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CME Credit Offered
CME Credit Offered
Abstract Award
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Poster Session 4

(1137) Brain Imaging for Evaluation of Severe Headache in Pregnancy

Friday, January 31, 2025
4:00 PM – 6:00 PM  
Objective: Headache is the most common neurologic symptom in pregnancy. There is a debate on the necessity and imaging indications for headache evaluation. We aimed to assess the effectiveness of brain imaging for persistent severe headaches in pregnant individuals.

Study Design: This retrospective study included pregnant individuals with headaches requiring brain imaging at a tertiary center from 2011 to 2024. Those with "red flags" (neurological signs, severe headaches, or lack of response to analgesics) were evaluated by a neurologist for imaging needs. Abnormal imaging was defined as new brain findings explaining the headache. The study details patient characteristics, etiologies, clinical features, immediate treatments, and impacts on pregnancy management.

Results:

During the study period, 458 pregnant individuals had brain imaging due severe headache. Of them only 34 (7.4%) had positive imaging. Abnormal Imaging results included stroke (n=10,29.4%), space-occupying lesion  (n=7,20.6%), Idiopathic Increased Intracranial Pressure (n=6,17.6%), Cavernoma (n=5, 14.7%), and other less frequent causes such as Multiple Sclerosis, Posterior Reversible Encephalopathy Syndrome (PRES) (n=2, 5.9%) Acute Disseminated Encephalomyelitis (ADEM), Optic Neuritis, Subarachnoid Hemorrhage, Reversible cerebral vasoconstriction syndrome (RCVS), Internal carotid thrombus (n=1, 2.9% each).

There were no differences in maternal and pregnancy baseline characteristics (Table 1).

Among individuals with abnormal imaging 19 (55.9%)  needed medical or surgical treatment including 4 (11.7%) brain surgeries, 1 (2.9%) angiographic intervention,  16 individuals (47.0%) received medical treatment such as aspirin, low molecular weight heparin, nimodipine, steroids, and acetazolamide. Five (14.7%) patients underwent an early delivery between 29-36 weeks (Table 2).

Conclusion: At a tertiary care center, the yield of brain imaging to diagnose significant etiologies in pregnant individuals is 7.4% with CVA being the most common etiology. Medical or surgical treatment was required in 55.9% of the positive imaging group.