Seminars in neurology
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Movement disorders are not commonly seen during pregnancy. As a result, there are few studies on whether disease manifestations are affected by the hormonal changes that occur during pregnancy or on the teratogenicity of commonly used medications for movement disorders on the developing fetus. This article discusses movement disorders that are seen only during pregnancy (chorea gravidarum) or that may present during pregnancy (restless legs syndrome), the effect that pregnancy has on symptoms and treatment (in Parkinson's disease, essential tremor, dystonia, tic disorders, and Wilson's disease), and the role of genetic testing for movement disorders in genetic counseling for pregnant women.
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Neurosurgical disorders are a significant cause of nonobstetric death and disability in pregnant women. The most common neurosurgical conditions encountered are intracranial hemorrhage, hydrocephalus, intracranial tumors, disc rupture, and head trauma. ⋯ Intracranial hemorrhage can sometimes be followed conservatively if it is not life-threatening; shunted hydrocephalus may get worse during the later stages of pregnancy but can usually be followed; meningiomas and pituitary adenomas may increase in size and require urgent surgical decompression because of apoplexy; disc ruptures can usually be treated conservatively; head trauma should be treated in the same way as in a nonpregnant patient. This article discusses several surgical and anesthetic issues that are important in dealing with these conditions.