clinical algorithm. Neurovascular disorders in pregnancy are reviewed, including acute ischemic strokes with data on tPA and thrombectomy; cerebral venous sinus thrombosis diagnosis and management; posterior reversible encephalopathy syndrome management; reversible cerebral vasoconstriction syndrome; and intracerebral hemorrhage. Attention is paid to management of cerebral edema and safety of osmotic therapies. A review of seizures in pregnancy is provided, including new-onset causes and decreased seizure thresholds. For status epilepticus, a low teratogenicity risk medication protocol in pregnancy is provided.
Collapse
Affiliation(s)
- Elizabeth Macri
- Department of Neurology, University of New Mexico, MSC10 5620, 1 University of New Mexico, Albuquerque, NM 87131, USA. https://twitter.com/SportsDoc2009
| | - Diana Greene-Chandos
- Neurosciences Critical Care Fellowship, Department of Neurology, University of New Mexico; MSC10 5620, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| |
Collapse
|
21
|
Don't Forget Rare Causes of Postpartum Headache! Cases Report and Literature Review. ACTA ACUST UNITED AC 2021; 57:medicina57040376. [PMID: 33924718 PMCID: PMC8069772 DOI: 10.3390/medicina57040376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
Headache is a common finding in the postpartum period, caused by a spectrum of different conditions. Most headaches in the postpartum period are self-limiting and benign in etiology, but there are some potentially serious causes to be considered. We disclose two cases of postpartum headache, initially considered as post-dural puncture headache (PDPH), that evolved into a harmful condition and showed that an expanded differential diagnosis for headache in the postpartum is mandatory, requiring a high level of attention from health professionals. In fact, a careful examination of the medical history, physical examination, and the recognition for the need for early neuroradiological imaging should increase diagnostic accuracy.
Collapse
|
22
|
Metodiev Y, Braveman F. Anaesthesia and neurological disorders in pregnancy. BJA Educ 2021; 21:210-217. [PMID: 34026274 DOI: 10.1016/j.bjae.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Y Metodiev
- Cardiff & Vale University Health Board, Cardiff, UK
| | - F Braveman
- University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
23
|
Wang N, Shen X, Zhang G, Gao B, Lerner A. Cerebrovascular disease in pregnancy and puerperium: perspectives from neuroradiologists. Quant Imaging Med Surg 2021; 11:838-851. [PMID: 33532282 DOI: 10.21037/qims-20-830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pregnancy-related cerebrovascular disease is a serious complication of pregnancy and puerperium. The etiology and pathological mechanisms of cerebrovascular disease are complex, involving changes in the cardiovascular, endocrine, and immune systems. Vascular risk factors during pregnancy and puerperium may cause vasospasm and endothelial cell damage leading to cerebral ischemia, hemorrhage, posterior reversible encephalopathy syndrome (PRES), and reversible cerebral vasoconstriction syndrome. Arterial or venous obstruction may damage the blood-brain barrier (BBB) and impede venous return, resulting in cerebral edema, hemorrhage, and intracranial hypertension. Pregnancy with hypercoagulability may threaten the lives of both the mother and the developing fetus. With improvements in stroke treatment during pregnancy and puerperium, neuroradiologists have gained new insights into this problem. This article reviews the pathogenesis, imaging findings, and risk factors of stroke during pregnancy and puerperium, focusing on imaging diagnosis and prognostic assessment.
Collapse
Affiliation(s)
- Naiwu Wang
- Department of Radiology, Jinan City People's Hospital, Laiwu, China
| | - Xudong Shen
- Department of Radiology, Enshi Center Hospital, Enshi, China
| | - Gang Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.,Key Laboratory of Brain Imaging, Guizhou Medical University, Guiyang, China
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
24
|
Iffland Y, Stoenescu A, Argyriadis A, Ludolph A, Skoberne T, Henn KH, Jackisch C. Seltene vasodysregulatorische Enzephalopathien in Assoziation mit Präeklampsie und HELLP-Syndrom. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1266-2808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
25
|
Dooley A, Djabatey E. Incidence of antenatal lower limb/sub-umbilical neurological complications and antenatal backache in a tertiary maternity hospital obstetric anaesthesia clinic. Anaesthesia 2021; 76:426-427. [PMID: 33406292 DOI: 10.1111/anae.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A Dooley
- Liverpool Women's Hospital, Liverpool, UK
| | - E Djabatey
- Liverpool Women's Hospital, Liverpool, UK
| |
Collapse
|
26
|
Jones A, Cometa MA, Euliano T, Lopez BM. Postpartum Headache—Unmasking the Zebra Among the Horses: A Case Report. A A Pract 2020; 14:e01340. [DOI: 10.1213/xaa.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
27
|
|
28
|
Giller A, Andrawus M, Gutman D, Atzmon G. Pregnancy as a model for aging. Ageing Res Rev 2020; 62:101093. [PMID: 32502628 DOI: 10.1016/j.arr.2020.101093] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 04/21/2020] [Accepted: 05/23/2020] [Indexed: 12/12/2022]
Abstract
The process of aging can be defined as the sum accumulation of damages and changes in metabolism during the life of an organism, due to both genetic predisposition and stochastic damage. During the gestational period and following parturition, similar damage can be seen due to the strenuous effect on the maternal body, exhibited on both the physiological and cellular level. In this review, we will focus on the similar physiological and cellular characteristics exhibited during pregnancy and aging, including induction of and response to oxidative stress, inflammation, and degradation of telomeres. We will evaluate any similar processes between aging and pregnancy by comparing common biomarkers, pathologies, and genetic and epigenetic effects, to establish the pregnant body as a model for aging. This review will approach the connection both in respect to current theories on aging as a byproduct of natural selection, and regarding unrelated biochemical similarities between the two, drawing on existing studies and models in humans and other species where relevant alike. Furthermore, we will show the response of the pregnant body to these changes, and through that illuminate unique areas of potential study to advance our knowledge of the maladies relating to aging and pregnancy, and an avenue for solutions.
Collapse
Affiliation(s)
- Abram Giller
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Mariana Andrawus
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Danielle Gutman
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Gil Atzmon
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel; Departments of Genetics and Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, New York, 10461, USA.
| |
Collapse
|
29
|
Bilello LA, Greige T, Singleton JM, Burke RC, Edlow JA. Retrospective Review of Pregnant Patients Presenting for Evaluation of Acute Neurologic Complaints. Ann Emerg Med 2020; 77:210-220. [PMID: 32418678 DOI: 10.1016/j.annemergmed.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/05/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Data suggest an increase in neurologic-related hospitalizations during pregnancy. It is crucial for health care providers to develop effective strategies to evaluate this young, generally healthy cohort of patients for whom missed neurologic diagnoses can have devastating results. We aim to describe the epidemiology of this high risk patient population by investigating exam findings, imaging studies, and clinical outcomes of pregnant women presenting to the emergency department (ED) with acute neurologic complaints. METHODS We conducted a 7-year retrospective chart review of pregnant patients presenting with neurologic chief complaints to the emergency department of an urban tertiary academic medical center in the northeastern United States. We investigated examination findings, imaging studies, and clinical outcomes. RESULTS Between January 1, 2010, and May 31, 2017, 205 pregnant patients presented to the ED with a neurologic chief complaint. The majority of patients had a normal neurologic examination result. Patients with an abnormal examination result were not more likely to have clinically significant imaging findings. Within our population, 28% underwent imaging, and noncontrast magnetic resonance imaging was the most common modality. Five patients had clinically significant imaging findings. Specifically, 3.3% of patients with abnormal examination result had significant findings and 2.3% of those with a normal examination result had significant findings. A minority of the patients with a visit resulting in discharge (9.8%) returned to the ED within a 7-day period. None required additional neuroimaging. CONCLUSION To our knowledge, our study is unique in that it incorporated all neurologic complaints. Headache was the most common complaint, followed by dizziness and seizures. Most of the headaches were related to first-trimester migraines. There was a high incidence of imaging used in clinical practice even when there was a normal neurologic examination result. A normal examination result does not adequately exclude serious intracranial pathology, and diagnostic vigilance is justified.
Collapse
Affiliation(s)
- Leslie A Bilello
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
| | | | | | - Ryan C Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan A Edlow
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
30
|
Yentis SM, Lucas DN, Brigante L, Collis R, Cowley P, Denning S, Fawcett WJ, Gibson A. Safety guideline: neurological monitoring associated with obstetric neuraxial block 2020. Anaesthesia 2020; 75:913-919. [DOI: 10.1111/anae.14993] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- S. M. Yentis
- Department of Anaesthesia Chelsea and Westminster Hospital London UK
- Imperial College Working Party co‐Chair and Association of Anaesthetists London UK
| | - D. N. Lucas
- Department of Anaesthesia Northwick Park Hospital Working Party co‐Chair and Obstetric Anaesthetists’ Association London UK
| | - L. Brigante
- Quality and Standards Advisor Royal College of Midwives London UK
| | - R. Collis
- Department of Anaesthesia University Hospital of Wales Obstetric Anaesthetists’ Association Cardiff UK
| | - P. Cowley
- Department of Radiology National Hospital for Neurology and Neurosurgery London UK
| | - S. Denning
- East Midlands School of Anaesthesia Association of Anaesthetists Training Committee UK
| | - W. J. Fawcett
- Royal Surrey County Hospital Association of Anaesthetists Guildford Surrey UK
| | - A. Gibson
- Department of Surgery Royal National Orthopaedic Hospital British Association of Spinal Surgeons Stanmore Middlesex UK
| |
Collapse
|
31
|
Zhai Z, Guo Y. Posterior reversible encephalopathy syndrome induced by intracranial hypotension in a postpartum patient. Int J Neurosci 2020; 131:65-69. [PMID: 32098543 DOI: 10.1080/00207454.2020.1733555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: A number of hormonal, physiologic, immunologic, and hemodynamic changes can cause a series of central nervous system-related problems in pregnant and postpartum women. Posterior reversible encephalopathy syndrome (PRES) is commonly seen in these conditions. However, PRES during pregnancy and the postpartum period are not always due to pregnancy.Methods: We describe a patient who presented with headache followed by an epileptic seizure after cesarean section and whose computed tomography (CT) showed bilateral low-density lesions in the frontal lobe. To explore the pathogenesis, we further examined the patient with brain magnetic resonance imaging (MRI) and lumbar puncture.Results: Brain MRI revealed vasogenic edema in the frontal lobe and temporal-occipital regions of both hemispheres. MRI of the brain with contrast showed diffuse enhancement of the supratentorial dura mater and decreased of bilateral lateral ventricles. There was no abnormality in brain magnetic resonance angiography and magnetic resonance venography. Bloody cerebrospinal fluid flowed very slowly during lumbar puncture.Conclusion: These findings suggest that, although rare, intracranial hypotension in postpartum patients may be a cause of PRES.
Collapse
Affiliation(s)
- Zhiyong Zhai
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yang Guo
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| |
Collapse
|
32
|
|
33
|
Sankey EW, Hynes JS, Komisarow JM, Maule J, Griffin AS, Dotters-Katz SK, Mitchell CJ, Friedman AH. Masson's tumor presenting as a left frontal intraparenchymal hemorrhage resulting in severe expressive aphasia during pregnancy: case report. J Neurosurg 2019; 134:189-196. [PMID: 31675720 DOI: 10.3171/2019.8.jns191767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/16/2019] [Indexed: 11/06/2022]
Abstract
Intravascular papillary endothelial hyperplasia (IPEH), commonly known as Masson's tumor, is a benign lesion that manifests as an excessive proliferation of endothelial cells within a vessel wall. IPEH is extremely rare in the brain, with only 36 intracranial cases previously described in the literature. It is commonly mistaken for more malignant pathologies, such as angiosarcoma. Careful histopathological examination is required for diagnosis, as no clinical or radiographic features are characteristic of this lesion. In this first published case of intracranial IPEH presenting during pregnancy, the authors describe a 32-year-old female with a left frontal intraparenchymal hemorrhage resulting in complete expressive aphasia at 28 weeks 6 days' gestation. An MRI scan obtained at a local hospital demonstrated an area of enhancement within the hemorrhage. The patient underwent a left frontoparietal craniotomy for hematoma evacuation and gross-total resection (GTR) of an underlying hemorrhagic mass at 29 weeks' gestation. This case illustrates the importance of multidisciplinary patient care and the feasibility of intervention in the early third trimester with subsequent term delivery. While GTR of IPEH is typically curative, the decision to proceed with surgical treatment of any intracranial lesion in pregnancy must balance maternal stability, gestational age, and suspected pathology.
Collapse
Affiliation(s)
| | | | | | | | - Andrew S Griffin
- 4Radiology, Duke University Medical Center, Durham, North Carolina
| | | | | | | |
Collapse
|
34
|
Díaz-Ramírez G, Salgado-Cifuentes C, Zúñiga-Escobar G, Morales-Plaza C. Posterior reversible leukoencephalopathy syndrome associated with psychosis: An unusual presentation. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
35
|
Pezzali LG, Rostirolla GF, Luiz CB, Gomes LB, Rivero RC, Valério EG, Vettorazzi J. Brain Tumor in Differential Diagnosis of Seizures in Puerperium: Case Report. Open Neurol J 2019. [DOI: 10.2174/1874205x01913010067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Convulsive crisis is a transient disturbance of cerebral function, and the etiology of which may be manifold. Its clarification is essential for establishing adequate therapy and seizure control. In the pregnancy-puerperal cycle, eclampsia is the most common cause of it, but brain tumor, epilepsy and other disorders are part of the differential diagnosis. We report a case of seizure triggered by tumor in a primigest, 22 years old, at 38 weeks’ gestation with premature rupture of membranes. Cesarean section was performed due to non-reassuring fetal condition. On the second day of puerperium, she presented recurrent episodes of generalized tonic-clonic seizures and elevated blood pressure. She received magnesium sulfate for 24 hours and persisted with severe headache. Magnetic resonance imaging of the brain showed an expansive lesion in the left frontoparietal region. The patient underwent intracranial microsurgery on the eighth day after cesarean section, with complete resection of the lesion and anatomopathological diagnosis of schwannoma. She went through good postoperative evolution, without neurological deficits, and stayed on phenobarbital, with no seizures until 6 months of follow-up. From the case we conclude that although the first diagnosis in pregnant or puerperal women with seizures should be eclampsia, there are other causes, such as brain tumor and Posterior Reversible Encephalopathy Syndrome (PRES). Careful evaluation is required, especially in refractory cases and not responding to usual treatment.
Collapse
|
36
|
Neurological manifestations and neuroimaging presentations in patients with severe preeclampsia: predisposing factors and clinical implications. Neurol Sci 2019; 40:1245-1253. [PMID: 30891638 DOI: 10.1007/s10072-019-03833-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE Neurological manifestations and neuroimaging abnormalities are common in patients with severe preeclampsia; however, the differences between these abnormal features occurring during early- and late-onset severe preeclampsia are unclear, and the factors associated with abnormal imaging changes in patients with neurological manifestations have not yet been fully elucidated. MATERIALS AND METHODS A retrospective study was conducted on 172 patients with severe preeclampsia from January 2017 to June 2018 in the Department of Neurology and Obstetrics, Shengjing Hospital of China Medical University. The neurological manifestations, clinical parameters, laboratory, and neuroimaging findings were analyzed. RESULTS Early- and late-onset preeclampsia were diagnosed in 83 and 89 patients, respectively. Headache and dizziness were more common in patients with early-onset preeclampsia than in patients with late-onset preeclampsia (p = 0.013, p = 0.004, respectively). Serum uric acid, creatinine, and urea nitrogen were significantly elevated in the patients with early-onset preeclampsia (p < 0.001, p = 0.004, and p = 0.005, respectively). Neuroimaging was performed in 81 patients, of which 57 were positive. Findings indicating cerebral edema were the most common neuroimaging abnormality. Gestational weeks (p = 0.014), headache (p < 0.001), and blood urea nitrogen level (p = 0.027) may be associated with positive imaging findings. By multiple logistic regression, headache (OR = 10.2, 95% CI, 2.4-42.7; p = 0.002) proved to be an independent factor associated with neuroimaging abnormality. CONCLUSIONS Neurological symptoms such as headache and dizziness were more common in patients with early-onset preeclampsia. Renal dysfunction may also associate with early-onset severe preeclampsia. Cerebral edema was the most common neuroimaging abnormality, and headache might be independently associated with abnormal imagine changes.
Collapse
|
37
|
Postpartum Posterior Reversible Encephalopathy Syndrome (PRES): Three Case Reports and Literature Review. Case Rep Obstet Gynecol 2019; 2019:9527632. [PMID: 30809401 PMCID: PMC6369475 DOI: 10.1155/2019/9527632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 11/17/2022] Open
Abstract
Posterior reversible encephalopathy syndrome is a rare complication generally associated with headache and acute changes in blood pressure. Delay in the diagnosis and treatment may result in death or in irreversible neurological sequelae. We present three cases of PRES occurring in young women during puerperium. We report a literature review ranged from January 1990 to June 2015 describing clinical features, diagnostic and medical approach, and maternal outcome.
Collapse
|
38
|
Management of intracranial haemorrhage, unruptured aneurysms and arteriovenous malformations during and after pregnancy. Curr Opin Neurol 2019; 32:36-42. [DOI: 10.1097/wco.0000000000000643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
39
|
|
40
|
Al-Mufti F, Dodson V, Wajswol E, El-Ghanem M, Alchaki A, Nuoman R, Thabet A, Sutherland A, Roychowdhury S, Hidalgo A, Gupta G. Chemical angioplasty for medically refractory reversible cerebral vasoconstriction syndrome. Br J Neurosurg 2018; 32:431-435. [DOI: 10.1080/02688697.2018.1479512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Fawaz Al-Mufti
- Rutgers University – Robert Wood Johnson Medical School, Department of Neurology, New Brunswick NJ, USA
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Vincent Dodson
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Ethan Wajswol
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Mohammad El-Ghanem
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Abdulrahman Alchaki
- Rutgers University – New Jersey Medical School, Department of Neurology, Newark, NJ, USA
| | - Rolla Nuoman
- Rutgers University – New Jersey Medical School, Department of Neurology, Newark, NJ, USA
| | - Ahmad Thabet
- Rutgers University – New Jersey Medical School, Department of Neurosurgery, Newark, NJ, USA
| | - Anne Sutherland
- Rutgers University – New Jersey Medical School, Department of Medicine, Newark, NJ, USA
| | - Sudipta Roychowdhury
- Rutgers University – Robert Wood Johnson Medical School, Department of Radiology, New Brunswick NJ, USA
| | - Andrea Hidalgo
- Rutgers University – New Jersey Medical School, Department of Neurology, Newark, NJ, USA
| | - Gaurav Gupta
- Rutgers University – Robert Wood Johnson Medical School, Department of Neurosurgery, New Brunswick NJ, USA
| |
Collapse
|
41
|
Sedille L, Pierre F, Pourrat O, Desseauve D. Keeping eyes on preeclampsia. Pregnancy Hypertens 2018; 13:286-290. [PMID: 30177067 DOI: 10.1016/j.preghy.2018.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/15/2018] [Accepted: 06/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Lucie Sedille
- Department of Obstetrics and Gynecology, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France; Poitiers University, UFR Medicine and Pharmacy, Poitiers, France.
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France; Poitiers University, UFR Medicine and Pharmacy, Poitiers, France.
| | - Olivier Pourrat
- Poitiers University, UFR Medicine and Pharmacy, Poitiers, France; ICU and Internal Medicine, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France.
| | - David Desseauve
- Department of Obstetrics and Gynecology, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France; Poitiers University, UFR Medicine and Pharmacy, Poitiers, France
| |
Collapse
|
42
|
Gao G, Zucconi RL, Zucconi WB. Emergent Neuroimaging During Pregnancy and the Postpartum Period. Neuroimaging Clin N Am 2018; 28:419-433. [DOI: 10.1016/j.nic.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Haber MA, Nunez D. Imaging neurological emergencies in pregnancy and puerperium. Emerg Radiol 2018; 25:673-684. [PMID: 30030690 DOI: 10.1007/s10140-018-1625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/06/2018] [Indexed: 12/13/2022]
Abstract
The altered physiologic state of female patients during and just after pregnancy places them at an increased risk for several potentially life-threatening neurologic disorders. Swift diagnosis of such pathology and related complications is critical in order to reduce risk of morbidity and mortality to both the mother and the fetus. Neuroimaging plays an important role in the emergent diagnosis of pathology associated with pregnancy and puerperium, and it is critical for the radiologist to be cognizant of correlative imaging findings. Furthermore, given concerns regarding risks of neuroimaging to the fetus, it is important for the radiologist to act as an informed consultant regarding balancing fetal risks and the mother's health. The purpose of this review is to elucidate the underlying pathophysiology and neuroimaging findings associated with diagnoses that are unique to or highly associated with pregnancy and puerperium, as well as to understand the role that CT and MR play in diagnosis during and just after pregnancy, and their respective risks to the fetus.
Collapse
Affiliation(s)
- Matthew A Haber
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Diego Nunez
- Department of Radiology, Division of Neuroradiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, PBB RAD, 3rd Floor, Room 357, Boston, MA, 02115, USA.
| |
Collapse
|
44
|
Brain imaging in pregnant women with acute headache. J Neurol 2018; 265:1836-1843. [DOI: 10.1007/s00415-018-8924-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/30/2018] [Accepted: 06/02/2018] [Indexed: 12/19/2022]
|
45
|
Terón I, Eng MS, Katz JM. Causes and Treatment of Acute Ischemic Stroke During Pregnancy. Curr Treat Options Neurol 2018; 20:21. [PMID: 29785465 DOI: 10.1007/s11940-018-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state. RECENT FINDINGS Intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been used successfully to treat pregnant women with acute ischemic stroke. Recent national guidelines recommend considering tPA use during pregnancy for moderate and severe strokes if the potential benefits offset the risks of uterine hemorrhage. Pregnancy-associated ischemic stroke is rare, but can be devastating, and recanalization therapy should not be systematically withheld. Women who are at risk for stroke should be followed carefully, and providers caring for pregnant women should be educated regarding stroke signs and symptoms. Many of the standard post stroke diagnostic modalities may be used safely in pregnancy, and primary and secondary stroke prevention therapy must be tailored to avoid fetal toxicity.
Collapse
Affiliation(s)
- Ina Terón
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.
| | | | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.,Department of Radiology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, Hempstead, NY, 11549, USA
| |
Collapse
|
46
|
Edlow JA. Managing Patients With Nontraumatic, Severe, Rapid-Onset Headache. Ann Emerg Med 2018; 71:400-408. [DOI: 10.1016/j.annemergmed.2017.04.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 10/18/2022]
|
47
|
Bojja V, Keepanasseril A, Nair PP, Sunitha VC. Clinical and imaging profile of patients with new-onset seizures & a presumptive diagnosis of eclampsia - A prospective observational study. Pregnancy Hypertens 2018; 12:35-39. [PMID: 29674196 DOI: 10.1016/j.preghy.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/18/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the clinical and imaging profile of patients with new-onset seizures with a presumptive diagnosis of eclampsia. METHODS This was a cross-sectional study, conducted in a tertiary teaching hospital, on pregnant women presenting with new onset seizures with presumptive diagnosis of eclampsia excluding those with pre-existing neurological conditions. Demographic details, medical and obstetric examination findings were noted. All women underwent neuroimaging within 5 days of onset seizures. RESULTS Presumptive diagnosis of eclampsia was made in 0.7% (n = 186) of women delivering during the time period. Most women (55.4%) presented with seizures in the antenatal period. Neuroimaging is performed in 130 cases and it was found to be abnormal in 45.4% of women (59/130). Most common associated neurological condition was Posterior Reversible Encephalopathy Syndrome in 20% (n = 26) followed by Cerebral Venosus Sinus Thrombosis in 10% (n = 14). All six women with primary intracerebral haemorrhage succumbed to the disease. CONCLUSION New-onset seizures may be the initial presentation of uncommon and unpredictable complication of pregnancy with serious maternal/ fetal morbidity and mortality. Neuroimaging will help in these patients to avoid the delay or misdiagnosis, resulting in early initiation of specific treatment which will help to improve and optimize outcomes.
Collapse
Affiliation(s)
- Vandana Bojja
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India.
| | - Pradeep P Nair
- Department of Neurology, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India
| | - V C Sunitha
- Department of Radiodiagnosis, Jawaharlal Institute of Post-graduate Medical Education & Research, Puducherry 605006, India
| |
Collapse
|
48
|
Raffaelli B, Siebert E, Körner J, Liman T, Reuter U, Neeb L. Characteristics and diagnoses of acute headache in pregnant women – a retrospective cross-sectional study. J Headache Pain 2017; 18:114. [PMID: 29285572 PMCID: PMC5745375 DOI: 10.1186/s10194-017-0823-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/17/2017] [Indexed: 02/06/2023] Open
Abstract
Background Methods Results Conclusions
Collapse
|
49
|
Fortini A, Cincotta M, Faraone A, Baruffi C, Carrieri G, Limbucci N, Boccadori C, Nenci G. Headache and visual impairment after twin birth: a challenging diagnosis. Intern Emerg Med 2017; 12:975-980. [PMID: 28710712 DOI: 10.1007/s11739-017-1712-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/08/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Alberto Fortini
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy.
| | - Massimo Cincotta
- Department of Neurology, San Giovanni di Dio Hospital, Florence, Italy
| | - Antonio Faraone
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Cristina Baruffi
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Giovanni Carrieri
- Department of Radiology, San Giovanni di Dio Hospital, Florence, Italy
| | - Nicola Limbucci
- Department of Neuro-vascular Radiology, AOU Careggi, Florence, Italy
| | - Costanza Boccadori
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Gabriele Nenci
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| |
Collapse
|
50
|
Weiss N, Mochel F, Rudler M, Demeret S, Lebray P, Conti F, Galanaud D, Ottolenghi C, Bonnefont JP, Dommergues M, Bernuau J, Thabut D. Peak hyperammonemia and atypical acute liver failure: The eruption of an urea cycle disorder during hyperemesis gravidarum. J Hepatol 2017; 68:S0168-8278(17)32289-4. [PMID: 28939132 DOI: 10.1016/j.jhep.2017.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/04/2017] [Accepted: 09/13/2017] [Indexed: 02/08/2023]
Abstract
Inborn urea cycle disorders are under-recognised metabolic causes of hyperammonemia in adults. A 28-year-old primigravida, seven weeks pregnant, affected by hyperemesis gravidarum developed acute liver injury (ALI) and then acute liver failure (ALF) in less than 48 h. Because the patient developed atypical features, especially mildly elevated aminotransferases contrasting with very high blood ammonia levels (281 μmol/L), concomitant with normal serum creatinine, an inborn error of metabolism was suspected. We performed emergency metabolic analyses, stopped all protein intake and started with intravenous (i.v.) high caloric intake, nitrogen scavenger drugs and haemodialysis. The neurological and hepatic status of the patient quickly improved together with normalisation of her ammonemia levels. High plasma glutamine and urinary orotic acid, alongside low plasma arginine, citrulline and ornithine were suggestive of an ornithine transcarbamylase deficiency, later confirmed by molecular analyses. Foetal sex was female, as determined by foetal DNA analysis in maternal blood, and foetal development was unremarkable throughout the pregnancy. Delivery was induced at 39 weeks with a close monitoring of ammonemia levels and i.v. perfusion of carbohydrates and lipids during labour and immediately post-partum to avoid hypercatabolism. Delivery was uneventful and the patient delivered a healthy female baby. Urea cycle disorders should be contemplated in non-jaundiced patients with ALI or ALF, severe hyperammonemia and normal serum creatinine regardless of serum aminotransferase levels. The prompt recognition of this rare condition and the rapid initiation of adequate metabolic therapy are mandatory to prevent irreversible neurological sequelae and to avoid liver transplantation.
Collapse
Affiliation(s)
- Nicolas Weiss
- Brain Liver Pitié-Salpêtrière (BLIPS) study group, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie Paris 6, Sorbonne Universités, INSERM UMR_S 938, CDR Saint-Antoine Maladies métaboliques, biliaires et fibro-inflammatoires du foie, & Institut de Cardiométabolisme et Nutrition, ICAN, Paris, France; Unité de réanimation neurologique, Département de neurologie, pôle des maladies du système nerveux, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France; Institut de neurosciences translationnelles IHU-A-ICM, Paris, France
| | - Fanny Mochel
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013 Paris, France; Département de Génétique, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Neurométabolique, Université Pierre et Marie Curie, Paris, France
| | - Marika Rudler
- Brain Liver Pitié-Salpêtrière (BLIPS) study group, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie Paris 6, Sorbonne Universités, INSERM UMR_S 938, CDR Saint-Antoine Maladies métaboliques, biliaires et fibro-inflammatoires du foie, & Institut de Cardiométabolisme et Nutrition, ICAN, Paris, France; UF de Soins Intensifs d'Hépato-gastroentérologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sophie Demeret
- Unité de réanimation neurologique, Département de neurologie, pôle des maladies du système nerveux, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France; Institut de neurosciences translationnelles IHU-A-ICM, Paris, France
| | - Pascal Lebray
- UF de Soins Intensifs d'Hépato-gastroentérologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Filomena Conti
- UF de transplantation hépatique, service d'Hépato-gastroentérologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Damien Galanaud
- Service de neuroradiologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Chris Ottolenghi
- Service de Biochimie Métabolique, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Paul Bonnefont
- Laboratoire de Génétique Moléculaire, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Dommergues
- Service de Gynécologie-obstétrique, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jacques Bernuau
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dominique Thabut
- Brain Liver Pitié-Salpêtrière (BLIPS) study group, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie Paris 6, Sorbonne Universités, INSERM UMR_S 938, CDR Saint-Antoine Maladies métaboliques, biliaires et fibro-inflammatoires du foie, & Institut de Cardiométabolisme et Nutrition, ICAN, Paris, France; UF de Soins Intensifs d'Hépato-gastroentérologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France.
| |
Collapse
|