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  • Updated 02.26.2024
  • Released 06.03.2003
  • Expires For CME 02.26.2027

Pregnancy and stroke



Stroke is a focal neurologic deficit caused by a focal lesion of the central nervous system due to a vascular cause (174). During pregnancy, stroke is an uncommon but serious cause of morbidity and mortality. In this article, the author discusses the etiologies, diagnostic approaches, and therapeutic challenges of pregnancy-specific ischemic and hemorrhagic strokes. This updated article includes revised epidemiologic data, the potential mechanism of preeclampsia, peripartum infection as a risk factor for stroke, Moyamoya disease in pregnancy, and the treatment of antiphospholipid syndrome.

Key points

• Stroke is a rare but feared complication of pregnancy.

• Patent foramen ovale closure may prevent ischemic stroke in young patients, but insufficient data exist on the best approach for women desiring pregnancy or already pregnant.

• Routine testing for hypercoagulable state is not indicated.

• An overlap exists 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.

• Patients with ischemic stroke may benefit from intravenous thrombolysis.

• Endovascular thrombectomy may be useful in acute ischemic stroke due to large vessel occlusion.

• Decompressive craniotomy may be lifesaving in patients with venous sinus thrombosis, even in patients with severe edema, herniation, or coma.

Historical note and terminology

Stroke is a neurologic dysfunction caused by focal cerebral, spinal, or retinal infarction attributable to ischemia or hemorrhage (174). Although rare, stroke during pregnancy and puerperium accounts for significant morbidity and mortality. For this review, pregnancy-related stroke refers to all ischemic and hemorrhagic events occurring during the three trimesters of pregnancy and the first 6 weeks after delivery or puerperium.

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