Postpartum Stroke: The Importance of Early Recognition and Multidisciplinary Management

Pregnancy and the postpartum period are associated with an increased risk of stroke. We report the case of a 41-year-old para 6 woman with pre-existing hypertension who underwent a category 2 caesarean section at term for fetal distress. A few hours postoperatively, a family member noticed that she was more drowsy than usual. Subsequent clinical assessment revealed left-sided limb weakness and facial drooping. Prompt clinical assessment and multidisciplinary escalation were initiated, followed by transfer to a specialist stroke unit within the potential therapeutic window for reperfusion therapy. Computed tomography (CT) scan of the head and CT angiography showed no obvious thrombus or large-vessel occlusion. Magnetic resonance imaging (MRI) confirmed an acute ischaemic infarction involving the right basal ganglia and subcortical right frontal lobe. Magnetic resonance venography (MRV) showed no evidence of cerebral venous sinus thrombosis (CVT). Bilateral carotid Doppler ultrasonography was normal. Intravenous thrombolysis was considered by the stroke team but was not recommended, while mechanical thrombectomy was not indicated because there was no large-vessel occlusion. This case highlights the importance of maintaining a high index of suspicion for acute neurological deterioration in the immediate postpartum period, particularly in women with underlying vascular risk factors. Early recognition, prompt multidisciplinary escalation, and timely specialist management are essential to optimise outcomes in postpartum patients with suspected stroke.