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The Bath Advanced Neurology Course 2003: Progressive Neurological Decline in Pregnancy
  1. Fady Joseph, Specialist Registrar in Neurology*,
  2. Ken Dawson, Consultant Neurologist,
  3. Samar Betmouni, Specialist Registrar in Neuropathology,
  4. Tim Moss, Consultant Neuropathologist§,
  5. Philip Smith, Consultant Neurologist
  1. *Institute of Clinical Neurosciences, Frenchay Hospital, Bristol;
  2. Nevill Hall Hospital, Abergavenny;
  3. Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol;
  4. §Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol;
  5. University Hospital of Wales, Cardiff; E-mail: FadyGJoseph{at}



The story

A young right-handed woman 30 weeks into her third pregnancy presented to the accident and emergency department with a 14-day history of headache; 7 days of progressive left-sided visual blurring, speech difficulties and vomiting; and 2 days of memory impairment, agitation and confusion. The early pregnancy had been uneventful, but at 22 weeks gestation she had been admitted with low back pain and urinary incontinence; MRI of the brain and spine were normal. There was a previous history of asthma, appendicectomy, and a miscarriage 3 years before, with a strong maternal family history of recurrent deep venous thromboses. Her only child had recently contracted chickenpox.


On initial examination she was poorly co-operative, confused, distressed and agitated. Registration and recall were reduced and she had nominal dysphasia. She was afebrile without meningism. Visual acuity was 6/6 on the right, but reduced to finger counting on the

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