CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(10): 560-568
DOI: 10.1055/s-0037-1604058
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Acute Onset Neurological Disorders during Pregnancy: A Literature Review

Doenças neurológicas de início durante a gravidez: análise crítica da literatura
Zita Ferraz
1   Obstetrics Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
Joana Parra
2   Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
Ana Luísa Areia
1   Obstetrics Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
3   Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
,
Elsa Vasco
1   Obstetrics Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
Paulo Moura
1   Obstetrics Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
3   Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
› Institutsangaben
Weitere Informationen

Publikationsverlauf

11. Januar 2017

18. April 2017

Publikationsdatum:
26. Juni 2017 (online)

Abstract

Objectives To characterize the most common peripheral and central neurological disorders during pregnancy.

Methods Original research and review of the literature on neurological complications during pregnancy. We searched for keywords related to the topic on different databases.

Results Pregnancy involves physiological changes that can trigger peripheral neurological and/or central nervous system pathologies, which can sometimes be associated with hypertensive disorders. A definitive diagnosis of neurological disorders can be made according to the trimester of pregnancy and the clinical findings. Carpal tunnel syndrome and peripheral facial palsy are common peripheral neurological disorders, more frequent in the second half of pregnancy. Central nervous disorders are more complex and a precise diagnosis must be made in order to improve perinatal outcomes, provide correct management and treatment and to prevent acute and long-term complications.

Conclusions It is possible to achieve a precise diagnosis, management and treatment of neurological disorders during pregnancy, but these require a multidisciplinary approach, crucial to improve perinatal outcomes.

Resumo

Objetivos Caracterizar as alterações neurológicas centrais e periféricas mais comuns durante a gravidez.

Métodos Foi efetuada uma revisão da literatura acerca de complicações neurológicas durante a gravidez. Foram utilizadas diversas bases de dados usando palavras-chave relacionadas com o tema.

Resultados A gravidez envolve alterações fisiológicas que podem desencadear alterações neurológicas periféricas e/ou do sistema nervoso central, por vezes associadas a distúrbios hipertensivos. Um diagnóstico definitivo pode ser feito tendo em conta o trimestre de gravidez e os achados clínicos encontrados. A síndrome do túnel carpal e a paralisia facial periférica são alterações neurológicas periféricas comuns que ocorrem mais frequentemente na segunda metade da gravidez. As alterações em termos do sistema nervoso central são mais complexas. Um diagnóstico preciso é fulcral, não só para melhorar os desfechos perinatais, mas também para efetuar uma vigilância e tratamento adequados e para prevenir complicações agudas e a longo prazo.

Conclusões Um diagnóstico preciso e um acompanhamento e tratamento apropriados dos distúrbios neurológicos durante a gravidez são ações exequíveis. Contudo, requerem uma abordagem multidisciplinar, crucial para melhorar os desfechos perinatais.

 
  • References

  • 1 Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain 2012; 13 (03) 177-189
  • 2 Prabhu TRB. Cerebrovascular complications in pregnancy and puerperium. J Obstet Gynaecol India 2013; 63 (02) 108-111
  • 3 Wang Y, Hao M, Sampson S, Xia J. Elective delivery versus expectant management for pre-eclampsia: a meta-analysis of RCTs. Arch Gynecol Obstet 2017; 295 (03) 607-622
  • 4 Cipolla MJ, Sweet JG, Chan SL. Cerebral vascular adaptation to pregnancy and its role in the neurological complications of eclampsia. J Appl Physiol (1985) 2011; 110 (02) 329-339
  • 5 Karlı N, Baykan B, Ertaş M. , et al; Turkish Headache Prevalence Study Group. Impact of sex hormonal changes on tension-type headache and migraine: a cross-sectional population-based survey in 2,600 women. J Headache Pain 2012; 13 (07) 557-565
  • 6 Kataoka H, Miyoshi T, Neki R, Yoshimatsu J, Ishibashi-Ueda H, Iihara K. Subarachnoid hemorrhage from intracranial aneurysms during pregnancy and the puerperium. Neurol Med Chir (Tokyo) 2013; 53 (08) 549-554
  • 7 Zyluk A. Carpal tunnel syndrome in pregnancy: a review. Pol Orthop Traumatol 2013; 78: 223-227
  • 8 Monini S, Lazzarino AI, Iacolucci C, Buffoni A, Barbara M. Epidemiology of Bell's palsy in an Italian Health District: incidence and case-control study. Acta Otorhinolaryngol Ital 2010; 30 (04) 198
  • 9 Shiny Sherlie V, Varghese A. ENT changes of pregnancy and its management. Indian J Otolaryngol Head Neck Surg 2014; 66 (Suppl. 01) 6-9
  • 10 Khosrawi S, Maghrouri R. The prevalence and severity of carpal tunnel syndrome during pregnancy. Adv Biomed Res 2012; 1: 43
  • 11 Meems M, Truijens S, Spek V, Visser LH, Pop VJ. Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG 2015; 122 (08) 1112-1118
  • 12 Padua L, Di Pasquale A, Pazzaglia C, Liotta GA, Librante A, Mondelli M. Systematic review of pregnancy-related carpal tunnel syndrome. Muscle Nerve 2010; 42 (05) 697-702
  • 13 Pourrat O, Neau JP, Pierre F. Bell's palsy in pregnancy: underlying HELLP syndrome or pre-eclampsia?. Obstet Med 2013; 6 (03) 132-133
  • 14 Juan YC, Au HK, Hsu JJ, Ma PC, Liu WM, Jeng CJ. Bell palsy and preeclampsia superimposed on chronic hypertension. Taiwan J Obstet Gynecol 2010; 49 (02) 223-224
  • 15 Murthy JM, Saxena AB. Bell's palsy: Treatment guidelines. Ann Indian Acad Neurol 2011; 14 (Suppl. 01) S70-S72
  • 16 Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospital-based study. Neurology 2015; 85 (12) 1024-1030
  • 17 Turner DP, Smitherman TA, Eisenach JC, Penzien DB, Houle TT. Predictors of headache before, during, and after pregnancy: a cohort study. Headache 2012; 52 (03) 348-362
  • 18 Facchinetti F, Allais G, Nappi RE. , et al. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia 2009; 29 (03) 286-292
  • 19 Contag SA, Mertz HL, Bushnell CD. Migraine during pregnancy: is it more than a headache?. Nat Rev Neurol 2009; 5 (08) 449-456
  • 20 Kvisvik EV, Stovner LJ, Helde G, Bovim G, Linde M. Headache and migraine during pregnancy and puerperium: the MIGRA-study. J Headache Pain 2011; 12 (04) 443-451
  • 21 Schoen JC, Campbell RL, Sadosty AT. Headache in pregnancy: an approach to emergency department evaluation and management. West J Emerg Med 2015; 16 (02) 291-301
  • 22 Sasidharan PK. Cerebral vein thrombosis misdiagnosed and mismanaged. Thrombosis 2012; 2012: 210676
  • 23 Cripe SM, Frederick IO, Qiu C, Williams MA. Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy. Paediatr Perinat Epidemiol 2011; 25 (02) 116-123
  • 24 Hacein-Bey L, Varelas PN, Ulmer JL, Mark LP, Raghavan K, Provenzale JM. Imaging of cerebrovascular disease in pregnancy and the puerperium. AJR Am J Roentgenol 2016; 206 (01) 26-38
  • 25 Sarchielli P, Granella F, Prudenzano MP. , et al. Italian guidelines for primary headaches: 2012 revised version. J Headache Pain 2012; 13 (Suppl. 02) S31-S70
  • 26 Calhoun AH, Peterlin BL. Treatment of cluster headache in pregnancy and lactation. Curr Pain Headache Rep 2010; 14 (02) 164-173
  • 27 Rivera Díaz R, Lopera Rivera A. Management of non-obstetric pain during pregnancy. Review article. Colomb J Anesthesiol. 2012; 40 (03) 213-223
  • 28 Jaeschke H. Acetaminophen: dose-dependent drug hepatotoxicity and acute liver failure in patients. Dig Dis 2015; 33 (04) 464-471
  • 29 Torelli P, Jensen R. Headache diaries and calendars. Handb Clin Neurol 2010; 97: 137-146
  • 30 Weintraub A, Mankuta D. Dipyrone-induced oligohydramnios and ductus arteriosus restriction. Isr Med Assoc J 2006; 8 (10) 722-723
  • 31 Arruza Gómez L, Corredera Sánchez A, Montalvo Montes J, de Marco Guilarte E, Moro Serrano M. Intrauterine closure of the ductus arteriosus probably associated with the taking of metamizole during the third trimester. An Pediatr (Barc) 2008; 68 (06) 626-627
  • 32 Bar-Oz B, Clementi M, Di Giantonio E. , et al. Metamizol (dipyrone, optalgin) in pregnancy, is it safe? A prospective comparative study. Eur J Obstet Gynecol Reprod Biol 2005; 119 (02) 176-179
  • 33 Zanrosso CW, Emerenciano M, Gonçalves BA, Faro A, Koifman S, Pombo-de-Oliveira MS. N-acetyltransferase 2 polymorphisms and susceptibility to infant leukemia with maternal exposure to dipyrone during pregnancy. Cancer Epidemiol Biomarkers Prev 2010; 19 (12) 3037-3043
  • 34 Shastri AT, Abdulkarim D, Clarke P. Maternal diclofenac medication in pregnancy causing in utero closure of the fetal ductus arteriosus and hydrops. Pediatr Cardiol 2013; 34 (08) 1925-1927
  • 35 Ndour DD. Maternal use of non-steroidal antiinflammatory drugs and closure of the ductus arteriosus. Pan Afr Med J 2016; 25: 251
  • 36 Duong S, Bozzo P, Nordeng H, Einarson A. Safety of triptans for migraine headaches during pregnancy and breastfeeding. Can Fam Physician 2010; 56 (06) 537-539
  • 37 Jo YY, Kim YB, Yang MR, Chang YJ. Extrapyramidal side effects after metoclopramide administration in a post-anesthesia care unit -A case report-. Korean J Anesthesiol 2012; 63 (03) 274-276
  • 38 Yis U, Ozdemir D, Duman M, Unal N. Metoclopramide induced dystonia in children: two case reports. Eur J Emerg Med 2005; 12 (03) 117-119
  • 39 Bordini CA, Roesler C, Carvalho DdeS. , et al. Recommendations for the treatment of migraine attacks - a Brazilian consensus. Arq Neuropsiquiatr 2016; 74 (03) 262-271
  • 40 Kennedy D. Ondansetron and pregnancy: Understanding the data. Obstet Med 2016; 9 (01) 28-33
  • 41 Arai N, Tabuse M, Nakamura A, Miyazaki H. Malignant isolated cortical vein thrombosis with type II protein S deficiency: a case report. BMC Neurol 2016; 16: 69
  • 42 Hosley CM, McCullough LD. Acute neurological issues in pregnancy and the peripartum. Neurohospitalist 2011; 1 (02) 104-116
  • 43 Aracic N, Roje D, Jakus IA, Bakotin M, Stefanovic V. The impact of inherited thrombophilia types and low molecular weight heparin treatment on pregnancy complications in women with previous adverse outcome. Yonsei Med J 2016; 57 (05) 1230-1235
  • 44 Meng R, Ji X, Wang X, Ding Y. The etiologies of new cases of cerebral venous sinus thrombosis reported in the past year. Intractable Rare Dis Res 2012; 1 (01) 23-26
  • 45 Cantu-Brito C, Arauz A, Aburto Y, Barinagarrementeria F, Ruiz-Sandoval JL, Baizabal-Carvallo JF. Cerebrovascular complications during pregnancy and postpartum: clinical and prognosis observations in 240 Hispanic women. Eur J Neurol 2011; 18 (06) 819-825
  • 46 Edlow JA, Caplan LR, O'Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol 2013; 12 (02) 175-185
  • 47 Coriu L, Ungureanu R, Talmaci R. , et al. Hereditary Thrombophilia and thrombotic events in pregnancy: single-center experience. J Med Life 2014; 7 (04) 567-571
  • 48 Gupta R, Aggarwal M, Patil S, Vyas V. Cerebral venous thrombosis associated with pregnancy: a case report. IOSR J Dent Med Sci. 2015; 14 (05) 43-45
  • 49 Shah M, Agarwal N, Gala NB, Prestigiacomo CJ, Gandhi CD. Management of dural venous sinus thrombosis in pregnancy. EJVES Extra 2014; 27 (05) e41-e42
  • 50 Nie Q, Guo P, Ge J, Qiu Y. Cerebral venous sinus thrombosis with cerebral hemorrhage during early pregnancy. Neurosciences (Riyadh) 2015; 20 (01) 48-51
  • 51 Saposnik G, Barinagarrementeria F, Brown Jr RD. , et al; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (04) 1158-1192
  • 52 Bereczki Jr D, Szegedi N, Szakács Z, Gubucz I, May Z. Cryptogenic postpartum stroke. Neurol Neurochir Pol 2016; 50 (05) 370-373
  • 53 Einhäupl K, Stam J, Bousser MG. , et al; European Federation of Neurological Societies. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol 2010; 17 (10) 1229-1235
  • 54 Marwah S, Shailesh GH, Gupta S, Sharma M, Mittal P. Cerebral venous thrombosis in pregnancy-a poignant allegory of an unusual case. J Clin Diagn Res 2016; 10 (12) QD08-QD09
  • 55 Hafed BM, Houcem R, Wassim S. , et al. Clinical and therapeutic aspects of post-partum cerebral thrombophlebites. Pan Afr Med J 2016; 25: 248
  • 56 Liu XJ, Wang S, Zhao YL. , et al. Risk of cerebral arteriovenous malformation rupture during pregnancy and puerperium. Neurology 2014; 82 (20) 1798-1803
  • 57 Grasso G, Alafaci C, Macdonald RL. Management of aneurysmal subarachnoid hemorrhage: State of the art and future perspectives. Surg Neurol Int 2017; 8: 11
  • 58 Pereira CE, Lynch JC. Management strategies for neoplastic and vascular brain lesions presenting during pregnancy: A series of 29 patients. Surg Neurol Int 2017; 8: 27
  • 59 Nossek E, Ekstein M, Rimon E, Kupferminc MJ, Ram Z. Neurosurgery and pregnancy. Acta Neurochir (Wien) 2011; 153 (09) 1727-1735
  • 60 Ishii A, Miyamoto S. Endovascular treatment in pregnancy. Neurol Med Chir (Tokyo) 2013; 53 (08) 541-548
  • 61 Kalani MY, Zabramski JM. Risk for symptomatic hemorrhage of cerebral cavernous malformations during pregnancy. J Neurosurg 2013; 118 (01) 50-55
  • 62 Bateman BT, Olbrecht VA, Berman MF, Minehart RD, Schwamm LH, Leffert LR. Peripartum subarachnoid hemorrhage: nationwide data and institutional experience. Anesthesiology 2012; 116 (02) 324-333
  • 63 Tiel Groenestege AT, Rinkel GJE, van der Bom JG, Algra A, Klijn CJM. The risk of aneurysmal subarachnoid hemorrhage during pregnancy, delivery, and the puerperium in the Utrecht population: case-crossover study and standardized incidence ratio estimation. Stroke 2009; 40 (04) 1148-1151
  • 64 Misra UK, Kalita J, Tripathi GM, Bhoi SK. Is β endorphin related to migraine headache and its relief?. Cephalalgia 2013; 33 (05) 316-322
  • 65 Osterman M, Ilyas AM, Matzon JL. Carpal tunnel syndrome in pregnancy. Orthop Clin North Am 2012; 43 (04) 515-520
  • 66 Finsen V, Zeitlmann H. Carpal tunnel syndrome during pregnancy. Scand J Plast Reconstr Surg Hand Surg 2006; 40 (01) 41-45
  • 67 Wu K, Guo C, Lu X, Wu X, Pan H, Su M. Impact of perinatal exposure to acetaminophen on hepatocellular metabolic function in offspring. Am J Transl Res 2016; 8 (12) 5646-5652
  • 68 Katarey D, Verma S. Drug-induced liver injury. Clin Med (Lond) 2016; 16 (Suppl. 06) s104-s109
  • 69 Blair EM, Nelson KB. Migraine and preterm birth. J Perinatol 2011; 31 (06) 434-439
  • 70 Chen HM, Chen SF, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes for women with migraines: a nationwide population-based study. Cephalalgia 2010; 30 (04) 433-438
  • 71 Cheng CA, Lee JT, Lin HC. , et al. Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk. QJM 2017; ; (Jan): 9 ; [ Epub ahead of print ]
  • 72 Aguiar de Sousa D, Canhão P, Ferro JM. Safety of pregnancy after cerebral venous thrombosis: a systematic review. Stroke 2016; 47 (03) 713-718
  • 73 Mehraein S, Ortwein H, Busch M, Weih M, Einhäupl K, Masuhr F. Risk of recurrence of cerebral venous and sinus thrombosis during subsequent pregnancy and puerperium. J Neurol Neurosurg Psychiatry 2003; 74 (06) 814-816
  • 74 Royal College of Obstetricians and Gynaecologists [Internet]. Thrombosis and embolism during pregnancy and the puerperium, reducing the risk (Green-top Guideline No. 37a). London: RCOG; 2015 [cited 2016 Jul 17]. Available from: < https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37a/ >
  • 75 Paidas MJ, Triche EW, James AH. , et al. Recombinant Human antithrombin in pregnant patients with hereditary antithrombin deficiency: integrated analysis of clinical data. Am J Perinatol 2016; 33 (04) 343-349
  • 76 Paidas MJ, Forsyth C, Quéré I, Rodger M, Frieling JT, Tait RC. ; Recombinant Human Antithrombin Study Group. Perioperative and peripartum prevention of venous thromboembolism in patients with hereditary antithrombin deficiency using recombinant antithrombin therapy. Blood Coagul Fibrinolysis 2014; 25 (05) 444-450