Stroke and pregnancy

Background aid Purpose-We sought to characterize the subtypes of stroke ass ociated with pregnancy and the puerperium, with emphasis on timing, etiolog y, risk factors, and outcome. Methods-We conducted a retrospective analysis of patients admitted to the T oronto Hospital between January 1, 1980, and June 30, 1997, with a diagnosi s of stroke during pregnancy or within 6 weeks postpartum. Strokes were cla ssified as ischemic (arterial or venous) or hemorrhagic (subarachnoid or in tracerebral). 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). O f 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 v enous 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 hemorrhag e, 7 were subarachnoid and 6 were intracerebral. The etiology was identifie d in 10 patients: 3 were due to ruptured aneurysms, 5 were associated with arteriovenous malformations, and 2 were associated with disseminated intrav ascular 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.