Neurology and Pregnancy: Neuro-Obstetric Disorders
FIRST EDITION
Eric A.P. Steegers
Marilyn J. Cipolla
Eliza C. Miller
Table of Contents
Cover image
Title page
Copyright
Available titles
Foreword
Preface
Contributors
Section I: Acute neurologic disorders during pregnancy
Chapter 1: Ischemic stroke and cerebral venous sinus thrombosis in pregnancy
Abstract
Introduction
Epidemiology of Maternal Arterial Ischemic Stroke and Cerebral Venous Sinus Thrombosis
Risk Factors for Maternal Stroke
Pathophysiology of Maternal Thrombotic Stroke
Special Populations at Risk for Maternal Stroke
Diagnosis and Management of Arterial Ischemic Stroke in Pregnancy
Diagnosis and Management of Cerebral Venous Sinus
Thrombosis in Pregnancy and Postpartum
Poststroke Management of the Pregnant or Postpartum Patient
Stroke Recovery: Special Considerations
Risk of Recurrent Arterial Ischemic Stroke or Venous Sinus
Thrombosis in Future Pregnancies
Conclusion
Chapter 2: Intracerebral and subarachnoid hemorrhage in pregnancy
Abstract
Introduction and Epidemiology
Etiology
Preeclampsia and Eclampsia
Aneurysms
Arteriovenous Malformations
Moyamoya Disease
Other Causes of ICH
Diagnosis and Management
Summary and Conclusions
Chapter 3: Traumatic brain injury in pregnancy
Abstract
Introduction and Epidemiology
Biology of Pregnancy
Hormonal Changes and the Effect of Elevated Progesterone on TBI
Management of the Pregnant Patient With a TBI
Prognosis/Long-Term Sequalae
Future Developments
Chapter 4: Preeclampsia, eclampsia, and posterior reversible encephalopathy syndrome
Abstract
Introduction
Hypertensive Disorders of Pregnancy and Preeclampsia
Epidemiology
Risk Factors
Pathophysiology of Preeclampsia
General Neurologic Sequelae of Preeclampsia
Cerebrovascular Sequelae and Radiographic Findings
Mechanisms of Cerebrovascular Injury in Preeclampsia
Electroencephalogram (EEG) Findings
Laboratory Findings
Thrombotic Thrombocytopenic Purpura (TTP) and Hemolytic
Uremic Syndrome (HUS)
Management
Prognosis
Chapter 5: Neurologic infections during pregnancy
Abstract
Introduction
Viruses
Parasitic Infections
Bacteria
Overview of Sequelae of Infection During Pregnancy
Poliovirus, Clostridium tetani, and Human Immunodeficiency
Virus
Conclusion
Chapter 6: Neuroimmunologic disorders in pregnancy
Abstract
Multiple Sclerosis and Pregnancy
Neuromyelitis Optica Spectrum Disorder
Anti-NMDA Receptor Encephalitis
Conclusion
Chapter 7: Acute psychiatric illness and drug addiction during pregnancy and the puerperium
Abstract
Introduction
Key Points
Depressive Disorders
Agitation
Psychotic Episode
Manic Episode
Postpartum Psychosis
General Principles of Psychopharmacology During Pregnancy and Puerperium
Suicidal Behavior and Suicides in the Peripartum Period
Mental Competency
Illicit Drug Use During Pregnancy
Cannabis
Opioids
Cocaine
(Meth)Amphetamine
Conclusion
Chapter 8: Mononeuropathies in pregnancy
Abstract
Introduction
Mechanism of Mononeuropathy: Entrapment vs Compression
Cranial Mononeuropathies
Upper Extremity Mononeuropathy
Neuralgic Amyotrophy/Brachial Plexopathy
Lower Extremity Mononeuropathy
Sensory Mononeuropathy
Truncal Mononeuropathy
Section II: Management of chronic neurologic
disorders during pregnancy
Chapter 9: Epilepsy
Abstract
Introduction
Preconception Counseling
Maternal Effects
Developing Fetus
Postpartum
First Seizure in Pregnancy
Status Epilepticus
Future Directions
Conclusion
Chapter 10: Sleep and sleep disorders in pregnancy
Abstract
Sleep in Pregnancy
Sleep-related breathing disorders (SRBDs) during pregnancy
RLS During Pregnancy
Consequences of RLS
Insomnia During Pregnancy
Narcolepsy During Pregnancy
Other Sleep Disorders
Conclusion
Chapter 11: Migraine and other headache disorders in pregnancy
Abstract
Migraine Prevalence in Women
Migraine Prevalence in Pregnancy and the Postpartum Period
Hormonal Status During Pregnancy and the Postpartum Period
Pharmacologic Acute Treatment of Migraine During Pregnancy
Pharmacologic Acute Treatment of Migraine During Lactation
Pharmacologic Preventive Treatment of Migraine During Pregnancy
Pharmacologic Preventive Treatment of Migraine During Lactation
Other Primary Headaches During Pregnancy
Pharmacologic Treatment of Cluster Headache During Pregnancy
Secondary Headaches During Pregnancy and the Postpartum Period
Concluding Remark
Chapter 12: Neuromuscular disorders in pregnancy
p p g y
Abstract
Introduction
Neuropathies
Neuromuscular Junction Disorders
Muscle Disorders
Motor Neuron Diseases
Autonomic Disorders
Chapter 13: Movement disorders in pregnancy
Abstract
Introduction
Movement Disorders That Develop During Pregnancy
Women With Chronic Movement Disorders During Pregnancy
Huntington Disease
Wilson Disease
Prepregnancy Ataxia
Conclusions
Chapter 14: Benign and malignant tumors of the central nervous system and pregnancy
Abstract
Introduction
Symptom Management
Meningiomas
Pituitary Adenomas
Gliomas
Brain Metastases
Fertility and Family Planning
Conclusions
Index
Available titles
Foreword
Michael J. Aminoff
François Boller
Dick F. Swaab
Pregnancy and childbirth directly concern a sizeable portion of the world's population. The nervous system participates in these processes in many ways and makes them possible through hormonal changes. In addition, any treatment of a pregnant patient may have important and often long-term consequences for the developing fetus. Yet, standard neurology textbooks often fail to discuss these topics in any depth. The previous series of the Handbook of Clinical Neurology (HCN) had close to 100 entries under the indexed heading of “Pregnancy,” but these usually consisted of footnotes added to the discussion of major disorders such as headache or epilepsy. Therefore we are proud to introduce the present two volumes dedicated to various aspects of neurology and pregnancy.
The first volume is dedicated to the neurophysiologic changes that accompany pregnancy, an overview of the neurologic and psychiatric diseases seen during that period, and the approach to the care of these conditions. A chapter entitled “Neuro-obstetrics” emphasizes the need for a multidisciplinary approach to the care of women with neurologic comorbidities, both preconceptionally and throughout pregnancy. Other chapters discuss in detail neuroimaging and radiation exposure during pregnancy as well as the ethical aspects of complicated pregnancies. The volume concludes with a discussion of the diagnosis and management of congenital neurologic diseases during pregnancy.
The second volume deals in detail with neurologic disorders that may accompany pregnancy, such as stroke, trauma, and neurologic complications associated with preeclampsia and eclampsia. There are chapters that discuss compression neuropathies, acute psychiatric illnesses, migraine and other headaches, movement disorders, disorders of sleep, and CNS tumors. Moreover, a chapter is dedicated to the management of chronic neurologic disorders during pregnancy.
We have had the good fortune of working with three experienced and world-renowned volume editors. Prof. Eric A.P. Steegers is a gynecologist and the head of the Department of Obstetrics & Gynecology at the Erasmus University Medical Center in Ro erdam. Dr. Marilyn J. Cipolla is professor in the Department of Neurological Sciences with joint appointments in Obstetrics, Gynecology & Reproductive Sciences and Pharmacology at the University of Vermont Larner College of Medicine, Burlington. Dr. Eliza C. Miller is a vascular neurologist and assistant professor of neurology in the Division of Stroke and Cerebrovascular Disease at Columbia University, New York City. As series editors, we reviewed all the chapters in the volumes and made suggestions for improvement, but we are delighted that the volume editors and chapter authors produced such scholarly and comprehensive accounts of different aspects of the neurology of pregnancy. Hence, we hope that the volumes will appeal to clinicians and neuroscientists alike. Our goal is to provide clinicians with a state-of-the-art reference that summarizes the clinical features and management of the many neurologic manifestations of pregnancy. We also intend to provide basic researchers with the foundations for new approaches to the study of the complex changes that accompany pregnancy.
In addition to the print version, the chapters in the two volumes are also available electronically on Elsevier's ScienceDirect website, which is becoming increasingly popular with readers and will improve the book's accessibility. Indeed, all the volumes in the present series of Handbook are available electronically on this website. This will make them even more accessible to readers and facilitate searches for specific information.
As always, it is a pleasure to thank Elsevier, our publisher, and in particular Michael Parkinson in Scotland, Nikki Levy and Kristi Anderson in San Diego, and Punithavathy Govindaradjane at Elsevier Global Book Production in Chennai, for their assistance in the development and production of the Handbook of Clinical Neurology.
Preface
Eric A.P. Steegers
Marilyn J. Cipolla
Eliza C. Miller
Neurology and Pregnancy is a two-volume comprehensive multidisciplinary guide to best practices for neurologists, obstetricians, and other specialists who care for women with acute or chronic neurologic disorders. All aspects of care for the pregnant woman with neurologic illness, such as preconception care, genetic counseling, pregnancy in patients with chronic neurologic disorders, and acute pregnancy-related neurologic complications, are covered. Postpartum care and complications, including lactation concerns, are also addressed, as are the long-term effects of pregnancy and its associated problems on maternal brain health.
In the first volume (vol. 171 of the Handbook of Clinical Neurology), the complex neurophysiologic changes in pregnancy are summarized from a basic and translational science perspective. This is followed by a discussion of general issues relevant to the provision of multidisciplinary neurologic care for pregnant patients, including neuroimaging, the principles of neuro-obstetric critical care, and ethical and medicolegal concerns. The final part describes normal fetal cerebral development and summarizes the management of the most common prenatal neurologic disorders.
The second volume (vol. 172 of the Handbook of Clinical Neurology) covers acute neurologic disorders presenting in pregnancy, including preeclampsia/eclampsia, ischemic and hemorrhagic stroke, and infections of the central nervous system. This is followed by discussions of chronic neurologic conditions, such as epilepsy,
g p p y migraine, and multiple sclerosis. As innovative care can be achieved only by the continuous integration of clinical management with advances in research, all chapters provide insights into the newest developments in related translational neuroscience and the implications for the future of the field.
The many contributors to this volume reflect diverse perspectives, from basic and translational researchers to clinicians and clinical researchers in a broad range of specialties. We are grateful to have been given the opportunity to learn and benefit from their extraordinary expertise. Michael Parkinson, the development editor, has thoughtfully provided vital support throughout the process of bringing this work to publication.
We believe that this text will improve the complex multidisciplinary care needed for pregnant women with neurologic disorders, contribute to improved maternal and fetal outcomes, and enhance the long-term health of mothers affected by neurologic disease and also that of their children.
Contributors
S E C T I O N I
Acute neurologic disorders during pregnancy
Chapter 1: Ischemic stroke and cerebral venous sinus thrombosis in pregnancy
Hannah J. Roeder1; Jean Rodriguez Lopez1; Eliza C. Miller1,2,* 1 Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
2 NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States
* Correspondence to: Eliza C Miller, M D , M S , Department of Neurology, Columbia University, 710 West 168 St 6th floor, New York, NY 10032, United States Tel: +1-212-3058389, Fax: +1-212-305-3741 email address: ecm2137@cumc.columbia.edu
Abstract
Maternal ischemic stroke and cerebral venous sinus thrombosis (CVST) are dreaded complications of pregnancy and major contributors to maternal disability and mortality. This chapter summarizes the incidence and risk factors for maternal arterial ischemic stroke (AIS) and CVST and discusses the pathophysiology of maternal AIS and CVST. The diagnosis, treatment, and secondary preventive strategies for maternal stroke are also reviewed. Special populations at high risk of maternal stroke, including women with moyamoya disease, sickle cell disease, HIV, thrombophilia, and genetic cerebrovascular disorders, are highlighted.
