• Print ISSN: 2395 - 1400, Online ISSN: 2455 - 8923

Review Article

Diagnosis and Management of acute Neurological disorders in Pregnancy and Postpartum

*Y.S.Kanni1, Sathya Srinivas2, Jayachander3

Professor and HODl, Assistant Professor2, Post Graduate3, Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally ,Nalgonda,Telangana.

Introduction: For physicians attending an emergency call from department of Obstetrics, pre-eclampsia and eclampsia are often the default diagnoses in pregnant and postpartum women who present with acute neurological symptoms of Headache, Acute neurological deficit and or Seizures. However, there are other conditions that overlap with eclampsia and with each other in terms of their presentations. Pre-eclampsia is defined as the new onset of hypertension and proteinuria after 20 weeks in a previously normotensive woman. Eclampsia is defined as pre-eclampsia and a generalised seizure in the absence of other conditions that could cause seizures. Acute neurological symptoms in pregnant and post- partum women could be caused by 1. Exacerbation of a pre-existing neurological condition. 2. The initial presentation of a non-pregnancy-related problem or 3. A new acute-onset neurological problem that is either unique to or occurs with increased frequency during or just after pregnancy.

Here we focus on diagnosis of the later patient group, which most commonly includes Pre- eclampsia and eclampsia. However there are a range of conditions that overlap with eclampsia and with each other in terms of their presentations, including cerebral venous sinus thrombosis (CVT), reversible cerebral vasoconstriction syndrome (RCVS; also referred to as postpartum angiopathy and Call-Fleming syndrome) which can develop during puerperium in the absence of hypertension or other features of pre-eclampsia. Pre-eclampsia, eclampsia, and RCVS can all be complicated by posterior reversible encephalopathy syndrome (PRES). PRES is not a primary diagnosis, but a clinical and imaging syndrome caused by vascular abnormalities that are present in preeclampsia and eclampsia, RCVS, and other conditions. The continuum between potential causes of some neurological problems that can arise in pregnancy must be recognized, and we need to understand that various diagnoses can arise independently or simultaneously, and are not mutually exclusive. Additionally, whereas eclampsia is specific to pregnancy, PRES, RCVS, and CVT occur in non- pregnant individuals too.