Neuro-Ophthalmology and Pregnancy

Abstract

Management of the pregnant woman with a neuro-ophthalmic disorder may be challenging. Physiologic changes in pregnancy make vascular conditions more frequent, including retinal artery occlusion, spontaneous orbital hemorrhage, and pituitary apoplexy. Papilledema may signal cerebral venous sinus thrombosis or idiopathic intracranial hypertension. Manifestations of severe preeclampsia and eclampsia include choroidal infarction, serous retinal detachment, and disorders of higher cortical function, such as alexia, simultanagnosia, and cerebral blindness. Cranial neuropathies have also been reported. Transient Horner syndrome, intracranial hypotension with comitant esotropia may occur in the postpartum period. Treatment of the neuro-ophthalmic complications of pregnancy requires an understanding of the risks of medications. Taking optimal care of the mother will usually result in the best care for her baby.

A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes

“…Varicose veins can become symptomatic due to increased blood volume. Little is known about their treatment [68]. Complications are similar to those found in pregnant women: bleeding, glaucoma, and thrombosis.…”

“…Complications are similar to those found in pregnant women: bleeding, glaucoma, and thrombosis. Cesarean delivery is not mandatory but can be performed with epidural anesthesia, "rest and descent", and vacuum or forceps [68].…”

“…Spontaneous orbital bleeding may occur in the first quarter (additional to nausea and vomiting) or during pregnancy (additional to Valsalva maneuver) [68]. The symptoms are sudden onset diplopia, proptosis, and pain [69].…”

“…Cerebral vascular diseases represent 0.47-6% of the causes of maternal mortality [70]. Cardiac embolism (endocarditis, paradoxical embolism) is the most common cause of acute brain phenomena [68]. Peripartum cardiomyopathy, of unknown etiology and incompletely misunderstood pathophysiology, may present as acute heart failure that is usually not reversible, with patients showing symptoms a few weeks or months postpartum [71].…”

Headache in pregnancy

“…Лечение заключается в назначении гепарина и гепариноидов. Варфарин противопоказан во время беременности, поскольку вызывает эмбриопатию [17]. При наличии отека ДЗН обязательны проведение и мониторирование периметрии и оценки остроты зрения для предотвращения развития стойкой слепоты.…”