Cerebrovascular disorders complicating pregnancy--beyond eclampsia.
OBJECTIVE
Our purpose was to investigate the problems encountered in the diagnosis and management of cerebrovascular disorders associated with pregnancy and the puerperium.


METHODS
Pregnancies complicated by cerebrovascular disorders were identified by retrospective chart review (1985 to 1995). Events associated with trauma, neoplasm, drug ingestion, and infection were excluded.


RESULTS
The study population comprised 24 women with a variety of cerebrovascular disorders: 14 with infarction (5 arterial, 9 venous), 6 with intracranial hemorrhage (3 anatomic malformation, 3 unknown etiology), 3 with hypertensive encephalopathy, and 1 with an unruptured aneurysm. Blood pressure reflected physical condition at presentation and did not predict diagnosis or outcome except in the 3 women with hypertensive encephalopathy. Only 4 of 14 women with infarction and 1 of 6 with intracranial hemorrhage had a diastolic blood pressure > or = 110 mm Hg. Presumption of eclampsia delayed the diagnosis in 10 women (41.7%). In addition, patient delay in seeking medical attention complicated 10 cases. After review, none of the adverse maternal outcomes were deemed preventable by earlier physician intervention. Seven maternal deaths occurred (29.2%). Neonatal outcome was related to the gestational age and the maternal condition at presentation.


CONCLUSIONS
Cerebrovascular disorders are an uncommon and unpredictable complication of pregnancy that are associated with substantial maternal and fetal mortality. Suspected eclampsia unresponsive to magnesium sulfate therapy warrants an immediate neuroimaging study. Interestingly, in women with intracranial hemorrhage, severe hypertension was not an associated predictive factor.
Witlin
A G
AG
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103, USA.
Friedman
S A
SA
Egerman
R S
RS
Frangieh
A Y
AY
Sibai
B M
BM
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000783:Aneurysm / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004461:Eclampsia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D008278:Magnesium Sulfate