Emergent Headaches during Pregnancy: Correlation between Neurologic Examination and Neuroimaging

Ramchandren, Sindhu; Cross, Brian; Liebeskind, David S

doi:10.3174/ajnr.a0506

Cited by 42 publications

(19 citation statements)

References 8 publications

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“…Headache is a well-known symptom in eclampsia/preeclampsia [8,9,10]. It is also common after delivery [11, 12]. It has further been suggested that there is a connection between preeclampsia and migraine [13].…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Is There a Difference between Pregnant and Non-Pregnant Patients?

Roth

Ferbert

2009

Eur Neurol

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Background: Clinical and imaging abnormalities similar to those seen in posterior reversible encephalopathy syndrome (PRES) have been observed in patients with eclampsia. It remains unclear whether both conditions are in fact the same disease entity. Methods: We retrospectively identified 21 patients with PRES and separated them into 2 groups: patients who were symptomatic during pregnancy, and a group of non-pregnant patients. We recorded symptoms, premedical history and paraclinical investigations of both groups and compared them to each other. Results: We found 8 pregnant patients and 13 non-pregnant patients with PRES. There was no difference between both groups with regard to symptoms, cerebral imaging, or outcome, apart from a difference in age, the premedical history and a significantly higher occurrence of headache in the pregnant group. All of our pregnant women were primigravid. Follow-up was done over a mean period of 2,171 (range 59–9,396) days. Overall, there was a good clinical outcome. Conclusion: We suggest that PRES in non-pregnant patients and eclampsia presenting with MRI abnormalities similar to those seen in PRES represent the same disease entity, but are triggered by different pathologies.

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Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Is There a Difference between Pregnant and Non-Pregnant Patients?

Roth

Ferbert

2009

Eur Neurol

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“…Ramchandren et al 16 reviewed 63 pregnant women presenting to an emergency department with headache, two-thirds of whom received neurologic consultation and all had neuroimaging, yielding 26.9% with secondary headache. An abnormal neurologic examination was more common in patients with secondary headache, but this did not reach significance.…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines do not exist for diagnostic strategies in this patient population, developed algorithms are not validated, 14,15 and clinical series describing demographics, symptomatology, and diagnoses of pregnant women evaluated for acute headache are scarce. 16,17 We aimed to study a large number of pregnant women presenting with acute headache to the inpatient setting to better characterize demographics, comorbidities, symptoms, examination findings, rates, and risk factors of primary and secondary headache diagnoses.…”

mentioning

confidence: 99%

Acute headache diagnosis in pregnant women

et al. 2015

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Objective: To characterize demographic and clinical features in pregnant women presenting with acute headache, and to identify clinical features associated with secondary headache. Methods:We conducted a 5-year, single-center, retrospective study of consecutive pregnant women presenting to acute care with headache receiving neurologic consultation.Results: The 140 women had a mean age of 29 6 6.4 years and often presented in the third trimester (56.4%). Diagnoses were divided into primary (65.0%) and secondary (35.0%) disorders. The most common primary headache disorder was migraine (91.2%) and secondary headache disorders were hypertensive disorders (51.0%). The groups were similar in demographics, gestational ages, and most headache features. In univariate analysis, secondary headaches were associated with a lack of headache history (36.7% vs 13.2%, p 5 0.0012), seizures (12.2% vs 0.0%, p 5 0.0015), elevated blood pressure (55.1% vs 8.8%, p , 0.0001), fever (8.2% vs 0.0%, p 5 0.014), and an abnormal neurologic examination (34.7% vs 16.5%, p 5 0.014). In multivariate logistic regression, elevated blood pressure (odds ratio [OR] 17.0, 95% confidence interval [CI] 4.2-56.0) and a lack of headache history (OR 4.9, 95% CI 1.7-14.5) had an increased association with secondary headache, while psychiatric comorbidity (OR 0.13, 95% CI 0.021-0.78) and phonophobia (OR 0.29, 95% CI 0.09-0.91) had a reduced association with secondary headache.Conclusions: Among pregnant women receiving inpatient neurologic consultation, more than onethird have secondary headache. Diagnostic vigilance should be heightened in the absence of a headache history and if seizures, hypertension, or fever are present. Attack features may not adequately distinguish primary vs secondary disorders, and low thresholds for neuroimaging and monitoring for preeclampsia are justified. Neurology ® 2015;85:1024-1030 GLOSSARY CI 5 confidence interval; HELLP 5 hemolysis, elevated liver enzymes, and low platelet count; ICHD-3 beta 5 International Classification of Headache Disorders, 3rd edition (beta version); OR 5 odds ratio; PRES 5 posterior reversible encephalopathy syndrome.The most common primary headache disorders have a peak prevalence and incidence at a younger age and affect women disproportionately, particularly during childbearing years.1 The female predilection may be explained by the relationship of headache and sex hormones, particularly estrogen.2 Migraine is the most common disabling primary headache disorder, and, in pregnancy, retrospective and prospective studies consistently demonstrate that by the second trimester, migraine frequency typically improves, although attacks of migraine with aura and aura without headache may not reflect this pattern. [3][4][5][6][7][8][9][10] Acute, severe headache in pregnancy is generally regarded as a "red flag" and a cause for further investigation, particularly when new onset. [11][12][13] Various secondary headache disorders are more likely to occur during this time period, 12 possibly related t...

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“…[22] Literatürde, hangi durumlarda hastalara kraniyel görüntüleme önerilmesi gerektiğine dair değişik çalışmalar mevcuttur. [23][24][25][26] Genel kabul gören endikasyonlar şunlardır: a) bireyin hayatındaki ilk ya da en kötü başağrısını yaşıyor olması, b) tipik aura dışında eşlik eden fokal nörolojik defisit, bilinç değişikliği, ense sertliği ya da papilödem varlığı, c) öksürük, efor ya da cinsel ilişki ile ortaya çıkan başağrısı, d) 50 yaş üzerinde, hamilelik ya da postpartum dönemde yeni gelişen başağrısı, e) ani başlangıçlı ya da giderek kötüleyen sürekli bir ağrı paterninin varlığı, f ) ateş, döküntü ya da temporal arter trasesinde hassasiyet gibi vasküliti düşündüren bulgular, g) kanser, AIDS ya da lyme hastalarında gelişen başağrısı.…”

Section: (A) (B)unclassified

Vertebrobasilar artery dolichoectesia and pain; coincidence or etiology ?

Alemdar¹

2016

Agri

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ÖzetDolikoektazi arterlerin uzaması, genişlemesi ve büküntülü hale gelmesi olarak tanımlanır. En sık etkilenen damarlar; intrakranial vertebral ve baziler arterlerdir. Vertebrobaziler arter dolikoektazisi genellikle asemptomatiktir. Semptomatik olgularda, serebral iskemi, kanama ya da kitle etkisine bağlı bası bulguları görülür. Literatürde beşinci kraniyel sinir basısına bağlı olarak gelişen trigeminal nevralji ile ilgili olgu sunumları mevcut ise de, bildiğimiz kadarıyla, vertebrobaziler arter dolikoektazisine ikincil gelişen hemikrani veya sürekli bir yüz ağrısı daha önce rapor edilmemiştir. Burada, sağ tarafta sürekli yarım başağrısı şikayeti ile başvuran vertebrobaziler arter dolikoektazili 42 yaşında bir erkek hasta ve onun yeğeni olan, sağda sürekli fasiyel ağrı ile başvuran 19 yaşında bir kadın hasta sunuldu.Anahtar sözcükler: Ağrı; başağrısı; dolikoektazi; vertebrobaziler. SummaryDolichoectesia is described as elongation, widening, and tortuosity of an artery. Most commonly involved vessels are the intracranial vertebral and basilar arteries. Vertebrobasilar artery dolichoectesia is usually asymptomatic. Cerebral ischemia, hemorrhage, or compression findings due to mass effect can be seen in symptomatic patients. Although there are case reports of trigeminal neuralgia due to fifth cranial nerve compression in the literature, to the best of our knowledge, neither hemicranial nor continuous facial pain secondary to vertebrobasilar artery dolichoectesia has been reported previously. Presently described is case of a 42-year-old male with vertebrobasilar dolichoectesia who had complaint of continuous right-sided hemicranial pain, and his 19-year-old niece, who presented with continuous right-sided facial pain.

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Emergent Headaches during Pregnancy: Correlation between Neurologic Examination and Neuroimaging

Cited by 42 publications

References 8 publications

Posterior Reversible Encephalopathy Syndrome: Is There a Difference between Pregnant and Non-Pregnant Patients?

Posterior Reversible Encephalopathy Syndrome: Is There a Difference between Pregnant and Non-Pregnant Patients?

Acute headache diagnosis in pregnant women

Vertebrobasilar artery dolichoectesia and pain; coincidence or etiology ?

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