Ischaemic stroke and pre-eclampsia in the third trimester of pregnancy: a diagnostic and therapeutic challenge

Abstract

A 23-year-old low-risk primiparous patient, who was 35 weeks pregnant, presented in the emergency department after collapsing at home. Her observations showed severe hypertension with proteinuria. On examination, she had left hemiparesis and was aphasic. Fetal monitoring was reassuring. Initial CT did not reveal any evidence of intracranial pathology. She was stabilised and delivered via emergency caesarean section. Subsequent MRI and CT showed an acute right-sided infarct involving the right middle cerebral artery territory, frontal and parietal regions, and increased mass effect. She was transferred to the nearest neurosurgical centre where she was conservatively managed and discharged home 3 weeks later for continuing rehabilitation. She achieved a good recovery.

Stroke in a Retrospective Cohort of Patients with Eclampsia

“…have described that the first 5 hours postpartum are the period with the highest risk for maternal death from a venous stroke. Patients with eclampsia and stroke currently represent a diagnostic and therapeutic challenge with a high degree of difficulty that has not been resolved [28]. Furthermore, contemporary research suggests an association between preeclampsia and stroke during pregnancy and postpartum, but also in later life [13,14,29].…”

Anaesthetic management of a case of severe preeclampsia with hemiplegia undergoing emergency caesarean section: A case report

“…Grammatis et al reported a case of left hemiplegia due to ischemic stroke in preeclampsia patient but there they did CT scan brain prior to caesarean section to rule out intracerebral hemorrhage as the patient had GCS of 14/15 without foetal distress. 5 In our hemiplegic patient with features of increasing intracranial pressure without prior knowledge of the type of CVA, anaesthetic management was focussed primarily on immediate protection of airway, improving oxygenation & protective ventilation to prevent further lung injury as the patient was full stomach & had aspirated. Also, the aim was to prevent further neuronal damage by reducing the increased intra-cranial pressure & to prevent hemodynamic fluctuation in response to laryngoscopic & surgical stimuli.…”