Ischemic stroke and cerebral venous sinus thrombosis in pregnancy

Roeder, Hannah; Lopez, Jean Rodriguez; Miller, Eliza C.

doi:10.1016/b978-0-444-64240-0.00001-5

Cited by 26 publications

(50 citation statements)

References 222 publications

(235 reference statements)

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“…A meta-analysis comparing pregnancies via ovulation induction to controls found a trend toward increased risk of stroke [23]. Infertility may result from an underlying risk of vascular disease [24]. The results suggest that infertility may re ect an underlying predisposition to vascular disease and pregnancy can unmask this predisposition in women undergoing IVF or other forms of ART, and NVP/HG present in ART pregnancy could probably further increase the thrombosis risk.…”

Section: Discussionmentioning

confidence: 97%

Cerebral Venous Thrombosis Presenting in Early Pregnancy Complicated with Nausea and Vomiting: A Single-Institute Consecutive Case series and Literature Review

Wang

Lin

et al. 2022

Preprint

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Objectives Cerebral venous thrombosis (CVT) is a rare but potentially life-threatening condition in early pregnancy. We sought to describe the manifestation, treatment and outcomes of CVT presenting in early pregnancy through a retrospective consecutive case series in a tertiary referral center, so as to improve the awareness of this rare disease.Methods Between May 2018 and November 2021, consecutive seven patients with CVT presenting in early pregnancy were enrolled in Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University. All patients’ data like manifestations, laboratory and radiological data, treatment and prognosis were analyzed, and relevant literatures were also reviewed. Results All seven patients had been suffering from nausea and vomiting accompanied with headache prior to CVT occurrence. The headache was complained aggravation in severity with an average from 3.86 to 7.16 by visual analogue scale over several days. The mean age was 32.4±2.28 years, and mean BMI was 21.67 km/m2. All seven patients showed typical neurological symptoms on admission including epileptic seizures (n=2, 28.6%), limb weakness (n=4, 57.1%), aphasia (n=5, 71.4%), blurred vision (n=2, 28.6%), disturbed consciousness (n=3, 42.9%). Average score was 11.3 points (range from 3 to 15) on Glasgow coma scale (GCS). All patients were diagnosed with CVT at the first visiting day by imaging examinations and multiple venous sinuses thrombosis with average number of 3.7 per patient (range from 2 to 6) were confirmed, the most involved was transverse sinus (n=7, 100%), followed by sigmoid sinus (n=5, 71.4%). All of them was initiated anticoagulation treatment with low-molecular weight heparin (LMWH) instantly as soon as the CVT was defined. Two serious patients underwent catheter thrombolysis or/and decompressive craniotomy, but both still died of CVT deterioration within 5 days of admission. Other five patients were all performed selective induced abortion and was discharged after significant symptomatic improvement. They were remained anticoagulation for one year. At 12-month follow-up, MRI/MRV revealed sinuses were completely recanalized. Conclusions The present retrospective study should raise awareness of diagnosis and treatment of CVT in nausea and vomiting of early pregnancy complicated with headache. GCS evaluation on admission probably correlated with the prognosis. Neuroimaging remains the cornerstone for the diagnosis and instant anticoagulation prior to severe CVT aggravation is the key for the disease prognosis. Early pregnancy combined with CVT is not a contraindication of continued pregnancy based on the literature review.

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Section: Discussionmentioning

confidence: 97%

Cerebral Venous Thrombosis Presenting in Early Pregnancy Complicated with Nausea and Vomiting: A Single-Institute Consecutive Case series and Literature Review

Wang

Lin

et al. 2022

Preprint

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“…12 Increasing progesterone, placental chorionic somatomammotropin, and prolactin lead to an increase in erythropoiesis. 12 Maternal plasma volume and cardiac output peak around 28 to 32 weeks of gestation. 13 Peripheral vascular resistance decreases, which leads to a decrease in blood pressure temporarily and causes atrial dilation.…”

Section: Pathophysiologymentioning

confidence: 99%

“…12 An increase in proinflammatory cytokines (T-helper cells type 1, interleukin 6, C-reactive protein, and tumor necrosis factor α) occurs during the first trimester of pregnancy. 12 The increase in the proinflammatory cytokine and CRP can lead to thrombus formation because of their effects on endothelial cells (PM-3 Roeder). 12 Physiologic pregnancy changes increase the risk for stroke (Table 1).…”

Section: Pathophysiologymentioning

confidence: 99%

“…12 The increase in the proinflammatory cytokine and CRP can lead to thrombus formation because of their effects on endothelial cells (PM-3 Roeder). 12 Physiologic pregnancy changes increase the risk for stroke (Table 1).…”

Section: Pathophysiologymentioning

confidence: 99%

“…15 Women who are pregnant or postpartum (up to 6 weeks) are at a 2.4 times greater risk of stroke compared with nonpregnant women. 12,16 The risk of stroke in multiple gestation pregnancies is 12-fold higher than singleton pregnancies. 17 In pregnancies of multiples, the normal maternal adaptations are exceeded resulting in altered cardiovascular function and an increased risk of stroke.…”

Section: Pregnancy-related Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Pregnancy-Related Stroke: A Review

Doiron

Ramseyer²,

Phelps³

et al. 2022

Obstetrical &Amp; Gynecological Survey

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ImportanceThe maternal risk of strokes in the United States is approximately 30/100,000 pregnancies, and strokes are the eighth leading cause of maternal death. Because of the relationship between stroke and significant neurological disability/maternal death, obstetrical health care providers must be able to identify, evaluate, diagnosis, and treat these women.Evidence AcquisitionPubMed was searched using the search terms “stroke” OR “cerebrovascular accident” OR “intracranial hemorrhage” AND “pregnancy complications” OR “risk factors” OR “management” OR “outcome.” The search was limited to the English language and was restricted to articles from 2000 to 2020.ResultsThere were 319 abstracts identified, and 90 of the articles were ultimately used as the basis of this review. Presenting stroke signs and symptoms include headache, composite neurologic defects, seizures, and/or visual changes. Diagnosis is typically made with computed tomography scan using abdominal shielding or magnetic resonance imaging without contrast. Management options for an ischemic stroke include reperfusion therapy with intravenous recombinant tissue plasminogen activator catheter-based thrombolysis and/or mechanical thrombectomy. Hemorrhagic strokes are treated similarly to strokes outside of pregnancy, and that treatment is based on the severity and location of the hemorrhage.Conclusions and RelevanceEarly recognition and management are integral in decreasing the morbidity and mortality associated with a stroke in pregnancy.Relevance StatementThis study was an evidence-based review of stroke in pregnancy and how to diagnose and mange a pregnancy complicated by a stroke.Target AudienceObstetricians and gynecologist, family physiciansLearning ObjectivesAfter completing this learning activity, the participant should be better able to identify the pregnancy-related risk factors for a stroke; explain the presenting signs and symptoms of a stroke in pregnancy; describe the imaging modalities available to diagnose a stroke; and outline treatment options for an ischemic stroke and a hemorrhagic stroke.

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