Stroke and pregnancy.
OBJECTIVE
We sought to characterize the subtypes of stroke associated with pregnancy and the puerperium, with emphasis on timing, etiology, risk factors, and outcome.


METHODS
We conducted a retrospective analysis of patients admitted to the Toronto Hospital between January 1, 1980, and June 30, 1997, 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.


RESULTS
Of approximately 50 700 admissions for delivery, 34 patients with a diagnosis of stroke were identified (21 infarctions and 13 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 13 patients with arterial territory infarction, including cardiac emboli, coagulopathies, and carotid artery dissection. Of patients with hemorrhage, 7 were subarachnoid and 6 were intracerebral. The etiology was identified in 10 patients: 3 were due to ruptured aneurysms, 5 were associated with arteriovenous malformations, and 2 were associated with disseminated intravascular coagulation. All patients with infarction survived, but 3 patients with hemorrhage died.


CONCLUSIONS
The majority of strokes associated with pregnancy were arterial occlusions. Most presented during the third trimester and puerperium.
Jaigobin
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Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto (Ontario, Canada).
Silver
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D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000453:epidemiology; D011263:Pregnancy Trimester, Third; D011644:Puerperal Disorders / Q000175:diagnosis*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed