Imaging of Neurologic Disorders Associated with Pregnancy and the Postpartum Period

Abstract

Diverse pathologic conditions affect the central nervous system (CNS) and pituitary gland during pregnancy and the puerperium. Some are specific to the physiologic process of reproduction (eg, eclampsia, postpartum cerebral angiopathy, Sheehan syndrome, lymphocytic adenohypophysitis). Others are nonspecific but occur more often in pregnant women (eg, cerebral infarction, dural venous thrombosis, pituitary apoplexy). Recognition of the characteristic imaging findings in eclampsia, for example, may allow exclusion of other disorders. Even when imaging changes are nonspecific, knowledge of those entities associated with pregnancy and awareness of the increased likelihood of certain diseases in pregnancy will allow a more informed differential diagnosis. Differentiation of primary nonaneurysmal subarachnoid hemorrhage (SAH) from aneurysmal SAH is an example. Moreover, earlier use of imaging will result in fewer delayed diagnoses. For example, magnetic resonance venography allows early diagnosis of cerebral venous thrombosis. Even when the imaging changes are less specific, knowledge of likely possibilities will lead to more appropriate earlier use of imaging. For example, the stimulatory effects of pregnancy on prolactinoma, meningioma, hemangioblastoma, vestibular schwannoma, and metastatic tumors such as breast cancer and choriocarcinoma suggest the early use of CNS imaging to avoid the consequences of a delayed diagnosis.

Correlation between neuroimaging (CT scan) and neurological presentation in antepartum and postpartum eclampsia

“…Furthermore, even when the imaging changes are less specific, knowledge of likely possibilities will lead to more appropriate earlier use of imaging. 14 In this study CT scan revealed normal findings in 48% of the women. In those with abnormal CT scan findings the commonest diagnosis was CVT with infarct (23%) followed by infarct (14%), PRES (6%), HLE (5%), CVT (3%), cerebral atrophy (1%).…”

Ressonância magnética hepática em puérperas estáveis com síndrome HELLP

“…Ainda em relação ao realce, o que chamou atenção dos autores foi a ausência de distúrbios de perfusão e de sinais de infarto hepático. Como discutido, a etiopatogenia envolve dano endotelial e presença de vasoespasmo na circulação cerebral, o que já foi demonstrado através da angiografia digital, comprometendo artérias cerebrais de grosso e médio calibre, particularmente a artéria basilar 26 . Assim, acreditava-se inicialmente que poderiam ser encontradas alterações na RM relacionadas ao vasoespasmo e, conseqüentemente, redução de fluxo arterial no fígado.…”

Imaging of traumatic and non-traumatic emergencies – one approach

“…An excellent review appeared in RadioGraphics (18). These latter entities are best diagnosed by MRI.…”