Chapter 26 - Neurological disease and neurological catastrophes

Summary

Pregnant women may have chronic neurological disease or may develop neurological disease during pregnancy and the postpartum period. Status epilepticus, stroke, cerebral vein thrombosis, posterior spinal encephalopathy syndrome (PRES), are some neurological conditions that are more likely to occur during pregnancy. Clinical trials of PRES treatment are lacking. Intensive care is usually indicated, with continuous blood pressure monitoring, treatment of hypertension, and if possible, removal of the underlying cause. Both neuraxial (including both spinal and epidural anesthesia/analgesia) and general anesthesia have been described for delivery of patients with Guillain-Barre syndrome. High thoracic or cervical spinal cord lesions are associated with neurogenic shock because of blockade of autonomic function at the level of the spinal cord injury (SCI). Spinal/epidural hematoma is a rare complication of neuraxial procedures in the obstetric population. Pregnant patients are hypercoagulable and this may confer some degree of protection.