Neurologic disorders complicating pregnancy
- Men-Jean Lee, MD
Men-Jean Lee, MD
- Associate Professor
- University of Hawaii
- Susan Hickenbottom, MD, MS
Susan Hickenbottom, MD, MS
- Adjunct Associate Professor of Neurology
- University of Michigan
- Section Editors
- Michael J Aminoff, MD, DSc
Michael J Aminoff, MD, DSc
- Editor-in-Chief — Neurology
- Section Editor — Medical Neurology
- Professor of Neurology
- University of California, San Francisco School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Pregnancy adds a unique and, at times, challenging facet to the management of neurologic disease. The pregnant state can affect many neurologic diseases, while certain neurologic diseases or their treatments may have a significant negative effect on pregnancy, labor, or delivery. This topic review will focus on the relationship between pregnancy and a wide spectrum of neurologic illnesses.
Cerebrovascular disease during pregnancy results from any of three major mechanisms: arterial infarction/ischemia, hemorrhage, or venous thrombosis. Pregnancy and the postpartum period are associated with a marked increase in the relative risk and a small increase in the absolute risk of stroke.
Risk factors for stroke related to pregnancy include cesarean delivery, pregnancy-induced hypertension, postpartum infection, and possibly multiple gestations. In addition, conditions unique to pregnancy can occur, which can present as either a stroke or a stroke-like event. These include eclampsia, peripartum cardiomyopathy, peripartum angiopathy, and gestational trophoblastic disease. Of these, preeclampsia/eclampsia is the most common cause of stroke in pregnancy. Other causes are listed in Table 1 (table 1). The risk of stroke in women with preeclampsia/eclampsia is discussed in detail separately. (See "Management of hypertension in pregnant and postpartum women", section on 'Indications for antihypertensive therapy'.)
Cerebrovascular disease and stroke in pregnancy is discussed in detail separately. (See "Cerebrovascular disorders complicating pregnancy".)
Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system typically characterized by relapses and remissions of neurologic deficits. MS affects women more than men by a ratio of approximately 2:1; the mean age of onset of MS is approximately 30 years. (See "Pathogenesis and epidemiology of multiple sclerosis" and "Clinical features of multiple sclerosis in adults".)
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- CEREBROVASCULAR DISEASE
- MULTIPLE SCLEROSIS
- Effect of pregnancy on MS activity
- Assisted reproductive technology
- Effect of MS on pregnancy outcomes
- Treatment of MS in pregnancy
- Breastfeeding and MS
- Carpal tunnel syndrome
- Bell's palsy
- Meralgia paresthetica
- Guillain-Barré syndrome
- Hereditary peripheral neuropathies
- Postpartum compression neuropathies
- MUSCLE DISEASE
- CHOREA GRAVIDARUM
- BRAIN TUMORS
- Clinical manifestations
- Pituitary adenoma
- VENTRICULOPERITONEAL SHUNT
- SPINAL CORD INJURY
- RESTLESS LEGS SYNDROME
- SEIZURES AND EPILEPSY
- MYASTHENIA GRAVIS
- LOW BACK PAIN AND DISC DISEASE
- SUMMARY AND RECOMMENDATIONS