title: Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging.
abstract: OBJECTIVE
  Emergent evaluation of the pregnant headache patient requires rational selection of acute neuroimaging studies, yet guidelines do not exist. We investigated the demographic and clinical features that are predictive of intracranial pathologic lesions on neuroimaging studies in pregnant women with emergent headaches.
  
  
  METHODS
  We conducted a retrospective review of demographic factors, clinical features, and radiologic findings in a consecutive case series of 63 pregnant women emergently evaluated with a chief complaint of headache, including those with previous headache histories. Clinical data were abstracted from emergency department records, hospital course, and discharge summaries. Multivariate logistic regression analysis examined predictors of intracranial pathologic lesions on emergent neuroimaging studies.
  
  
  RESULTS
  Multiparous African American women constituted 63% of the case subjects. Headaches were frequently accompanied by photophobia (59%), nausea (52%), vomiting (37%), and occasionally with fever (11%), meningismus (9%), or seizures (7%). A total of 43% of case subjects had abnormal neurologic examination findings. Emergent neuroimaging, including noncontrast head CT and MR imaging, revealed an underlying headache etiology in 27%, including cerebral venous thrombosis, reversible posterior leukoencephalopathy, pseudotumor, and intracranial hemorrhage. The odds of having intracranial pathologic lesions on neuroimaging were 2.7 times higher in patients with abnormal results on neurologic examination (P=.085).
  
  
  CONCLUSIONS
  Emergent neuroimaging studies may reveal an underlying headache etiology in 27% of pregnant women. Further research with a larger sample size is needed to determine what clinical factors are predictive of a pathologic condition on neuroimaging studies.
authors.affiliation: Department of Neurology, University of Michigan Health System, Ann Arbor, MI 48109, USA. sindhur@med.umich.edu
authors.forename: S
authors.initials: S
authors.lastname: Ramchandren
authors.forename: B J
authors.initials: BJ
authors.lastname: Cross
authors.forename: D S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D003952:Diagnostic Imaging / Q000379:methods*; D003943:Diagnostic Techniques, Neurological; D005260:Female; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity