NEUROLOGIC DISEASES IN PREGNANCY 1.1 (AB)

Question 1

What is the best imaging modality to detect recent hemorrhage in pregnancy?

Answer 1

Computed Tomography (CT) Scan

Question 2

Which CNS abnormalities can be identified using MRI in pregnancy?

Answer 2

Demyelinating diseases, AVM, congenital and developmental nervous system abnormalities, posterior fossa lesions

Question 3

Why is a lateral tilt with a wedge under one hip recommended during CNS imaging in pregnancy?

Answer 3

To prevent hypotension and diminish aortic pulsations

Question 4

What is cerebral angiography and how is it performed?

Answer 4

Cerebral angiography with contrast is injected via the femoral artery to diagnose and treat cerebrovascular diseases

Question 5

What imaging modalities have not been evaluated for use in pregnant patients?

Answer 5

PET and fMRI

Question 6

What is the most prevalent neurologic condition in pregnancy?

Answer 6

Headache

Question 7

Which vital sign is crucial in assessing new-onset headache during pregnancy?

Answer 7

Blood pressure

Question 8

What condition is suspected if headache in pregnancy is associated with BP ≥ 140/90 mmHg?

Answer 8

Preeclampsia with severe features

Question 9

What are the primary classifications of headache?

Answer 9

Migraine, Tension-type, Trigeminal cephalalgia, Other

Question 10

What are the secondary causes of headache?

Answer 10

Trauma, Vascular disorders, Substance abuse, Infection, Disorders of homeostasis, Craniofacial disorders, Psychiatric disorders

Question 11

What is the leading cause of headache during pregnancy?

Answer 11

Migraine

Question 12

What type of migraine is most common during pregnancy?

Answer 12

Migraine with aura

Question 13

How does aura in migraine typically present?

Answer 13

Visual scotoma or hallucinations

Question 14

What are common features of tension headache?

Answer 14

Muscle tightness, mild to moderate pain in the neck and head, absence of nausea and neurological disturbances

Question 15

How is episodic tension headache managed in pregnancy?

Answer 15

Rest, massage, local heat or ice, paracetamol first, then NSAIDs like celecoxib or mefenamic acid if needed

Question 16

What medication is used to treat chronic tension headache?

Answer 16

Amitriptyline

Question 17

What characterizes migraine without aura?

Answer 17

Unilateral throbbing headache, nausea, vomiting, +/- photophobia

Question 18

What is the safest analgesic for migraine in pregnancy?

Answer 18

Acetaminophen (Paracetamol)

Question 19

What are examples of 5-HT receptor agonists used for migraines?

Answer 19

Triptans: oral, nasal, parenteral

Question 20

What are common dopamine receptor antagonists for migraine?

Answer 20

Metoclopramide, Prochlorperazine, Chlorpromazine

Question 21

What migraine type is linked with increased ischemic stroke risk?

Answer 21

Migraine with aura

Question 22

What distinguishes chronic migraine?

Answer 22

At least 15 days/month for >3 months with unilateral throbbing headache, nausea, vomiting, +/- photophobia

Question 23

What antihypertensive medications can be given for migraines in hypertensive pregnant patients?

Answer 23

Hydralazine IV, Labetalol IV, Methyldopa (tablet)

Question 24

Why are ergotamine derivatives avoided in pregnancy?

Answer 24

They are potent vasoconstrictors with uterotonic effects

Question 25

What is the incidence of migraines in pregnancy?

Answer 25

185 per 100,000 deliveries

Question 26

What conditions are associated with migraines in pregnancy?

Answer 26

Preeclampsia, gestational hypertension, preterm birth, cardiovascular morbidities

Question 27

What are women with migraine before pregnancy at higher risk for?

Answer 27

Stroke, MI, heart disease, VTE, preeclampsia, low birthweight neonates

Question 28

What prophylactic treatments are used for frequent migraines in pregnancy?

Answer 28

Amitriptyline, propranolol, metoprolol

Question 29

Which beta blocker is avoided due to fetal bradycardia?

Answer 29

Metoprolol

Question 30

What is a cluster headache?

Answer 30

Severe unilateral pain with autonomic symptoms and agitation, lasting 15 to 180 minutes

Question 31

How is an acute cluster headache managed?

Answer 31

100% oxygen therapy and subcutaneous Sumatriptan

Question 32

What medication is used for cluster headache prophylaxis?

Answer 32

Verapamil

Question 33

What is the second most prevalent neurological condition in pregnancy?

Answer 33

Seizures

Question 34

What is a seizure?

Answer 34

A transient combination of signs and symptoms from abnormal, excessive, or synchronous neuronal activity in the brain

Question 35

What is the hallmark of epilepsy?

Answer 35

Predisposition to recurrent unprovoked seizures

Question 36

What are the main seizure categories?

Answer 36

Focal seizure onset, generalized seizure onset, unknown seizure onset

Question 37

What causes focal seizures?

Answer 37

Trauma, abscess, tumor, perinatal factors

Question 38

What is a characteristic of focal seizures without dyscognitive features?

Answer 38

Begin in one region of the body and progress ipsilaterally without impaired awareness

Question 39

What are common signs of focal seizures with dyscognitive features?

Answer 39

Aura, impaired awareness, motionless stare, lip smacking

Question 40

What characterizes generalized tonic-clonic seizures?

Answer 40

Loss of consciousness, tonic contraction, clonic movements, followed by confusion

Question 41

What is another term for absence seizures?

Answer 41

Petit mal seizures

Question 42

What distinguishes absence seizures?

Answer 42

Brief loss of consciousness without muscle activity and immediate recovery

Question 43

When are seizures classified as unknown onset?

Answer 43

When the onset is unwitnessed or unclear

Question 44

What is the folic acid supplementation recommendation before conception?

Answer 44

0.4 mg daily, increased to 4 mg during pregnancy

Question 45

When can anticonvulsant medication withdrawal be considered preconceptionally?

Answer 45

If seizure-free for 2 years or more

Question 46

What pregnancy-related risks are increased with epilepsy?

Answer 46

Fetal malformations, convulsions, status epilepticus, PPD, maternal death

Question 47

What factors can lead to subtherapeutic anticonvulsant levels in pregnancy?

Answer 47

Nausea, vomiting, reduced motility, antacid use, physiologic changes, sleep deprivation, labor pain

Question 48

What seizure-free duration before pregnancy predicts low seizure recurrence?

Answer 48

At least 9 months

Question 49

What is the major goal of epilepsy management during pregnancy?

Answer 49

Seizure prevention

Question 50

What are key elements of prenatal epilepsy care?

Answer 50

Folic acid 4 mg, mid-pregnancy anomaly scan, monotherapy with compliance