DOI: 10.36347/sjams.2014.v02i04.022

Pages: 1270-1273

Stroke is the second leading cause of death of women even in the developed countries. Stroke associated with pregnancy has been long recognized and may partly be responsible for this increased incidence. Stroke related to pregnancy is associated with significant morbidity and mortality. Aim of the study was to characterize the subtypes of stroke associated with pregnancy and the puerperium, with emphasis on timing, etiology, risk factors, and outcome. It is a retrospective analysis of patients admitted to the neuro department over a period of 5 years from January 2009 to December 2013, with a diagnosis of stroke during pregnancy or within 6 weeks postpartum. Strokes were classified as ischemic (arterial or venous) or hemorrhagic (subarachnoid or intracerebral). All patients were investigated with at least a CT scan of the head, and most had MRI and/or cerebral angiography. 35 patients with a diagnosis of stroke were identified (21 infarctions and 14 hemorrhages). Of patients with infarction, 13 were arterial and 8 were venous. Nine of 13 arterial events occurred in the third trimester or puerperium. Seven of 8 venous occlusions occurred postpartum. An etiologic diagnosis was made in 7 of 14 patients with arterial territory infarction, including cardiac emboli, coagulopathies, and carotid artery dissection. Of patients with hemorrhage, 8 were subarachnoid and 6 were intra cerebral. The etiology was identified in 10 patients: 3 were due to ruptured aneurysms, 5 were associated with arterio venous malformations, and 2 were associated with disseminated intravascular coagulation. All patients with infarction survived, but 3 patients with hemorrhage died. In conclusion, the majority of strokes associated with pregnancy were arterial occlusions. Most presented during the third trimester and puerperium.