{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T22:37:04Z","timestamp":1784068624159,"version":"3.55.0"},"reference-count":107,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Neurol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The evaluation and diagnosis of altered mental status in the pregnant or postpartum patient largely parallels the approach used for any other patient; however, there are several critical differences including that some neuroobstetric diagnoses require emergent delivery of the fetus. Being familiar with the physiological changes and medical complications of pregnancy and delivery is therefore essential. This review first addresses pregnancy-specific disorders that may result in altered mental status, such as the hypertensive disorders of pregnancy and pregnancy-related metabolic and endocrinopathies. The focus then shifts to the complex physiologic changes in pregnancy and how these changes contribute to the distinct epidemiology of pregnancy-related cerebrovascular complications like intracranial hemorrhage, ischemic stroke, and reversible cerebral vasoconstriction syndrome. Medical disorders that are not unique to pregnancy, such as infections and autoimmune conditions, may present de novo or worsen during pregnancy and the peripartum period and require a thoughtful approach to diagnosis and management. Finally, the unique nervous system complications of obstetric anesthesia are explored. In each section, there is a focus not only on diagnosis and syndrome recognition but also on the emergent treatment needed to reverse these complications, bearing in mind the unique physiology of the pregnant patient.<\/jats:p>","DOI":"10.1055\/s-0044-1788977","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T23:38:21Z","timestamp":1723851501000},"page":"695-706","source":"Crossref","is-referenced-by-count":9,"title":["Approach to Altered Mental Status in Pregnancy and Postpartum"],"prefix":"10.1055","volume":"44","author":[{"given":"Adam J.","family":"Kroopnick","sequence":"additional","affiliation":[{"name":"Department of Neurology, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza C.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurology, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,8,16]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1097\/AOG.0000000000003891","article-title":"Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222","volume":"135","author":"Gestational Hypertension and Preeclampsia","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"17","key":"ref3","doi-asserted-by":"crossref","first-page":"585","DOI":"10.15585\/mmwr.mm7117a1","article-title":"Hypertensive disorders in pregnancy and mortality at delivery hospitalization - United States, 2017-2019","volume":"71","author":"N D Ford","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"L Say","year":"2014","journal-title":"Lancet Glob Health"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/AOG.0000000000000590","article-title":"Hypertensive disorders and pregnancy-related stroke: frequency, trends, risk factors, and outcomes","volume":"125","author":"L R Leffert","year":"2015","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.preghy.2021.09.008","article-title":"The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice","volume":"27","author":"L A Magee","year":"2022","journal-title":"Pregnancy Hypertens"},{"issue":"18","key":"ref7","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1161\/CIRCULATIONAHA.115.015721","article-title":"Epidemiology and mechanisms of de novo and persistent hypertension in the postpartum period","volume":"132","author":"A Goel","year":"2015","journal-title":"Circulation"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1097\/AOG.0b013e318231934c","article-title":"Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications","volume":"118","author":"Z Al-Safi","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"10","key":"ref9","first-page":"CD003106","article-title":"Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation","volume":"10","author":"D Churchill","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0002-9378(99)70022-0","article-title":"The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification","volume":"180","author":"J N Martin Jr","year":"1999","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1055\/s-2007-994482","article-title":"Severe preeclampsia with fulminant and extreme elevation of aspartate aminotransferase and lactate dehydrogenase levels: high risk for maternal death","volume":"12","author":"V A Catanzarite","year":"1995","journal-title":"Am J Perinatol"},{"issue":"09","key":"ref12","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1111\/j.1471-0528.2007.01423.x","article-title":"Eclampsia in the United Kingdom 2005","volume":"114","author":"M Knight","year":"2007","journal-title":"BJOG"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/jog.12697","article-title":"Should magnesium sulfate be administered to women with mild pre-eclampsia? 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