NEUROLOGIC DISEASES IN PREGNANCY 1.2 (AB) Flashcards by Shiela Micah Gascon

When do most strokes in pregnancy occur?

During postpartum (53%)

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What are the common times for stroke occurrence during the peripartum period?

During labor (45%)

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Name 3 pregnancy-unrelated risk factors for stroke.

Age ,migraines,hypertension, obesity, and diabetes; cardiac
disorders such as endocarditis, valvular prostheses,
and patent foramen ovale and smoking

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What are cardiac-related risk factors for stroke unrelated to pregnancy?

Endocarditis

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What pregnancy-related conditions increase stroke risk?

Hypertensive disorders

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How does general anesthesia affect stroke risk compared to neuraxial anesthesia?

General anesthesia may carry a higher stroke risk

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How much higher is the stroke risk with cesarean delivery versus vaginal delivery?

1.5-fold higher

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What systemic condition increases postpartum stroke risk?

Sepsis

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What causes ischemic stroke?

Acute occlusion or embolization of an intracranial vessel

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What is a TIA?

Transient Ischemic Attack – reversible ischemia lasting <24 hours

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What are 3 symptoms of ischemic stroke?

Severe headache
Hemiplegia
Seizures

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List pregnancy-related causes of ischemic stroke.

Preeclampsia syndrome
Arterial thrombosis
Venous thrombosis
Lupus anticoagulant
Antiphospholipid antibodies
Thrombophilias
Migraine
Paradoxical embolus
Cardioembolic
Sickle hemoglobinopathy
Arterial dissection
Vasculitis
Moyamoya disease
Cocaine, amphetamines

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Name types of stroke seen in pregnancy.

SUBCORTICAL INFARCTION (PREECLAMPSIA)
HYPERTENSIVE HEMORRHAGE
ANEURYSM
EMBOLISM OR THROMBOSIS IN MIDDLE
CEREBRAL ARTERY
ARTERIOVENOUS MALFORMATION
CORTICAL VEIN THROMBOSIS

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What labs and imaging are done for stroke evaluation in healthy pregnant women?

APAS Panel
●
Lupus anticoagulant
●
Thrombophilias,
●
Sickle-cell syndromes
●
CT / MRI
●
Embolism: cardiac-associated embolism, vasculitis,
or vasculopathy such as Moyamoya disease
(Miyakoshi, 2009)

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What imaging is used to detect vasculopathy like Moyamoya disease?

CT or MRI

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What brain imaging findings are seen in preeclampsia-related stroke?

Subcortical edema

petechial hemorrhage

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What is Reversible Cerebral Vasoconstriction Syndrome?

Postpartum angiopathy with cerebral edema

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Which artery is usually involved in cerebral embolism?

Middle cerebral artery

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What is needed before diagnosing cerebral embolism?

Exclusion of thrombosis and hemorrhage

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How is cerebral embolism managed in pregnancy?

Supportive care + antiplatelet therapy

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Which artery is commonly affected in thrombotic stroke?

Internal carotid artery

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What is the thrombolytic therapy of choice in stroke?

Recombinant tissue plasminogen activator (rtPA or Alteplase)

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What is the time window for rtPA administration?

Within first 3 hours if no hemorrhage

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What percentage of pregnancy-related strokes are cerebral venous thromboses?

0.02

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When is the risk highest for cerebral venous thrombosis?

Late pregnancy and puerperium

Which venous sinuses are most commonly affected in CVT?

Lateral or superior sagittal sinus

What are symptoms of cerebral venous thrombosis?

Headache

Best imaging modality for CVT?

MR venography

How is CVT managed?

Heparin

When is fibrinolytic therapy indicated in CVT?

For women failing systemic anticoagulation

What are the two categories of hemorrhagic stroke?

Intracerebral and subarachnoid hemorrhage

What causes intracerebral hemorrhage in pregnancy?

Hypertension and rupture of Charcot-Bouchard aneurysms

What is the most common cause of subarachnoid hemorrhage?

Ruptured berry aneurysms (80%)

What is the incidence of subarachnoid hemorrhage in pregnancy?

8.5 per 100

What is the cardinal symptom of aneurysmal rupture?

Sudden severe headache

What is the first-line imaging for suspected subarachnoid hemorrhage?

Noncontrast CT

How is subarachnoid hemorrhage managed?

Bed rest

Preferred aneurysm repair technique in pregnancy?

Clipping > Coiling

How is delivery planned in near-term pregnant women with aneurysmal hemorrhage?

Cesarean delivery followed by aneurysm repair

What are AVMs?

Congenital abnormal artery-vein tangles lacking capillaries

Preferred mode of delivery in AVMs?

Cesarean section (due to risk of hemorrhage)

What causes demyelinating diseases?

Immune-mediated destruction of myelin

What causes MS?

T-cell mediated autoimmune destruction of oligodendrocytes

What is the most common clinical type of MS?

Relapsing MS (RMS)

What defines Secondary Progressive MS?

Relapsing MS followed by progressive decline

What defines Primary Progressive MS?

Disability progresses from onset without relapses

What are classic symptoms of MS?

Sensory loss

How is MS diagnosed?

MRI (white matter plaques)

What happens to MS relapse rates during pregnancy and postpartum?

Decrease during pregnancy

What treatment is used for acute MS attack?

IV methylprednisolone

What if MS is resistant to steroids?

Plasma exchange

How is neurogenic pain in MS managed?

Carbamazepine

What prevents MS relapse postpartum?

IVIG (0.4 g/kg for 5 days on weeks 1

What are cardinal features of Myasthenia Gravis?

Weakness

What is the worst complication of MG?

Respiratory muscle paralysis

First-line treatment for MG?

Oral pyridostigmine

What is used in MG crisis or surgery?

IVIG or plasma exchange

What drugs are avoided in MG?

Magnesium sulfate

Preferred delivery mode in MG?

Assisted vaginal delivery with oxytocin

What neonatal effects occur in MG?

Feeble cry

What is Guillain-Barré Syndrome?

Areflexic ascending paralysis after infection or immunization

What are common infections associated with GBS?

Campylobacter jejuni

What symptoms are seen in GBS?

Symmetrical paralysis

How is GBS managed?

Supportive care

What is Bell's palsy?

Acute facial nerve palsy with abrupt onset

When is Bell's palsy more common?

During pregnancy

What virus is linked to Bell’s palsy?

HSV or herpes zoster

First-line treatment for Bell’s palsy?

Prednisone 1 mg/kg/day for 5 days

What causes Carpal Tunnel Syndrome?

Median nerve compression

What are symptoms of Carpal Tunnel?

Tingling

What is treatment for Carpal Tunnel?

Surgical decompression

What is Meralgia Paresthetica?

Compression of lateral femoral cutaneous nerve

How is Meralgia Paresthetica treated?

Groin corticosteroid injection

What complications arise from spinal cord injury above T10?

Impaired cough reflex Compromised Respiratory function Pneumonitis from covert aspiration

What is autonomic dysreflexia?

Sympathetic overactivity from lesions above T5-T6

Symptoms of autonomic dysreflexia?

Vasoconstriction with severe hypertension and symptoms that include throbbing headaches, facial flushing, sweating, bradycardia, tachycardia, arrhythmias, and respiratory distress. Dysreflexia can be precipitated by various stimuli

NEUROLOGIC DISEASES IN PREGNANCY 1.2 (AB) Flashcards

(76 cards)