Pregnancy and stroke

Introduction
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By Adrian Marchidann MD

Stroke during pregnancy is an uncommon but serious cause of morbidity and mortality among women of childbearing age. In this review, we discuss the etiologies of pregnancy-specific ischemic and hemorrhagic strokes, diagnostic approaches, and therapeutic challenges. The discussion has been updated by Dr. Adrian Marchidann of SUNY Downstate Health Science Center in Brooklyn, New York. The most important additions to this update are the revised definition of preeclampsia and the recommendations for its treatment, new data on the risk of hemorrhage of cavernous hemangioma, arteriovenous malformation and aneurysm, and the most recent recommendations for antiplatelet and anticoagulation management for secondary stroke prevention during pregnancy and puerperium.

  • Because of the recent change of stroke definition and similarity of symptoms of different conditions associated with pregnancy, the true incidence of ischemic stroke during pregnancy and puerperium is still unknown.
  • There is an incomplete overlap between the mechanism, clinical presentation, and complications of preeclampsia, eclampsia, posterior reversible encephalopathy syndrome (PRES), and reversible cerebral vasoconstriction syndrome (RCVS).
  • Primary CNS vasculitis is extremely rare during pregnancy and outcome with treatment is better than considered in the past.
  • Ischemic stroke patients may benefit from intravenous rt-PA treatment; intraarterial therapy may be useful if intravenous rt-PA is contraindicated and a large vessel occlusion is suspected.

 

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Anesthesia
References cited
Contributors