E2910. Imaging Neurologic Complications in Pregnancy
  1. Manav Bhalla; University of Texas Health Science Center
  2. Rohan Samant; University of Texas Health Science Center
  3. Shekhar Khanpara; University of Texas MD Anderson Cancer Center
  4. Rajan Patel; Texas Childrens Hospital
Several physiologic, hemodynamic, and hormonal changes that occur during pregnancy may precipitate or worsen an existing neurologic condition or initiate a new condition. Some neurologic conditions may incidentally have initial manifestation in pregnancy. There can be a significant overlap in clinical presentation of these neurologic complications. Magnetic Resonance Imaging (MRI), being diagnostically accurate, is a relatively safe imaging modality in pregnancy, particularly when performed on 1.5-T magnet. CT imaging of the head and neck is relatively safe given distance to the scanning field and low scatter radiation to the fetus.

Educational Goals / Teaching Points
The goal of this exhibit is to review imaging of neurologic complications that can be seen during pregnancy. Common neurologic conditions in pregnancy include headache, seizure, pre-eclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), ischemic/hemorrhagic stroke, subarachnoid hemorrhage, cerebral venous thrombosis and pituitary disorders. Amongst the less common conditions are intracranial hypotension, and multiple sclerosis meningioma.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Headache is the most common presenting complaint during pregnancy. PRES can present with typical imaging features involving parieto-occipital regions, or have atypical features when the involvement is outside of parieto-occipital regions with internal hemorrhage or diffusion restriction. The most common imaging features noted with status epilepticus that can result from eclampsia are cortical- and subcortical-restricted diffusion and FLAIR hyperintensity, usually bilateral, which is an imaging appearance that could mimic hypoxic ischemic encephalopathy, with basal ganglia FLAIR hyperintensity seen with the latter. Watershed infarcts could result from dissections and obstetric hemorrhage. Pituitary apoplexy and autoimmune hypophysitis are rare conditions seen during pregnancy.

A variety of common and uncommon neurologic conditions can be seen on imaging during pregnancy. This exhibit highlights the key imaging features and relevant clinical facts related to these conditions.