Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Curr Pain Headache Rep. 2021 Apr 7;25(6):40. doi: 10.1007/s11916-021-00958-z.
Preeclampsia and related hypertensive disorders of pregnancy affect up to 10% of pregnancies. Neurological complications are common and neurologists often become involved in the care of obstetric patients with preeclampsia. Here, we review the definition(s), epidemiology, clinical features, and pathophysiology of preeclampsia, focusing on maternal neurological complications and headache as a common presenting symptom of preeclampsia.
Neurological symptoms are early and disease-defining features of preeclampsia. Neurological complications of preeclampsia may include headaches, visual symptoms, cerebral edema, seizures, or acute cerebrovascular disorders such as intracerebral hemorrhage or reversible cerebral vasoconstriction syndrome. A history of migraine is an independent risk factor for vascular diseases during pregnancy, including preeclampsia and maternal stroke. The pathophysiology of both preeclampsia and migraine is complex, and the mechanisms linking the two are not fully understood. Overlapping clinical and pathophysiological features of migraine and preeclampsia include inflammation, vascular endothelial dysfunction, and changes in vasoreactivity. Neurological complications are recognized as a major contributor to maternal morbidity and mortality. Pregnant and postpartum women commonly present with headache, and red flags in the clinical history and examination should prompt urgent neuroimaging and laboratory evaluation. A focused headache history should be elicited from patients as part of routine obstetrical care to identify patients at an increased risk of preeclampsia and related hypertensive disorders of pregnancy. Collaborative models of care and scientific investigation in the emerging field of neuro-obstetrics have the common goal of reducing the risk of maternal neurological morbidity and mortality from preeclampsia.
子痫前期及相关妊娠高血压疾病影响多达 10%的妊娠。神经系统并发症常见，神经科医生常参与子痫前期产科患者的治疗。本文回顾子痫前期的定义、流行病学、临床特征和病理生理学，重点关注母体神经系统并发症和头痛，作为子痫前期的常见表现症状。
神经症状是子痫前期的早期和疾病特征。子痫前期的神经系统并发症可能包括头痛、视觉症状、脑水肿、癫痫发作或急性脑血管疾病，如脑出血或可逆性脑血管收缩综合征。偏头痛史是妊娠期间血管疾病（包括子痫前期和母体卒中）的独立危险因素。子痫前期和偏头痛的病理生理学均很复杂，两者之间的机制尚不完全清楚。偏头痛和子痫前期的重叠临床和病理生理学特征包括炎症、血管内皮功能障碍和血管反应性改变。神经系统并发症被认为是导致母体发病率和死亡率的主要原因。妊娠和产后妇女常因头痛就诊，临床病史和检查中的警示征象应提示立即进行神经影像学和实验室评估。在常规产科护理中，应从患者中引出详细的头痛病史，以识别发生子痫前期和相关妊娠高血压疾病风险增加的患者。神经产科这一新兴领域中的协作式护理模式和科学研究具有共同的目标，即降低子痫前期导致的母体神经系统发病率和死亡率。
