A number of neurological diseases are relatively common in women of childbearing age. In the past, some of these may have precluded pregnancy, however, few do so now. Most of those encountered during pregnancy are the same as for nonpregnant women. That said, there are a few neurological disorders that may be seen more frequently in pregnant women. Some examples are Bell palsy, specific types of strokes, and benign intracranial hypertension or pseudotumor cerebri. Neurovascular disorders are an important cause of maternal mortality and accounted for 10 percent of maternal deaths in the United States from 1998 through 2005 (Berg, 2010b).
Because many neurological disorders are chronic, they frequently precede pregnancy. Although most women with chronic neurological disease who become pregnant will have successful outcomes, some of these disorders have specific risks with which clinicians should be familiar. Conversely, some women will have new-onset neurological symptoms during pregnancy, and these frequently must be distinguished from other pregnancy complications. Psychiatric disorders may also manifest with cognitive and neuromuscular abnormalities, and they should be considered in the evaluation.
Central Nervous System Imaging
Computed tomography (CT) and magnetic resonance (MR) imaging have opened new vistas for the diagnosis, classification, and management of many neurological and psychiatric disorders. As discussed in Chapter 46 (Computed Tomography), these cranial imaging methods can be used safely during pregnancy. CT scanning is commonly used whenever rapid diagnosis is necessary and is excellent for detecting recent hemorrhage (Smith, 2012). Because it does not use radiation, MR imaging is often preferred. It is particularly helpful to diagnose demyelinating diseases, screen for arteriovenous malformations, evaluate congenital and developmental nervous system abnormalities, identify posterior fossa lesions, and diagnose spinal cord diseases (Gjelsteen, 2008). Whenever either test is done, the woman should be positioned in a left lateral tilt with a wedge under one hip to prevent hypotension as well as to diminish aortic pulsations, which may degrade the image.
Cerebral angiography with contrast injection, usually via the femoral artery, is a valuable adjunct to the diagnosis and treatment of some cerebrovascular diseases. Fluoroscopy delivers more radiation but can be performed with abdominal shielding. Positron emission tomography (PET) and functional MRI (fMRI) have not been evaluated for use in pregnant patients (Chiapparini, 2010).
The National Health Interview Survey is provided by the Centers for Disease Control and Prevention (Pleis, 2010). In the 2009 survey, a fifth of all women aged 18 to 44 years reported a severe headache or migraine within the past 3 months, and headache was the most common neurological complaint during pregnancy. Smitherman and coworkers (2013) found that 26 percent of nonpregnant women in this age group were similarly affected. Interestingly, Aegidius and colleagues (2009) reported an overall decrease in prevalence of all headache types during ...