title: Cryptogenic postpartum stroke.
abstract: An estimated 25-40% of ischemic strokes are classified as cryptogenic, which means the cause of the cerebral infarction remains unidentified. One of the potential pathomechanisms - especially among young patients with no cardiovascular risk factors - is paradoxical embolism through a patent foramen ovale. Pregnancy, cesarean delivery and the postpartum period are associated with an increased risk of cerebrovascular events. Factors that may contribute to ischemic strokes during gestation and puerperium include classic cardiovascular risk factors, changes in hemostaseology/hemodynamics, and pregnancy-specific disorders such as pre-eclampsia, eclampsia, postpartum cerebral angiopathy or peripartum cardiomyopathy. In this case report, we present a 36-year-old thrombolysis candidate undergoing mechanical thrombectomy 3 weeks after a cesarean section due to HELLP-syndrome. After evaluation of anamnestic and diagnostic parameters, closure of the patent foramen ovale has been performed. In the absence of specific guidelines, diagnostic work-up for cryptogenic stroke should be oriented after the suspected pathomechanism based on patient history and clinical picture. As long as definite evidences emerge, management of cryptogenic stroke patients with pathogenic right-to-left shunt remains individual based on the mutual decision of the patient and the multidisciplinary medical team.
authors: Department of Neurology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary. Electronic address: bereczki.daniel@hotmail.com.
authors: Dániel
authors: D
authors: Bereczki
authors: Department of Neurology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary.
authors: Norbert
authors: N
authors: Szegedi
authors: Department of Neurology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary.
authors: Zoltán
authors: Z
authors: Szakács
authors: Department of Neurointervention, National Institute of Clinical Neurosciences, Budapest, Hungary.
authors: István
authors: I
authors: Gubucz
authors: Department of Neurology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary.
authors: Zsolt
authors: Z
authors: May
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002585:Cesarean Section; D005260:Female; D017359:HELLP Syndrome / Q000503:physiopathology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging; D049590:Postpartum Period; D011247:Pregnancy; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed
keywords: Cryptogenic; Patent foramen ovale; Postpartum period; Stroke; Thrombectomy