Epilepsy appears to have no effect on pregnancy, though at the time of labour it may be mistaken for eclampsia by inexperienced observers. If the attacks are frequent the patient should be put upon large doses of potassium bromide and treated just as at other times.
—J. Whitridge Williams (1903)
Although several neurological diseases are relatively common in women of childbearing age, less than two pages were devoted to Diseases of the Nervous System in this textbook’s first edition. In the past, some may have precluded pregnancy, however, few do so now. Most encountered during pregnancy are the same as for nonpregnant women, however a few neurological disorders may be seen more frequently in pregnant women. 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 2006 through 2010 (Creanga, 2015).
Many neurological disorders frequently precede pregnancy. Most women with chronic neurological disease who become pregnant will have successful outcomes, but some disorders have specific risks. Conversely, other women will have new-onset neurological symptoms during pregnancy, and these often must be distinguished from pregnancy complications. Psychiatric disorders can also manifest with cognitive and neuromuscular abnormalities and should be considered in the evaluation.
CENTRAL NERVOUS SYSTEM IMAGING
Computed tomography (CT) and magnetic resonance (MR) imaging assist in the diagnosis, classification, and management of many neurological and psychiatric disorders. As discussed in Chapter 46, these imaging methods can be used safely during pregnancy. CT scanning is often used when rapid diagnosis is necessary and is excellent for detecting recent hemorrhage. Because it does not use radiation, MR imaging is often preferred and is particularly helpful to diagnose demyelinating diseases, arteriovenous malformations, congenital and developmental nervous system abnormalities, posterior fossa lesions, and spinal cord diseases. Whenever either test is done, the woman with advanced pregnancy should be positioned in a left lateral tilt with a wedge under one hip to prevent hypotension and 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 MR imaging (fMRI) have not been evaluated for use in pregnant patients (Chiapparini, 2010).
In one national survey in the United States in 2012, 17 percent of those aged 18 to 44 years reported a severe headache or migraine within the past 3 months (Blackwell, 2014). Burch and coworkers (2015) reported that 24 percent of nonpregnant women in this age group were similarly affected. Of pregnant women presenting with headache who received a neurological consultation, two thirds were due to primary disorders, ...