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This article discusses the neurologic complications during pregnancy.
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This article analyzes and summarizes the most recent data about stroke, eclampsia, status epilepticus, neuromuscular disease, and brain death during pregnancy.
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This article emphasizes the physiopathology, epidemiology, and modality of treatments of the previously mentioned conditions.
Neurologic Complications in Pregnancy
Section snippets
Key points
Preeclampsia-eclampsia
Preeclampsia (PREC) is defined as the constellation of newly diagnosed hypertension (systolic/diastolic blood pressure [BP] ≥140/90 mm Hg on 2 occasions at least 4 hours apart after 20 weeks’ gestation in a woman with previously normal BP; or BP ≥160/110 mm Hg, confirmed within a few minutes to facilitate timely antihypertensive treatment) and proteinuria (>300 mg/24 h or ≥1+ in dipstick testing; because of variability of qualitative determinations, this method is discouraged for diagnostic use
Hemolysis, elevated liver enzyme levels, and low platelet levels syndrome
The hemolysis, increased liver enzyme levels, and low platelet levels syndrome is a laboratory defined severe form of PREC. The acronym stands for hemolysis (anemia, increased bilirubin level, schistocytes in blood smear), increased liver enzyme levels (AST or ALT >70 U/L), and low platelet levels (<100,000/mm3). It is associated with poor maternal (0%–24%) and perinatal (8%–60%) mortality caused by multisystem involvement. The incidence has been reported as 4% to 12% of patients with severe
Myasthenia gravis
Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction, commonly affecting women in their third decade of life, who are of childbearing age.36
Guillain-Barré syndrome
Guillain-Barré syndrome (GBS), or acute inflammatory demyelinating polyradiculoneuropathy (AIDP), is the most common cause of acute neuromuscular generalized paralysis. The diagnosis is made when there is progressive areflexic weakness (usually starting in the lower extremities), preceded in 50% of patients by back pain or leg paresthesias. Increased protein levels without cells in the cerebrospinal fluid (after the first week), prolonged distal latencies, and F-waves and antiganglioside
Stroke
Pregnancy is a physiologic state. However, it causes remodeling of the heart and all blood vessels. In animal studies, the walls of systemic arteries have shown a reduction in collagen and elastin content as well as a loss of distensibility. These biomechanical changes, along with the hemodynamic variation and changes in the levels of procoagulant factors, coagulation inhibitors, and other mediators of clot formation and lysis, make pregnancy a state of hypercoagulability. The incidence and the
Status epilepticus
Most epileptic women have unchanged seizure frequency during pregnancy. Exacerbation of seizures can occur in 37% of pregnant epileptics.107 Status epilepticus (SE) during pregnancy is rare. In a 1999 review of the English literature, 19 case reports were identified. SE was previously experienced in only 3 of 19 women and occurred in the third trimester in 74% of cases.108 In a large prospective antiepileptic drugs and pregnancy registry (EURAP [European Registry of Antiepileptic Drugs and
Brain death
The criteria of diagnosing brain death during pregnancy do not differ from those for nonpregnant women. However, there are several controversial ethical issues for supporting the mother until or beyond the fetus is viable (24 weeks). Her right for autonomy should be balanced against fetal rights for survival. Her wishes and, if never expressed, those of the next of kin, and particularly those of the biological father of the fetus, should be respected.120
How often this catastrophic event happens
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Disclosures: The authors have nothing to disclose.