title: Ischemic stroke related to an amniotic fluid embolism during labor.
abstract: We report a young woman who survived multiple cerebral infarctions related to an amniotic fluid embolism (AFE) during labor. To our knowledge, an embolic stroke due to the coexistence of an AFE and patent foramen ovale (PFO) has not been reported. We describe the patient's clinical and radiological features and discuss the stroke mechanism in relation to our AFE hypothesis. A 32-year-old woman presented to the emergency room after experiencing convulsions during labor (blood pressure, 64/28mmHg; oxygen saturation, 67%). She was in a stupor, and her response to painful stimuli on the right side was weaker than on the left side. Acute stroke was considered as a possible cause. Additionally, an AFE was suspected due to cardiopulmonary arrest during labor. Brain MRI revealed multiple territory embolic infarctions. The transcranial Doppler with bubble study demonstrated a right-to-left shunt during the Valsalva maneuver. A transesophageal echocardiogram revealed a PFO with a right-to-left shunt. The elevated intrathoracic pressure during labor may have caused blood to flow backward through the heart, shunting blood from the right side to the left through the PFO. In cases such as this, an amniotic fluid embolus may travel directly from the venous to the arterial circulation via the PFO, leading to multiple cerebral infarctions.
authors.affiliation: Department of Neurology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Republic of Korea.
authors.forename: Yeon-Sun
authors.initials: YS
authors.lastname: Woo
authors.affiliation: Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Soon-Cheol
authors.initials: SC
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seong-Mi
authors.initials: SM
authors.lastname: Park
authors.affiliation: Department of Neurology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Republic of Korea. Electronic address: kh.cho.neuro@gmail.com.
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Cho
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D004619:Embolism, Amniotic Fluid; D005260:Female; D054092:Foramen Ovale, Patent / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D036801:Parturition; D011247:Pregnancy; D020521:Stroke / Q000209:etiology*; D014636:Valsalva Maneuver
keywords: Amniotic fluid embolism; Patent foramen ovale; Pregnant women; Stroke