Zofkie A, et al. - Physicians designed this study to assess the incidence, presentation, and causes of pregnancy-related strokes at their single-center institution in relation to timing, characterization of stroke, risk factors, pregnancy outcomes, and residual neurologic deficits in order to identify at risk patients and to improve outcomes. Women with hemorrhagic strokes were more likely to be older. However, the distribution of hemorrhagic vs ischemic strokes was almost equal. An inordinately high incidence of any hypertension (53%) and preeclampsia syndrome (39%) was noted among these women with strokes. Findings revealed that 63% had residual neurological defects out of 41 women with long-term follow up.

Methods

• The physicians performed this retrospective observational review at a large county hospital.
• They defined stroke as an acute neurological deficit lasting greater than 24 hours.
• They identified patients using 3 sources from June 1984 through June 2017: Medical records with ICD-9 codes for pregnancy and stroke, OB-GYN departmental database, and records of the senior author.
• They included women if they suffered a stroke during pregnancy or within the 6-week puerperal period.

Results

• Fifty-seven women were identified to have a pregnancy-associated stroke during the 33-year period.
• There were 466,000 births at their hospital for an incidence of 12 per 100,000 deliveries during this same time period.
• In this study, the mean patient age was 24.9 years (range 15-42).
• The strokes were classified as hemorrhagic in 49%, ischemic in 47%, and atypical in 4%.
• In 42% of women, these strokes occurred in the third trimester and in 36% in the puerperium.
• Headache, seizure, altered mental status, and vision changes were the most common presenting symptoms.
• They found a significant difference in regard to maternal age (p=0.0019), but no significant statistical incidence of any pregnancy-associated hypertension (p=0.347) or preeclampsia-eclampsia syndrome (p=0.322), type of delivery (SVD p=0.322, C-section p=0.159), and persistence of residual neurological deficits (p=0.659) when hemorrhagic strokes were compared with ischemic strokes.