Hemorrhagic Stroke Resulting From Venous Malformation at 20 Weeks of Pregnancy

Stroke in the pregnant patient is not a common occurrence. Despite its relative rarity, stroke during pregnancy is associated with high morbidity and mortality for both mother and infant. We report the case of a patient who experienced a hemorrhagic stroke during pregnancy because of venous cavernoma.

A 34-year-old patient, gravida 5 para 1-0-3-1, presented to labor and delivery triage at 21 weeks, 0 days' gestation with the concern of sudden-onset right-sided facial, arm, and leg numbness and weakness. Intracranial imaging via magnetic resonance imaging demonstrated a small left midbrain venous cavernoma in the periaqueductal region of the posterior lateral cerebral peduncle area with evidence of edema and focal hemorrhage. During a 3-day hospital admission, the patient's deficits slowly improved, and she was discharged home. She subsequently delivered vaginally without incident. Six days postpartum, the patient presented with symptoms that were similar to her initial presentation. She was correctly diagnosed with migraine with aura after the appropriate neuroimaging studies did not show an acute stroke.

This case demonstrates the similarities between the perilous diagnosis of stroke and the more routine diagnosis of migraine. The case also highlights the need for caution and for a multidisciplinary treatment approach when the diagnosis of stroke is considered, particularly in the pregnant patient.