Arterial and Venous Stroke Associated with Pregnancy

Donaldson, James O.; Lee, Nora S.

doi:10.1016/s0733-8619(18)30088-4

Cited by 41 publications

(24 citation statements)

References 80 publications

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“…Current mortality rates are estimated to be as low as 5.5% with anticoagulation. 16 CNS infections showed a lower incidence in this study than in others (3.8%). Poliomyelitis was the most common cause in the present studies when compared to other studies [3][4][5][6] .…”

contrasting

confidence: 80%

“…The difference is due to less cases of CVT (3.8%) as compared to these studies where CVT accounted for 35-65% of the cases [4][5][6] . CVT has an exceptionally high incidence in India, attributable to a combination of dehydration; infection; and the traditional fat-rich diet fed to postpartum women causing a hypercoagulable state 16 . All cases presented with classical clinical features, similar to those in other studies.…”

mentioning

confidence: 99%

“…One patient had residual motor paralysis, but no mortality was seen. Mortality rate in cases of CVT was approximately 28% in most studies 5,[16][17][18][19] . Current mortality rates are estimated to be as low as 5.5% with anticoagulation.…”

mentioning

confidence: 99%

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Neurological Disorders in Pregnancy and Puerperium

Shubha¹,

Rao²,

Raghavendra³

2017

IOSR JDMS

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confidence: 80%

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confidence: 99%

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Neurological Disorders in Pregnancy and Puerperium

Shubha¹,

Rao²,

Raghavendra³

2017

IOSR JDMS

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“…O mecanismo hemodinâmico para AVCI também deve ser considerado, pois pode haver grande sangramento durante o parto 16 . Pesquisa de anticorpos antifosfolipídicos deve ser realizada assim como perfil reumatológico e pesquisa de doenças hematológicas pró-trombóticas (anemia falciforme, purpura trombótica trombocitopênica, deficiência congênita de antitrombina III, proteína C e proteína S) 4 -69 . O conjunto destes fatores parece ter importância para a instalação dessas doenças.…”

Section: Discussionunclassified

Gravidez, puerpério e doença vascular cerebral

Fukujima¹,

Oliveira²,

Shimazaki³

et al. 1996

Arq. Neuro-Psiquiatr.

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RESUMO -Foram estudadas seis pacientes com doenças cerebrovasculares no período gravídico-puerperal. Uma apresentou hemorragia cerebral, três apresentaram infarto cerebral e duas trombose de seio venoso cerebral. A associação de fatores clínicos ao estado peculiar produzido pela gravidez parece ter resultado nas doenças apresentadas, com especial ênfase à doença de Chagas presente em todos os infartos cerebrais.PALAVRAS CHAVE: gravidez, puerpério, acidente vascular cerebral, infarto cerebral, hemorragia cerebral, trombose venosa cerebral, doença de Chagas. Pregnancy, puerperium and cerebrovascular diseaseABSTRACT -Six patients who presented cerebrovascular disease during puerperium or pregnancy were studied. One of them presented hemorrhagic stroke caused by intracerebral bleeding due to pre-eclampsia. Three patients presented ischemic stroke, they all had positive serologic reactions for Chagas' disease, but only two of them had clinical cardiopathy; one of these patients had anticardiolipin antibody. The other two patients presented cerebral venous thrombosis of sagittal sinus. Both were smokers and one of them used oral contraceptive. We emphasize the importance of clinical investigation to seek for the common causes of cerebrovascular disease in young people, with special attention to Chagas disease in Brazil.KEY WORDS: pregnancy, puerperium, stroke, cerebral infarction, cerebral hemorrhage, cerebral venous thrombosis, Chagas 1 disease.No período gravídico-puerperal, isto é, do início da gestação até 90 dias após o parto, ocorre uma série de alterações na fisiologia materna, que podem resultar em complicações neurológicas, dentre elas, fenômenos vasculares cerebrais. Estes representam 4 a 8% dos óbitos maternos; este índice vem crescendo relativamente devido ao declínio da mortalidade por causas obstétricas 12 . Sabe-se que nesse período o risco de acidente vascular cerebral isquêmico (AVCI) aumenta até 13 vezes; no entanto, a incidência não é bem definida, variando de 1 em 26000 a 1 em 481 gestações 2.3.8,13.15 Nesse período ocorrem classicamente as tromboses de seios venosos cerebrais (TVC), com predomínio no puerpério (95% da 1* à 5* semanas após o parto), enquanto os infartos por oclusão arterial predominam nos 2° e 3° trimestres da gestação (cerca de 60%). A incidência de TVC varia de 1 em 10000 a 1 em 2500 gestações, com mortalidade que vem decrescendo de 30% a 5,5% nos últimos anos devido a maior precisão diagnostica e tratamento precoce 1 -416 . A incidência de hemorragia cerebral intraparenquimatosa (AVCH) varia de 1 a 5 em 10000 gestações, com mortalidade de 30 a 40% 17 .Esses fenômenos vasculares cerebrais durante o período gravídico-puerperal requerem especial atenção tanto do neurologista quanto do obstetra, com o intuito de proporcionar as melhores condições possíveis para o feto e minimizar as seqüelas maternas, como se mostra nesta casuística.

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“…Because pregnancy usually occurs in women under the age of 50 years, stroke in pregnancy may reflect the spectrum of causes of stroke in young adults [1,2], as well as disorders unique to the pregnant state [3][4][5][6][7][8]. In young adults, the cause of ischemic stroke may be atherosclerosis in 0% to 63%, non-atherosclerotic disease in 3% to 33%, lacunes in 2% to 21%, cardiac embolism in 5% to 37%, hematologic disease in 3% to 28%, oral contraceptives in 3% to 24%, illicit drug abuse in 2% to 12%, migraine in 2% to 18%, and unknown or other in 4% to 56% [1].…”

Section: Introductionmentioning

confidence: 99%

Cerebrovascular disease in pregnancy

Sloan

Stern²

2003

Curr Treat Options Neurol

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Stroke during pregnancy is a special category of stroke in young women. Although the absolute risk is small, there are diverse causes, including those inherent to the pregnant state, that may have a significant impact on maternal and fetal outcome. Severe pre-eclampsia and eclampsia are commonly associated with ischemic and hemorrhagic stroke, but must not be presumed the sole cause of stroke in pregnant women. Magnesium sulfate is the treatment of choice to prevent eclampsia. Randomized clinical trials in pregnant women are not available to provide guidance for the treatment of ischemic and hemorrhagic stroke in pregnant women. Various antithrombotic agents may be safely used during specific stages of pregnancy for treatment and prevention of ischemic stroke, with low-dose aspirin, unfractionated heparin, and low molecular weight heparin the preferred agents. Low molecular weight heparin may be safer than unfractionated heparin. Treatment of parenchymatous intracerebral hemorrhage and subarachnoid hemorrhage during pregnancy and the puerperium must be individualized. Aneurysms may be treated with neurosurgical clipping or endovascular coiling, depending on neurosurgical considerations. Cesarean or vaginal delivery may be used depending on the timing of delivery, adequacy of aneurysm occlusion, and risk to mother and fetus. Arteriovenous malformations are best treated in a multimodal fashion at a specialized treatment center.

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Arterial and Venous Stroke Associated with Pregnancy

Cited by 41 publications

References 80 publications

Neurological Disorders in Pregnancy and Puerperium

Neurological Disorders in Pregnancy and Puerperium

Gravidez, puerpério e doença vascular cerebral

Cerebrovascular disease in pregnancy

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