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Background. Migraine is a frequent neurological disorder affecting mostly women in the childbearing age. It is influenced by fluctuation of female hormones, especially estrogen levels. Objectives. This review aims to describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options. Materials and methods. We performed a systematic literature review searching information on the subject in PubMed and Medscape databases between 2000-2022. Outcomes. It reveals that during the first trimester due to symptoms of hyperemesis gravidarum, migraine attacks can exacerbate, while, through second and third trimester when estrogen levels rise, women report relief of symptoms. Therapy includes firstly behavioural approach and secondly pharmacological drugs along with non-invasive procedures, some still under investigation for pregnant state. For mild cases the first line is acetaminophen alone or together with antiemetics and in more severe cases or in women with past history of migraine triptans can used as the mainstay therapy. Conclusions. Despite recent discoveries on therapy and drugs, our understanding of the way medications may affect the fetus or new-born is incomplete and further evidence is needed, bringing potential for improved management of migraine during pregnancy.

Aneurysms are sac-like dilatations of weakened wall areas within blood vessels. Cardiovascular related issues, such as hypertension, can put one at risk of developing such complications, with the possibility of rupturing. In the case of intracranial aneurysms, an outpouching forms where there is turbulent blood flow, often at the bifurcation of arteries. Depending on the morphology and location, different treatments need to be considered, but during pregnancy, further physiological changes also factor into decision making. In pregnant patients, intracranial hemorrhage cases are relatively low, yet they cause a high mortality rate amongst women, hence early detection and management of unruptured aneurysms is of significant importance.

Background. Women are commonly diagnosed with multiple sclerosis during reproductive age. There is need for disease control management during pregnancy, taking into consideration potential maternal and fetal risks. This review article aims to summarize what is acknowledged so far regarding treatment options of multiple sclerosis and outcomes in pregnancy, providing up-to-date information. Methods. In order to write this review a comprehensive literature electronic search for journal articles and guidelines regarding multiple sclerosis during pregnancy was undertaken. Results and conclusion. Multiple sclerosis management in pregnancy is a challenging issue. The use of disease-modifying drugs has improved both the course of the disease and the attitude towards pregnancy in patients living with multiple sclerosis. Pregnancy appears to have a protective effect on disease activity, particularly during the third trimester.

Moyamoya disease (MMD) is a chronic vasculopathy characterized by progressive bilateral stenosis and occlusion of the terminal portion of the internal carotid artery (ICA) and the presence of an abnormal vascular network at the base of the brain, termed Moyamoya vessels (MMV). The main presentations of MMD are ischemia and hemorrhage, and diagnosis is done via angiography. Cerebral events were reported in 5.1% of pregnancies of MMD diagnosed mothers, in Japan. In the case of MMD diagnosis due to cerebrovascular events during gestation, 34.7% of patients presented with an ischemic event, while 69.5% suffered from hemorrhage. During gestation, hemorrhagic events were found to occur mostly antepartum, after 24 weeks of gestation, while cerebral infarction peaked 3-7 days after delivery. No treatment has been found to halt or reverse the progress of the disease. Interventions focus on reducing the risk of stroke and cognitive disfunction as a result of ischemia. In the case of pregnant women suffering hemorrhage due to MMD, conservative treatment, as well as ventricle puncture and drainage were to be efficient, and did not severely impact the child. When diagnosed before pregnancy occurs, MMD under treatment does not pose a significantly increased risk of complications, compared to pregnancies in unaffected women. No evidence suggests that MMD is a contraindication for pregnancy.

Posterior reversible encephalopathy syndrome (PRES) is a clinical radiologic syndrome characterized by visual deficits, altered consciousness, headache, confusion, seizures and focal neurological signs. Its pathophysiology is still uncertain, with vasogenic edema being the most frequent incriminated mechanism. It was described in correlation with hypertensive encephalopathy, eclampsia, use of cytotoxic and immunosuppressive drugs and renal diseases. Regarding its association with pregnancy, it is important to deliver the baby as soon as possible, to administer proper medication for hypertension, with labetalol being first choice and combat seizures or any signs of status epilepticus. A clear diagnosis can be established by combining clinical presentation with imaging techniques, especially T2 images of MRI. It has a rapid progression and good prognosis is obtained by early recognition and prompt treatment of associate condition.

Planning a pregnancy for a woman diagnosed with epilepsy might be a challenge, but nowadays it is no more a contraindication. By offering careful education to this population, maternal and neonatal normal outcome is expected. It is important to have a multidisciplinary team of professionals that include a neurologist, a maternal fetal medicine specialist, an obstetrician and an anesthesiologist that manage the case and inform the women about potential risks for them and for fetuses, evolution of their scheme of treatment and particular adjustments that they need to do, as well as advices and strategies for postpartum period. The goal should always be optimal seizure control and minimal exposure to antiepileptic drugs for fetus. Preconception counseling should accomplish the four most important steps for the benefits of both mother and fetus: particular choice of antiepileptic drugs and the lowest effective dose, valproate avoidance, folate supplementation and birth control with contraceptives until baseline is achieved. Finally, although there is an increased risk for congenital malformations and neurodevelopment disorders, a good managed pregnancy can maintain to a minimum the fetal exposure to side effects of antiepileptic drugs and maternal risk for seizure.

Myasthenia gravis (MG) is an autoimmune disorder defined by weakness and rapid fatigue of skeletal muscles due to deterioration of neuromuscular junction by autoantibodies targeting either acetylcholine receptors (AchRs) or other molecules such as muscle specific kinase receptors (MuSK). It affects predominantly women in the third decade of life and the effects of pregnancy on the evolution of the disease is variable, usually the aggravation of symptoms occurs during the first trimester or first month postpartum. The aim of this review is to discuss the clinical management of MG in pregnancy and to highlight the implications of MG on pregnancy and vice-versa, as well as reviewing the available treatment by using documentary analysis. The findings of this review show a variable clinical course of the disease with remission, worsening or preserving the status quo. MG does not influence the course of pregnancy to a large degree and by careful antenatal care and a multidisciplinary team approach a normal pregnancy and delivery can be achieved.