Imaging Neurologic Conditions in Pregnant Patients

Executive Summary:

  • Neurological symptoms may be exacerbations of existing problems (MS, seizure); initial manifestation of neurological disorder (tumor, stroke) or issue unique to pregnancy (eclampsia, postpartum cerebral angiopathy, Sheehan syndrome and lymphocytic adenohypophysitis.
  • ACR Guidance on safe MRI practices states pregnant patients should undergo MRI only if the information cannot be obtained any other way.
  • Autoimmune hypophysitis is a rare chronic inflammatory disorder of the pituitary stalk and gland.  It is classified by involved portions of the gland.
  • Spontaneous or postinstrumentation intracranial hypotension.
  • Source Paper

Iodinated CT contrast and Gadolinium contrast agents are acceptable to use, so long as the diagnostic benefit outweighs the risk.  CT contrast is category B and Gad is Category C.  Usual principles of limiting imaging apply.

More Common and Less Common Neurologic Conditions in Pregnant Patients

More common conditions

Headache
Epilepsy and seizure
Preeclampsia
Eclampsia
PRES
Infarct- or hemorrhage-related stroke
SAH
Venous thrombosis
Pituitary disorders

Less common conditions

Metastasis from choriocarcinoma
Meningioma and glioma
Vasoconstriction syndrome
Aneurysm
AVM rupture
Movement disorders
Multiple sclerosis
Wernicke encephalopathy
Bell palsy
Intracranial hypotension

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