The incidence of Bell’s palsy is approximately 45 in 100,000 pregnancies with the condition having a 10-fold increase compared to the non-pregnant state. This suggests that appropriate counselling should be based on the specific AED combinations.A recent study looking at the cognitive function at six years of age after fetal exposure to AEDs showed a statistically significant decrease in IQ scores of children whose mothers were exposed to valproate Women with epilepsy should be referred to a neurologist before getting pregnant. The majority of cases are seen in pregnant or puerperal women. The pathogenesis of MS is incompletely understood but involves a maladaptive T-cell-mediated immune response to an unknown antigen. Diagnosis is confirmed by serum autoantibody analysis and EMG evidence of disordered neuromuscular transmission.40% of women with MG have an exacerbation in pregnancy, in 30% there is no change in symptoms and 30% go into remission. Management depends on the underlying cause, and includes 75mg aspirin daily, which should be continued postpartum.
A lumbar puncture should be performed to measure the cerebrospinal fluid (CSF) opening pressure (>25 cm HIn contrast, a post-dural puncture headache (PDPH) arises due to loss of CSF and a reduction in cerebrospinal pressure. Congenital MD occurs in some pregnancies and is characterized by severe generalized hypotonia and weakness of the neonate, difficulties in breathing, sucking and swallowing, talipes, and neurodevelopmental problems.This is a unilateral lower motor neurone lesion of the facial (VIIth cranial) nerve which causes a unilateral facial weakness. The risk of having a seizure in the first 24 hours post delivery is approximately 1-2% so women should, therefore, not be left unattended during this time. β-blockers (propranolol 10–40 mg three times a day) are effective in more than 80% of cases and can be used in patients without contraindications if aspirin is ineffective. Involvement of frontalis muscle on the affected side distinguishes this from an upper motor neurone lesion. Ramsay Hunt syndrome (herpes zoster of the geniculate ganglion) should be excluded in women presenting with Bell’s palsy, in which herpetic vesicles may be visualized in the external auditory meatus or soft palate. Any focal signs lasting longer than 24 hours warrant further investigation with cerebral imaging. Maternal pyrexia and leucocytosis may be present.Diagnosis is made using CT or MR venous angiography. Non-pharmacological measures to avoid migraine such as adequate sleep and stress management may be of benefit. The patient may present with sudden-onset severe ‘thunderclap’ headache, with nausea and vomiting. Peripartum Bell’s palsy may be related to swelling of the facial nerve within the petrous temporal bone, which may be related to oedema. Gabellari, P. Borgogno, C. de Lorenzo, C. Benedetto.
Exacerbation in pregnancy is less likely if the woman has undergone previous thymectomy, as 10% have an associated thymoma. Respiratory insufficiency may occur during pregnancy or postpartum so close monitoring by a multidisciplinary team is necessary.Recent recommendations from a UK multispecialty working group recommend that pre-pregnancy counselling should be offered to all women of childbearing age with MG, and specific advice about the safety of different therapies in pregnancy should be offered with clear instructions not to discontinue safe immunosuppressive agents or pyridostigmine in pregnancy.Monitoring of fetal movements should be encouraged because transplacental passage of AChR antibodies may rarely cause arthrogryposis multiplex congenital where the fetus develops contractures due to lack of movement.
Severe headache in a woman with pre-eclampsia suggests the possibility of intracerebral haemorrhage especially if the blood pressure is very high.Subarachnoid haemorrhage (SAH) occurs in 20 per 100,000 pregnancies; this is two- to three-fold higher than non-pregnant rates. (a) To make a clinical diagnosis, there must be evidence of one CNS lesion(b) MS is not a contraindication to vaginal delivery or epidural anaesthesia(c) Patients are at increased risk of recurrent urinary tract infections in pregnancy(d) High dose corticosteroids are contraindicated during pregnancy and breastfeeding (e) Baclofen can also be used in pregnancy to relieve spasticityTo make a clinical diagnosis of MS, there must be evidence of at least two CNS lesions in different places at different times (dissemination in time and space), otherwise it is known as a ‘clinically isolated syndrome’. When MG symptoms are not satisfactorily controlled, corticosteroids, azathioprine and in some cases plasmapheresis has been used.
Arun Vijay was born into a film family as the only son of actor Vijayakumar and his first wife Muthukannu. The common risk factors for stroke outwith pregnancy, including hypertension, diabetes and smoking are less common in pregnancy, so rarer causes, for example, cardiac causes of arterial emboli or arrhythmias, mitral valve disease, paradoxical embolus through an atrial septal defect or patent foramen ovale, antophospholipid syndrome or an underlying vasculitis need to be considered.
There is no relation to the seizure type or course of epilepsy during previous pregnancies. Aarthi Mohan. Acyclovir must be commenced in Ramsay Hunt syndrome instead of steroids.Carpal tunnel syndrome affects 2–3% of pregnant women and arises due to median nerve compression at the flexor retinaculum. It is also important not to forget some drug side-effects, for example, the vasodilators, nifedipine and hydralazine, as well as analgesia overuse, as other causes of headache.Migraine is common in women of childbearing age. Onset is usually within 24 hours after epidural / spinal anaesthesia / analgesia and often presents as a fronto-occipital throbbing headache which occurs abruptly on standing and improves almost immediately on lying flat again. Guy’s and St Thomas’ Hospitals NHS Foundation TrustTel.
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