Neurological complications during pregnancy and the post-partum period pose a diagnostic challenge due to their often non-specific symptoms. Headaches, affecting up to 35% of pregnant women, can be the initial sign of a wide range of conditions, from benign migraines to rare life-threatening issues. Radiologists should be well versed on the key imaging features to guide prompt and appropriate management. While CT head is commonly the initial imaging choice due to availability, MRI offers greater sensitivity but comes with practical limitations and safety considerations, especially during pregnancy. Our comprehensive review illustrates the key imaging features of important neurological complications during this critical period, including cerebrovascular conditions (subarachnoid haemorrhage, venous sinus thrombosis, ischaemic stroke, eclamptic encephalopathy, PRES and RCVS), endocrine/metabolic disorders (Sheehan's syndrome and lymphocytic hypophysitis), and common primary CNS conditions that may manifest during pregnancy (neoplasms and multiple sclerosis).

Hematometrocolpos is the accumulation of blood products within uterine cavity and vagina because of anatomical outflow obstruction to menstrual blood passage. Vaginal septum is an important aetiology of obstruction amenable to surgical correction, among other causes such as imperforate hymen and distal vaginal atresia.However, the visualisation of vaginal septum in conventional MRI or ultrasound can be challenging due to lack of contrast between the septum and adjacent vaginal soft tissue. Gel instillation is used to achieve vaginal distension for better delineation for vaginal septum for surgical planning. We present companion cases of pelvic MRI assessment of vaginal septum, with and without vaginal gel instillation, to illustrate the optimized visualisation of vaginal septum with gel usage. Surgical and pathological correlation regarding fibrous nature of vaginal septum characteristics were addressed.