Cerebrovascular emergencies in pregnancy

• Care of pregnant patients with neurological emergencies must be multidisciplinary.
• Preeclampsia/eclampsia are reviewed.
• Reversible cerebral vasoconstriction and posterior reversible encephalopathy syndromes are discussed.
• Causes of and treatment for ischemic and hemorrhagic strokes are detailed, as these pertain to pregnancy.

Caring for pregnant and postpartum patients with neurological disease carries specific challenges. In performing a diagnosis, it is often difficult to differentiate between true pathology and neurological symptoms resulting from normal pregnancy physiology. Treating the pregnant patient can be problematic as well. Providers need to be aware of the possible untoward effects of maternal treatments on the developing fetus, but not withhold therapies that reduce disease-related morbidity and mortality. Given the complexities of conducting trials during pregnancy, few treatments are based on high-quality data; observational data and clinical expert opinion often guide treatments. With the exception of preeclampsia/eclampsia, neurological diseases typically do not warrant early delivery in the absence of fetal distress. Multidisciplinary care, utilizing the expertise of anesthesiology, critical care medicine, emergency medicine, maternal–fetal medicine, neurology, and radiology, is essential in ensuring prompt diagnosis and treatment.