RCVS, PRES, Pregnancy-Related Intracranial Hemorrhage, Aneurysm and AVM Management in Pregnancy, and Diagnostic Imaging
This session covers reversible cerebral vasoconstriction syndrome (RCVS) and PRES as manifestations of preeclampsia and eclampsia, their treatment priorities, the role of calcium channel blockers, causes of intracranial hemorrhage in pregnancy, management of aneurysms and AVMs before and during pregnancy, and a comparison of MRA versus CTA for intracranial and cervical arterial imaging.
Practitioner-Guided Note
Pregnancy-associated RCVS and PRES treatment priorities: blood pressure control, fluid volume normalization, and magnesium sulfate. Known aneurysms or AVMs should ideally be treated before conception. If discovered during pregnancy, risk assessment guides management, often favoring elective delivery by cesarean section. Once securely treated, normal vaginal delivery is generally safe. MRA and CTA have similar sensitivity and specificity for intracranial and cervical arterial disease.
Key Takeaways
RCVS: reversible multifocal arterial narrowing on angiography, often linked to pregnancy or the postpartum state.PRES and RCVS can be neurological manifestations of preeclampsia or eclampsia.Pregnancy-associated RCVS/PRES treatment: blood pressure control, fluid normalization, magnesium sulfate.Calcium channel blockers are commonly used for RCVS vasospasm despite limited formal evidence.Causes of pregnancy-related intracranial hemorrhage: CVST, RCVS/PRES, aneurysm or AVM rupture.Known aneurysms or AVMs should be definitively treated before conception.Aneurysms or AVMs discovered during pregnancy: risk-based management, often elective cesarean delivery.Ruptured aneurysms or AVMs during pregnancy: treated with surgical or endovascular techniques as in non-pregnant individuals.After secure treatment of aneurysm or AVM, normal vaginal delivery is generally safe.Negative leg ultrasound in young stroke with PFO: proceed to MR or CT venography for pelvic or proximal venous thrombosis.MRA and CTA have comparable sensitivity and specificity for intracranial and cervical arterial imaging.