Cerebrovascular Disease in Pregnancy

Area of Science:

• Neurology
• Obstetrics
• Maternal-Fetal Medicine

Background:

• Stroke in pregnancy is a distinct clinical entity affecting young women.
• Causes are diverse, including pregnancy-specific conditions like pre-eclampsia and eclampsia.
• While absolute risk is low, maternal and fetal outcomes can be significantly impacted.

Purpose of the Study:

• To review the causes, diagnosis, and management of stroke during pregnancy.
• To highlight the importance of considering non-eclampsia related causes of stroke.
• To provide guidance on the use of antithrombotic agents and management of cerebrovascular lesions.

Main Methods:

• Literature review of stroke in pregnancy, focusing on etiology, treatment, and outcomes.
• Analysis of current guidelines and evidence for managing ischemic and hemorrhagic stroke.
• Discussion of treatment options for aneurysms and arteriovenous malformations in pregnant patients.

Main Results:

• Severe pre-eclampsia and eclampsia are common, but not the only causes of stroke.
• Magnesium sulfate is recommended for eclampsia prevention.
• Low-dose aspirin, unfractionated heparin, and low molecular weight heparin are preferred antithrombotics for ischemic stroke, with LMWH potentially safer.
• Hemorrhagic stroke and vascular malformations require individualized, multimodal treatment strategies.

Conclusions:

• Stroke in pregnancy necessitates a comprehensive approach, considering both maternal and fetal well-being.
• Management strategies for different stroke types and vascular lesions must be tailored to the individual patient.
• Further research is needed due to the lack of randomized clinical trials in this population.