Acute Neurological Emergencies During Pregnancy and Postpartum in a Sample of Upper Egypt Women

Abstract

Background: Acute neurological emergencies in pregnant and postpartum women could be caused by exacerbation of a pre existing neurological condition (eg, multiple sclerosis or a seizure disorder), initial presentation of a non pregnancy related problem (eg, brain neoplasm) or pregnancy and postpartum related problems (eg, preeclampsia, eclampsia & PRES). Objective: Assessment of acute neurological emergencies during pregnancy and postpartum in a sample of Upper Egypt women for early diagnosis and proper management. Study design: It was a cross-sectional descriptive epidemiological study. Place and Duration of Study: This study was carried out at Sohag teaching hospital from 1st June 2014 to 31th May 2016. Materials and Methods: This study was applied for women during pregnancy and postpartum period (up to six weeks after delivery according to ICD-9) suffering from acute neurological emergencies then underwent detailed medical and neurological history and examination, routine labs, specialized labs, radiological and neuro physiological investigations. Results: There were 320 women classified into two groups; pregnant group (232 of them (72.5%) and postpartum group (88 of them (27.5%). The frequencies of all data were; for age of less than 30 years were 192 women (60%); for age of 30 years and more were 128 women (40%). As regard to residence; women live in rural area were 148 (77.5%) while women live in urban area were 72 (22.5%). According to initial presenting symptoms; headache were 205 (64%); seizures were 92 (28.8%); motor system affection were 34 (10.6%); cranial nerves affection were 31 (9.7%); disturbed conscious level (DCL) were 103 (32%); aphasia were 4 (1.3%); unsteady gait 7 (2.2%); urinary retention were 1 (0.3%). As regard to risk factors; preeclampsia were 87 (27.2%); thrombophilia 17 (5.3%); rheumatic heart disease were 9 (2.8%); hypertension were 2 (0.6%); diabetes were 4 (1.3%); systemic infections were 6 (1.9%); lowering or stop AEDs were 3 (0.9%). As regard to final diagnosis; preeclampsia were 150 (46.9%); eclamptic fits were 58 (18.1%); strokes were 47 14.7%); post dural puncture headache were 14 (4.4%); posterior reversible encephalopathy syndrome were 10 (3.1%); trigeminal neuralgia were 7 ( 2.2%); bell's palsy were 6 (1.9%); carpal tunnel syndrome were 8 (2.5%); sciatic neuropathy were 2 (0.6%); guillian baree syndrome was 1(0.3%); multiple sclerosis were 3 (0.9%); idiopathic increased intracranial pressure were 3 (0.9%); epilepsy were 3 (0.9%); Chorea gravidarum were 2 ( 0.6%); idiopathic thrombotic thrombocytopenic purpura were1 (0.3%); viral encephalitis was1(0.3%); transverse myelitis was 1 (0.3%); frontal meningioma was 1(0.3%). Conclusion: Frequancy of acute neurological emergencies during pregnancy and postpartum in a sample of upper Egypt women were higher in patients whose age less than 30 years old and live in rural than patients whose age 30 years old or more and live in urban area. Headache and seizures are the commonest among initial presenting sysmptoms. Preeclampsia, thrombophilia and rheumatic heart disease are the commonest among risk factors. As regard to final diagnosis; preeclampsia , eclamptic fits and strokes are the commonest among final diagnosis.