[Cerebrovascular disease in pregnancy and puerperium]

Cerebrovascular diseases are the main causes of neurological events occurring during pregnancy and puerperium.

We retrospectively reviewed the clinical records and imaging scans of females presenting with stroke during pregnancy or puerperium. We selected the cases with abnormal initial CT and/or MRI and a radiological follow-up until stabilization of the neurological condition.

Eleven patients with ages ranging from 21-38 years were found. The hospital admission occurred between the second trimester of pregnancy and the first two weeks after delivery. In six cases there was a clinical setting of preeclampsia/eclampsia (PE/E): five with reversible encephalopathy syndromes (hypertensive-like encephalopathy) and one with a hematoma in a HELLP patient. Three other cases had a clinical setting of hypertension, not fulfilling the PE/E criteria, presented with hemorrhagic infarct in one case and lenticular hematoma in the other two. The other two cases were a subarachnoid hemorrhage in a patient with a middle cerebral aneurysm and a cortical venous infarct in a patient with lateral sinus thrombosis.

Hypertension is the major underlying factor in peri-partum stroke. PE/E syndrome is the major leading cause of stroke in the peri-partum and maternal morbidity/mortality. MRI is very useful in evaluating this entity and, may have a positive impact on the management protocol.