Sign Up for a Free Account
  • Updated 01.20.2024
  • Released 02.02.2000
  • Expires For CME 01.20.2027

Pregnancy: CNS complications



Given the potentially severe consequences on the mother’s neurologic health, pregnancy may pose a serious challenge. Similarly, the postpartum period carries with it significant and unique neurologic risks. In this article, the common central nervous system complications during pregnancy and the postpartum period are reviewed, with an emphasis on eclampsia and stroke.

Key points

• Pregnancy and delivery trigger physiologic changes resulting in specific complications or modifying the course of neurologic disorders.

• Intractable vomiting may cause Wernicke encephalopathy, a potentially fatal condition that requires early recognition and urgent administration of thiamine.

• Most untreated or insufficiently treated survivors of Wernicke encephalopathy develop Korsakoff syndrome, characterized by anterograde and retrograde amnesia.

• The risk of ischemic and hemorrhagic stroke is elevated, mostly peripartum and postpartum.

• In young pregnant women, stroke shares the same risk factors with elderly women but is mostly caused by venous thrombosis, reversible cerebral vasoconstriction, and preeclampsia/eclampsia.

• Although pregnant women were excluded from the thrombolysis clinical trials, ischemic stroke was treated successfully with tPA in several cases.

• Stroke due to large vessel occlusion may benefit from endovascular thrombectomy guided by imaging.

• Low-dose aspirin may cause gastroschisis during the first trimester but is safe thereafter for prevention of ischemic stroke.

• Preeclampsia can be prevented by blood pressure control and low-dose aspirin; eclampsia responds to intravenous magnesium sulfate.

• Heparin given subcutaneously is preferably used in thrombophilia and cardioembolism, but not mechanical mitral valve, which requires warfarin.

• Subarachnoid hemorrhage management is according to the guidelines for nonpregnant women.

Historical note and terminology

The physiologic changes occurring during pregnancy and puerperium can affect the central nervous system and complicate the management of preexisting neurologic conditions. The effect of pregnancy on chronic neurologic conditions, such as epilepsy, multiple sclerosis, myasthenia gravis, and migraine, are not addressed in this article.

The complications of peripartum anesthesia are difficult to distinguish from those of pregnancy. Headaches following dural puncture and cerebrospinal fluid leak are the most frequent CNS complications of anesthesia. A retrospective cohort study consisting of 1,003,803 pregnant women who received neuraxial anesthesia revealed that headache may be caused by cerebral venous thrombosis, subdural hematoma, meningitis, and depression. Seventy percent of cerebral venous thrombosis and subdural hematoma were diagnosed during readmission after a median interval of 5 days (63).

Spinal cord lesions due to trauma, compression, ischemia, or total spinal block occur rarely, but the severity of these complications demands early recognition and rapid intervention. Seizures during anesthesia may be triggered by selective inhibition of the inhibitory neurons.

Wernicke encephalopathy, a potentially fatal, yet treatable complication of thiamine deficiency, was described initially by Carl Wernicke in 1881 in two alcoholic patients and one woman with intractable vomiting from gastric stenosis caused by sulfuric acid ingestion (89). Its association with hyperemesis gravidarum was later noted (143). In 1888 Sir William Gowers described eclampsia or toxemia of pregnancy characterized by convulsions in pregnant women with hypertension, proteinuria, and edema. This syndrome is uniquely associated with pregnancy-induced hypertension. In 1899, Edward Lazard discovered during autopsy the first intracerebral hemorrhage in pregnancy caused by a ruptured aneurysm. John Abercrombie made the first autopsy description of puerperal cerebral phlebothrombosis in 1828; however, the first clinical description of central venous thrombosis was made by Gowers in 1893.

This is an article preview.
Start a Free Account
to access the full version.

  • Nearly 3,000 illustrations, including video clips of neurologic disorders.

  • Every article is reviewed by our esteemed Editorial Board for accuracy and currency.

  • Full spectrum of neurology in 1,200 comprehensive articles.

  • Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink®, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660



ISSN: 2831-9125