Neurologic Diseases in Pregnancy

2018 ◽  
Author(s):  
Emily L Johnson ◽  
Peter W Kaplan
Keyword(s):  
Multiple Sclerosis ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Sinus Thrombosis ◽  
Venous Sinus ◽  
Key Words Epilepsy ◽  
Neurologic Diseases ◽  
Posterior Reversible Encephalopathy ◽  
Venous Sinus Thrombosis ◽  
Reversible Encephalopathy ◽  
Physiologic Changes Of Pregnancy

Neurologic conditions commonly affect women during pregnancy. The severity of some chronic conditions, such as headaches, epilepsy, and multiple sclerosis, may be affected by pregnancy. Due to teratogenicity, some medications used prior to pregnancy should be avoided or used at a lower dose during pregnancy. The physiologic changes of pregnancy put women at risk for new neurologic conditions, including posterior reversible encephalopathy syndrome, venous sinus thrombosis, and restless legs syndrome. Compression neuropathies may arise during pregnancy or delivery. Increased experience with neuroimaging has provided reassurance that magnetic resonance imaging may be used safely during pregnancy. This review contains 7 figures, 7 tables, and 30 references Key Words: epilepsy, headache, multiple sclerosis, myasthenia gravis, neurology, neuropathy, pregnancy, posterior reversible encephalopathy syndrome, stroke, venous sinus thrombosis

scholarly journals A case of PRES following intracranial hypotension, with spontaneous resolution with epidural blood patch

2018 ◽  
Vol 7 (12) ◽  
pp. 5190
Author(s):  
Sarada Murali Mamilla
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Intracranial Hypotension ◽  
Sinus Thrombosis ◽  
Cerebral Haemorrhage ◽  
Clinical Syndrome ◽  
Acute Hypertension ◽  
Posterior Reversible Encephalopathy ◽  
Blood Patch ◽  
Clonic Convulsions ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES (also known as reversible posterior leukoencephalopathy syndrome)) presents with rapid onset of symptoms including headache, seizures, altered consciousness, and visual disturbance. It is often but by no means always associated with acute hypertension. Diffusion-weighted MRI is the most sensitive exam to confirm the diagnosis of PRES. If promptly recognized and treated, the clinical syndrome usually resolves within a week, and the changes seen in magnetic resonance imaging (MRI) resolve over days to weeks. Posterior reversible encephalopathy syndrome is an increasingly recognized disorder, with a wide clinical spectrum of both symptoms and triggers, and yet it remains poorly understood. Differential diagnosis includes venous sinus thrombosis, cerebral haemorrhage, encephalitis, vasculititis and metabolic encephalopathys. No clinical trials have evaluated the management of PRES, but rapid withdrawal of the trigger appears to hasten recovery and to avoid complications: for example, aggressive blood pressure management, withdrawal of the offending drug, or delivery in eclampsia. We report a case of women presenting with severe headache, tonic clonic convulsions 7 days after spinal anaesthesia for caesarean delivery, MRI showed evidence of intracranial hypotension and posterior reversible encephalopathy syndrome. She was treated with Blood patch which lead to complete resolution of symptoms and radiological findings. The possible pathogenetic relationship between intracranial hypotension, secondary to the inadvertent dural puncture, and PRES is discussed. Prompt diagnosis and proper treatment results in complete cure without permanent neurological sequelae.

scholarly journals Acute posterior reversible encephalopathy syndrome (PRES) in setting of interferon-beta use: case presentation with reduction of edema in 72 h after cessation of interferon-beta therapy with sub-clinical inflammation

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicholas Dietz ◽  
Zarmina Mufti ◽  
Muhammed Yousaf ◽  
Randal Brown ◽  
Christopher Counts ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Blood Pressure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Inflammatory Markers ◽  
Interferon Beta ◽  
Vasogenic Edema ◽  
Case Presentation ◽  
Posterior Reversible Encephalopathy ◽  
Autoimmune Pathology ◽  
Reversible Encephalopathy

Abstract Background Posterior reversible encephalopathy syndrome (PRES) represents a transient change in mental status with associated vasogenic edema of cortical and subcortical brain structures. It is often attributed to multifactorial etiology including hypertension and altered hemodynamics and disruption of vessel integrity. Patients with autoimmune disease and certain immune modulator therapies are at greater risk. Case presentation A 54-year-old female with past medical history of well-controlled multiple sclerosis on interferon-beta since 2013, presented with witnessed tonic colonic seizure. She also was noted to demonstrate left gaze deviation and left-sided hemiparesis. MRI fluid-attenuated inversion recovery sequence showed hyperintensity of the subcortical U fibers, concentrated in the occipital, parietal lobes and frontal lobes. Systolic blood pressure was 160 mmHg on arrival. The patient was started on seizure prophylxis and Interferon beta was discontinued. The patient’s mentation, seizures and hemiapresis significantly improved in next 72 h with tight blood pressure control, and had notble improvement on MRI imaging and inflammatory markers. Lumbar puncture CSF results were devoid of infectious and autoimmune pathology. Conclusions A middle-aged female with multiple sclerosis who was on chronic IFN-beta presented to the emergency room with a witnessed tonic-clonic seizure, with MRI T2 FLAIR imaging consistent with PRES. She had notable clinical improvement with decreased edema on imaging and improved inflammatory markers 72 h after cessation of IFN-beta therapy.

scholarly journals Spectrum of neurological disorders during pregnancy and postpartum period from a tertiary hospital

2019 ◽  
Vol 6 (6) ◽  
pp. 1869
Author(s):  
Karthik Nagaraj ◽  
Chaithra S. P.
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Sinus Thrombosis ◽  
Neurological Complications ◽  
Tertiary Hospital ◽  
Cerebral Venous Sinus Thrombosis ◽  
Cerebrovascular Diseases ◽  
Posterior Reversible Encephalopathy ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
Reversible Encephalopathy

Background: Pregnancy and puerperium are states of hypercoagulability. This predisposes women in these phases to increased risk of cerebrovascular diseases. These neurological complications are important causes of maternal and foetal morbidity and mortality. These must be recognized and managed to decrease their burden on maternal and child health.Methods: The aim of this study was to consider the occurrence of neurological complications in pregnancy and puerperium and to analyse the clinical and radiological spectrum of them. This was a prospective study carried out with 1200 patients from January 2014 to August 2015.Results: Of the 1200 women, 87(7.25%) were diagnosed to have neurological complications. Overall mortality was 11.4%. Eclampsia (63.2%), Cerebral Venous sinus Thrombosis (CVT) (18.3%) and Posterior Reversible Encephalopathy Syndrome (PRES) in (8%) accounted for the majority of cases (Table 1). Eclampsia carried a significant mortality rate of 12.7% whereas CVT and PRES had favourable outcomes. Imaging of CVT revealed involvement of deep venous system in 12% and haemorrhagic infarcts in 69%.Conclusions: The commonest neurological complications seen in this cohort were eclampsia, cerebral venous thrombosis and posterior reversible encephalopathy syndrome. Hence a physician needs to bear in mind the common neurological complications that can occur during pregnancy and puerperium to avert poor pregnancy outcomes for both mother and child.

scholarly journals A Rare Case of Cyclophosphamide-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-GBM Vasculitis, and Review of Current Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Taha Nisar ◽  
Abdul R. Alchaki ◽  
Erin Feinstein
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Sinus Thrombosis ◽  
Altered Mental Status ◽  
Cerebral Venous Sinus Thrombosis ◽  
Clinical Syndrome ◽  
Posterior Reversible Encephalopathy ◽  
Posterior Leukoencephalopathy ◽  
Vessel Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome of headache, altered mental status, and seizures with reversible mainly posterior leukoencephalopathy on neuroimaging. Precipitating factors for PRES are multifactorial and include autoregulatory failure due to changes in blood pressure, metabolic derangements, and cytotoxic medications. We report the second case of cyclophosphamide-induced PRES in a patient with anti-glomerular basement membrane (Anti-GBM) positive vasculitis. In the acute setting, PRES can be challenging to distinguish from cerebral venous sinus thrombosis or cerebral vasculitis based on clinical presentation. Neuroimaging with magnetic resonance imaging (MRI) of the brain along with a vessel imaging, can help reach the diagnosis.

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