What is the role of imaging studies in the workup of cerebrovascular disease during pregnancy?

Updated: Nov 08, 2018
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Imaging studies are required, and several options are available. Computed tomography (CT) is the most useful study for ruling out acute hemorrhage; it is also useful for evaluating ischemic stroke. CT angiography (CTA) and CT venography (CTV) can also be useful for evaluating the cerebral vasculature. CT studies produce results quickly, but they also pose a small radiation risk to the fetus. Evaluation of bleeding from ruptured intracranial aneurysms or arteriovenous malformations (AVMs) may require extensive imaging, including cerebral arteriography.

Magnetic resonance imaging (MRI) is useful for evaluating stroke in a pregnant patient. It does not carry the risk of radiation exposure, and the contrast material required for some studies is associated with few reports of adverse reactions, unlike the contrast material used for CT studies. Although MRI takes longer to perform than CT does, it offers a more detailed view of the brain tissue (especially the posterior fossa). In addition, the diffusion-weighted images allow greater accuracy in the diagnosis of acute ischemic events. [69]

Other diagnostic studies that may be used to evaluate a patient with ischemic stroke include carotid Doppler imaging, transesophageal (TEE) or transthoracic echocardiography (TTE), electrocardiography (ECG), and, occasionally, transcranial Doppler imaging. [72]


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