hoppe neuro Flashcards
What is the most common neurological complaint in pregnancy?
headache
Why do migraines improve in pregnancy
because of the high levels of estrogen. Low levels are associated with worse migraines
Which headache type is unlikely to improve in pregnancy?
tension type headache
Which drug is really the only headache medication that is safe in pregnancy?
acetaminophen
High caffiene intake early in pregnancy is associated with _______
miscarriage
Codiene and barbiturate use near term is associated with ________
neonatal withdrawal
T/F the triptans are safe in pregnancy
false they should be avoided even in women of child bearing years having unprotected sex
Why is ergotamine absolutely contraindicated in pregnancy?
it can induce uterine contractions
What is a common way to prophylax against headaches in pregnancy?
beta blockers and CCBs
When should the presentation of headache make you consider pre-ecclampsia on your DDx?
ANY woman with a headache after 20 weeks
What is the triad of pre-ecclampsia?
HTN, proteinuria, and edema
What is the DOC for controlling ecclamptic seizures?
magnesium sulfate
Though they don?t know exaclty how magnesium works for seizures, it is known to antagonize these receptors
NMDA
Why do you need to check reflexes when administering magnesium sulfate?
it causes neuromuscular blockade
What is the classic demographic for pseudotumor cerebri (idiopathic intracranial HTN)?
young obese female (will have papilledema)
Explain the reciprocal effects that oral contraceptives and anti-epileptic drugs have on each other
they both essentially decrease the effectiveness of each other by inducing hepatic enzymes
What effect do convulsive seizures have on the fetus?
they can cause fetal bradycardia
What is the worst anti-epileptic drug with respect to its ability to cause fetal issues?
VALPROIC ACID
Name 4 SE in the fetus from exposure to phenobarbital and phenytoin
cleft lip and palate, cardiac, GU, fetal hydantoin syndrome
What is valproate most notorious for causing?
neural tube defects (elevated AFP)
Describe the pre-pregnancy planning regarding a woman’s anti-epileptic drugs if she has been SEIZURE FREE FOR 2 YEARS
consider a TAPERING and withdrawal of AED’s at least 6 months prior to becoming pregnant
When is valproate acceptable to give to a pregnant epileptic?
if no other drug will control her seizures
What 2 vitamins are important to give to a woman on AED’s?
folate (neural tube defects) and vitamin K (vitamin K is given late to prevent hemorrhagic disease of the newborn)–note, vitamin K is given in EVERY baby anyway upon birth as their gut flora are not yet present and so they produce no vitamin K
Which brain tumors may present in pregnancy due to the fact that they grow in size from stimulation of sex hormone receptors?
meningiomas and schwannomas
What clinical manifestations may lead you to think that a pregnant woman has a brain tumor?
nausea and vomiting LATE IN THE PREGNANCY is a big one; headache also, for obvious reasons
When is stroke the most common in pregnancy?
in the puerperium
tPA (alteplase) is pregnancy category ____
C
What is the most common cause of stroke in pregnancy?
preecclampsia/ecclampsia
When is central venous thrombosis most likely to present?
postpartum (puerperium)
T/F: A woman with MS is likely to have an exacerbation of the disease while pregnant but have a reprieve after delivery
false . Pregnancy is associated with a decrease in relapses but there is an increase in them post-partum
What is the most common neuropathy for a pregnant woman to develop? When is the most common time to develop it?
Carpal tunnel syndrome, in the 3rd trimester
This nerve is ___________ is being compressed by this structure __________ in meralgia parasthetica
lateral femoral cutaenous, inguinal ligament
Why shouldn’t you treat Bell palsy with corticosteroids in first 9 weeks?
increases risk of cleft palate
T/F : a woman with myasthenia gravis will have a very predictable clinical course in pregnancy
false. Recall the 1/3 rule? 1/3 exacerbate, 1/3 stay the same, 1/3 go into remission
This drug, which is used to Tx a particularly important complication of pregnancy, is relatively contraindicated in myasthenia gravis d/t its ability to precipitate myasthenic crisis
magnesium sulfate
If a child born to a woman with myasthenia gravis shows Sx should you be worried?
not in a long term sense, this is most likely transient neonatal myasthenia from “passive autoimmunity” from moms IgG Ab’s
What are 3 possible causes of restless leg syndrome?
folate deficiency, iron deficiency, and hormonal changes
Define chorea gravidarum? What are the causes?
Chorea from ANY cause during that presents itself during pregnancy; can be from anything but circulating hormones and birth control pills can do it
