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The occurrence of transient focal neurologic symptoms in otherwise healthy pregnant women are not uncommon and are frequently secondary to a first-ever migraine with aura, research indicates. The occurrence of transient focal neurologic symptoms in otherwise healthy pregnant women, which include visual phenomena, speech difficulties, limb weakness or sensory abnormalities, are not uncommon and are frequently secondary to a first-ever migraine with aura, research indicates.

"Although the symptoms appear very alarming to physicians and patients at first, most of these patients have a very benign course with low stroke incidence," Dr. Ronen R. Leker, who was involved in the research, told Reuters Health. "A thorough history of past headache symptoms with an emphasis on migraine has a high yield and many of these patients subsequently develop migraine headache."

Dr. Leker and colleagues of Hebrew University Hadassah Medical Center, Jerusalem, conducted a case-control study to determine the natural course and pathogenesis of transient focal neurologic symptoms during pregnancy. Subjects included 14 pregnant women with, and 28 pregnant women without, acute transient focal neurologic symptoms. Women with histories of migraine, recurrent thromboembolism, or cerebrovascular disease were excluded.

In the February Archives of Neurology, the researchers report that presenting symptoms included dysphasia in six patients and hemisensory and hemimotor syndrome in five and seven patients, respectively. In four patients (29 per cent), these symptoms were preceded by scintillating scotoma and in nine (64 per cent), the focal symptoms were followed by a first-ever, throbbing, migraine-like headache.

Most of the focal symptoms occurred during the third trimester or shortly after delivery, coinciding with the hypercoagulable period of pregnancy. Four case women (29 per cent) developed migraine headaches during follow up.

None of the women had ischemic events. However, Dr. Leker recommends that a "modified stroke MRI that includes diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) be done immediately at presentation to rule out stroke."

Echocardiography, carotid duplex ultrasonography, and hypercoagulability results were negative in all case patients. "Therefore, these tests should not be performed unselectively in all patients with such transient events but rather saved for those with a positive family history and those with previous thrombotic events," the researchers conclude.