Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging.

S Ramchandren,D.S Liebeskind,B.J Cross

doi:10.3174/ajnr.a0506

Abstract

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. 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. 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). 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.

Highlights

AND PURPOSE: Emergent evaluation of the pregnant headache patient requires rational selection of acute neuroimaging studies, yet guidelines do not exist
Further research with a larger sample size is needed to determine what clinical factors are predictive of a pathologic condition on neuroimaging studies
We investigated the demographic factors, clinical presentations, and examination findings of pregnant women with headaches presenting to an emergency department in an academic center

Summary

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. A retrospective review of demographic factors, clinical features, and radiologic findings was conducted in a consecutive case series of 63 pregnant women (median age, 25 years; range, 15– 41 years) evaluated for a chief complaint of headache at the emergency department of an urban, academic medical center. Radiologic variables included the use of various imaging modalities (CT, MR imaging, MR angiography [MRA], or MR venography [MRV]), time delay to imaging, and neuroimaging findings; classification of abnormal neuroimaging findings into incidental or pathologic groups was based on diagnosis given by the primary care providing team on patient discharge.

Results

Discussion

Conclusion