DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194859

The challenge of neuroimaging during pregnancy

Kariman Suel Ghazal, Abdul Rahman Shatila

Abstract


Background: Central nervous system conditions may affect every aspect of female reproduction from fertility to lactation. The objective of this study was to examine the performance of computed tomography and magnetic resonance imaging in the diagnosis of maternal neurologic disorders and to examine the outcome of pregnancies complicated by abnormal neurologic imaging.

Methods: Retrospective observational study of 20 parturients presenting with severe neurologic symptoms (January 2006 to January 2016).

Results: Abnormal neuro-radiological findings were found. Only 10% of the computed tomography-scans were normal. Both magnetic resonance imaging and computed tomography that were performed in all cases showed cerebral edema (90%) with different degrees, thereby cerebral edema was the predominant lesion. Pertaining to its localization, 65% were localized in the parietal or occipital area, 10% in the paraventricular area, and 10% were diffused. Also, 35% showed intracerebral hemorrhage and 10% showed cerebellar hemorrhage. The incidence of neurological disorders in pregnancy and puerperium was high. Epilepsy and headache were the most common primary and secondary neurological disorders.

Conclusions: The role of neuroimaging in diagnosing neurological disorders is crucial for prevention of severe complications.


Keywords


Computed tomography, Magnetic resonance imaging, Neuroimaging, Neurologic disorders, Pregnancy

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References


Kelin A, O'Neal MA, Scifres C, Waters J, Waters JH. Neurological illness in pregnancy: Principles and practice. John Wiley and Sons; 2016.

Renukesh S, Rai L. Neurological disorders complicating pregnancy-focus on obstetric outcome. J Clin Diagn Res. 2016;10:QC06-QC09.

Williams PM, Fletcher S. Health effects of prenatal radiation exposure. Am J Fam Phys. 2010;82:488-93.

Hira B, Moodley J. Role of cerebral computerized tomography scans in eclampsia. J Obstet Gynaecol. 2004;24:778-9.

Abdelazim IA, Abdelrazak KM, Ramy AR, Mounib AM. Complementary roles of prenatal sonography and magnetic resonance imaging in diagnosis of fetal renal anomalies. Aust N Z J Obstet Gynaecol. 2010;50:237-41.

Edlow JA, Caplan LR, O’Brien K. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol. 2013;12:175-85.

Feske SK, Singhal AB. Cerebrovascular disorders complicating pregnancy. Continuum (Minneap Minn). 2014; 20:180-99.

Sidorov EV, Feng W, Caplan LR. Stroke in pregnant and postpartum women. Expert Rev Cardiovasc Ther. 2011;9:1235-47.

Ng N, Cox S, Maiti S. Headache in pregnancy: an overview of differential diagnoses. J Preg Child Health. 2015;2(130):2.

Dolea C, AbouZahr C. Global burden of hypertensive disorders of pregnancy in the year 2000. GBD 2000 Working Paper, World Health Organization, Geneva. Available at: http://www. WHO. int/evidence/bod. 2003b.“Global Burden of Obstructed Labor in the Year 2000.” GBD 2000 Working Paper, World Health Organization, Geneva. http://www. WHO. int/evidence/bod; 2003 Jul.

Hiremath R, Mundaganur P, Sonwalkar P. Cross sectional imaging of post-partum headache and seizures. J Clin Diagn Res. 2014;8:RC01-RC05.

Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. Pre‐eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization multicountry survey on maternal and newborn health. BJOG. 2014;121:14-24.

Shankar J, Banfield J. Posterior reversible encephalopathy syndrome: a review. Can Assoc Radiol J. 2017;68:147-53.

Tanaka K, Matsushima M, Matsuzawa Y, Wachi Y, Izawa T, Sakai K, et al. Antepartum reversible cerebral vasoconstriction syndrome with pre‐eclampsia and reversible posterior leukoencephalopathy. J Obstet Gynaecol Res. 2015;41:1843-7.

Ugran SM, Donimath KV. Correlation between neuroimaging (CT scan) and neurological presentation in antepartum and postpartum eclampsia. Int J Reprod Contracept Obstet Gynecol. 2016;5:419-24.

Jindal MA, Gaikwad HS, Hasija BD, Vani K. Comparison of neuroimaging by CT and MRI and correlation with neurological presentation in eclampsia. Int J Reprod Contracept Obstet Gynecol. 2013;2:83-7.

Kokila MS, Dwivedi AD. Correlation of clinical and neuroimaging findings affecting management in postpartum eclampsia: a prospective study. J South Asian Federation Obstet Gynaecol. 2011;3:125-30.

Majoko F, Mujaji C. Maternal outcome in eclampsia at Harare Maternity Hospital. Cent Afr J Med. 2001;47:123-8.

Choudhary A. Eclampsia a hospital based retrospective study. Kathmandu University Med J. 2003;1:237-41.