title: Cerebrovascular emergencies in pregnancy.
abstract: Caring for pregnant and postpartum patients with neurological disease carries specific challenges. In performing a diagnosis, it is often difficult to differentiate between true pathology and neurological symptoms resulting from normal pregnancy physiology. Treating the pregnant patient can be problematic as well. Providers need to be aware of the possible untoward effects of maternal treatments on the developing fetus, but not withhold therapies that reduce disease-related morbidity and mortality. Given the complexities of conducting trials during pregnancy, few treatments are based on high-quality data; observational data and clinical expert opinion often guide treatments. With the exception of preeclampsia/eclampsia, neurological diseases typically do not warrant early delivery in the absence of fetal distress. Multidisciplinary care, utilizing the expertise of anesthesiology, critical care medicine, emergency medicine, maternal-fetal medicine, neurology, and radiology, is essential in ensuring prompt diagnosis and treatment.
authors.affiliation: Gynecology and Reproductive Biology, Harvard Medical School, Clinical Fellow, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shainker
authors.affiliation: Medicine Harvard Medical School, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
authors.affiliation: Gynecology and Reproductive Biology, Harvard Medical School, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. Electronic address: kobrie10@bidmc.harvard.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: O'Brien
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000150:complications; D036861:Delivery, Obstetric; D004461:Eclampsia / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000188:drug therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D063189:Symptom Assessment
chemical_list: D005343:Fibrinolytic Agents
keywords: eclampsia; migraine; neurological diseases; preeclampsia; pregnancy; stroke