![]() ![]() These were telephone interviewed by a trained doctor in neurology to get more detailed information about the symptoms. Right after delivery they were asked to return a similar questionnaire about symptoms occurring during the pregnancy 278 women reported new symptoms of potential focal neurological character during pregnancy. ![]() In short, 1,631 pregnant women returned screening questionnaires at the time of routine ultrasound screening in week 18 to 20 of the pregnancy about headache and focal neurological symptoms occurring before pregnancy. The remainder was recruited from a large prospective cohort study on headache and focal neurological symptoms among pregnant women. The reasons for referral were transient focal neurological deficits where the possibility of migraine aura or CV or other CNS disorders was present. The majority, 25 women, were recruited among patients routinely referred to our department from doctors at the Department of Obstetrics and Gynecology, and from general practitioners. There were 41 patients included in the study during the period from May 1997 to August 1999. We hoped that this would enable us to formulate guidelines on how to differentiate the two disorders among pregnant women. The aim of the present study was, with the help of thorough clinical and laboratory investigations and a follow-up, to ascertain the diagnoses for the neurological symptoms, and the CV risk factors in a sample of women with symptoms or signs indicative of transient CNS disorders during pregnancy. We have previously reported the occurrence of headache and transient neurological symptoms in a large cohort (n = 1,631) of pregnant women based on questionnaires and interviews. Although several studies have shown that migraine improves during pregnancy, the migraine worsens in some women, and some women experience their first migraine attack in this period, and particularly migraine with aura (MA). Migraine is particularly common among fertile women, affecting approximately 20–25% of young and middle aged women in Europe. To complicate the matter, TIAs may be accompanied by headache and migraine aura often occurs without ensuing headache (International Classification of Headache Disorders, second edition (ICHD-2), category 1.2.3 Typical aura without headache). Both disorders consist of transient neurological phenomena stemming from the central nervous system (CNS). The differentiation of TIAs from migraine aura in pregnancy is a rather common clinical problem. Pregnancy, as well as migraine, are well-known risk factors for cerebrovascular (CV) episodes (transient ischemic attacks (TIAs) and stroke). The five-year follow-up clearly indicates that migraine with aura in pregnancy usually has a good prognosis with regard to cerebrovascular events. A meticulous history and clinical neurological examination are more useful than routine supplementary investigations for cerebrovascular disease. Gradually developing aura symptoms, or different aura symptoms occurring in succession as described in the International Classification of Headache Disorders, seem to be useful for differentiating aura from other transient disorders. The aura features were more complex, with several aura symptoms and a higher prevalence of sensory and dysphasic aura than usual. The diagnosis of migraine aura was difficult because for many patients it was their first ever attack and headache tended to be absent or of non-migraineous type. None of the patients or the controls reported cerebrovascular episodes during the five-year follow-up. Patients had more headache before pregnancy than controls, but the average levels of vascular risk factors were similar. Migraine with aura was the most common cause of symptoms during pregnancy, occurring in 34 patients, while 2 were diagnosed with stroke, 2 with carpal tunnel syndrome, 1 with partial epilepsy, 1 with multiple sclerosis and 1 with presyncope. To assess the prognosis, both patients and controls were followed with questionnaires every year for five years. For comparison, the same investigations were performed in 41 pregnant controls. These were studied in detail with thorough clinical and laboratory investigations in order to make a certain diagnosis and to evaluate whether the episodes might be of a vascular nature. Methodsĭuring a 28 month period, 41 patients were detected with transient neurological symptoms during pregnancy. The aims of the present study were to investigate and diagnose all pregnant women with transient neurological disorders of suspected central nervous system origin, and to compare this group with a control group of pregnant women with regard to vascular risk factors and prognosis. Migraine aura may be difficult to differentiate from transient ischemic attacks and other transient neurological disorders in pregnant women. ![]()
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