Cerebral Strokes Associated with Pregnancy and the Puerperium

Cross, J. N.; Castro, P. Otero; Jennett, W. B.

doi:10.1136/bmj.3.5612.214

Cited by 127 publications

(69 citation statements)

References 23 publications

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“…Arterial occlusion, other than venous thrombosis, has generally been accepted as a predominant cause of pregnancy-associated ischemic stroke, constituting ≈60% to 80% of cases in Western countries. For example, Cross et al 22 confirmed the incidence of ischemic stroke from venous origin to be 1 in 20 000 pregnancies in Scotland, and Wiebers et al 23 reported 1 patient in 26 000 deliveries at the Mayo Clinic. On the contrary, previous studies in Asian countries have demonstrated venous thrombosis as a more common cause of ischemic stroke than in Western countries.…”

Section: Ischemic Strokementioning

confidence: 93%

Strokes Associated With Pregnancy and Puerperium

Yoshida

Takahashi

Takenobu

et al. 2017

Stroke

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Background and Purpose-The incidence and cause of strokes associated with pregnancy and the puerperium are still not fully understood. The aim of this study was to characterize pregnancy-related strokes in Japan using a large-scale survey with current imaging techniques. Methods-A retrospective analysis was conducted based on clinical chart reviews in 736 stroke teaching hospitals certified by the Japan Stroke Society between 2012 and 2013, using a web-based questionnaire requesting the detailed clinical course without any personally identifying information. The collection rate of this questionnaire was 70.5%, with 151 pregnancy-associated strokes extracted. Results-Hemorrhagic strokes were observed in 111 cases (73.5%), ischemic strokes in 37 (24.5%), and mixed type in 3 cases (2.0%). The estimated incidence of pregnancy-associated stroke was 10.2 per 100 000 deliveries. Major causes of hemorrhage were aneurysm (19.8%), arteriovenous malformation (17.1%), pregnancy-induced hypertension (11.7%), and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) (8.1%). Preexisting cerebrovascular diseases responsible for hemorrhage were detected in 59 cases (53.1%). Among the ischemic strokes, 28 (75.7%) were arterial and 9 (24.3%) were venous infarctions. The most frequent cause of arterial infarctions was reversible cerebral vasoconstriction syndrome. Hemorrhagic stroke showed much poorer prognosis than ischemic stroke. Conclusions-The incidence of pregnancy-associated stroke in Japan did not seem higher than that in other Asian and Western countries. The proportion of hemorrhagic stroke among Japanese women was much higher than that in white women. Preexisting cerebrovascular diseases and reversible cerebral vasoconstriction syndrome play a key role in hemorrhagic and ischemic stroke, respectively.

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Section: Ischemic Strokementioning

confidence: 93%

Strokes Associated With Pregnancy and Puerperium

Yoshida

Takahashi

Takenobu

et al. 2017

Stroke

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“…5 The incidence during pregnancy was reported to be 5 infarctions per 100 000 pregnancies in Glasgow, Scotland. 6 More recently, Sharshar et al 7 reported an incidence of 4.3 nonhemorrhagic strokes and 4.3 intracerebral hemorrhages per 100 000 deliveries. In the present study we report 69 strokes per 100 000 pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Stroke and Pregnancy

Jaigobin

Silver

2000

Stroke

262

199

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Background and Purpose-We sought to characterize the subtypes of stroke associated with pregnancy and the puerperium, with emphasis on timing, etiology, risk factors, and outcome. Methods-We conducted a retrospective analysis of patients admitted to the Toronto Hospital between January 1, 1980, and June 30, 1997, with a diagnosis of stroke during pregnancy or within 6 weeks postpartum. Strokes were classified as ischemic (arterial or venous) or hemorrhagic (subarachnoid or intracerebral). All patients were investigated with at least a CT scan of the head, and most had MRI and/or cerebral angiography. Results-Of approximately 50 700 admissions for delivery, 34 patients with a diagnosis of stroke were identified (21 infarctions and 13 hemorrhages). Of patients with infarction, 13 were arterial and 8 were venous. Nine of 13 arterial events occurred in the third trimester or puerperium. Seven of 8 venous occlusions occurred postpartum. An etiologic diagnosis was made in 7 of 13 patients with arterial territory infarction, including cardiac emboli, coagulopathies, and carotid artery dissection. Of patients with hemorrhage, 7 were subarachnoid and 6 were intracerebral. The etiology was identified in 10 patients: 3 were due to ruptured aneurysms, 5 were associated with arteriovenous malformations, and 2 were associated with disseminated intravascular coagulation. All patients with infarction survived, but 3 patients with hemorrhage died. Conclusions-The majority of strokes associated with pregnancy were arterial occlusions. Most presented during the third trimester and puerperium.

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“…Bár egy korábbi tanulmány szerint az anyai halálozás 26% [32], újabb vizsgálatok 14% alatti mortalitást említenek [5]. A magzati halálozási arány körülbelül 12% [3].…”

Section: Prognózisunclassified

Terhesség és akut ischaemiás stroke

Bereczki

2016

Orvosi Hetilap

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A graviditás alatt jelentkező ischaemiás stroke jelentős tényezője mind az anyai, mind a magzati morbiditásnak és mortalitásnak. A terhesség és gyermekágy során észlelt nagyobb kockázatot egyfelől a graviditással összefüggő haemostaseologiai és hemodinamikai változások, másfelől különböző, a terhességre specifikus és nem specifikus kocká-zati faktorok eredményezik. A diagnosztika, akut terápia és prevenció területén fontos kérdés a beavatkozások esetleges magzatkárosító veszélye. Multicentrikus regiszter létrehozása mindenképpen kívánatos volna a terhességi stroke alaposabb megismeréséhez. Tekintettel arra, hogy nagy esetszámú, randomizált, kontrollált vizsgálatok és ezekre alapozott definitív irányelvek nem állnak rendelkezésre, a terhesség alatt jelentkező akut stroke során minden esetben szakértők bevonásával és a haszon-kockázat megfelelő értékelésével kell egyénre szabott döntést hozni. Orv. Hetil., 2016, 157(20), 763-766. Kulcsszavak: terhesség, stroke, ischaemiás stroke Pregnancy and acute ischemic strokePregnancy-related ischemic strokes play an important role in both maternal and fetal morbidity and mortality. Changes in hemostaseology and hemodynamics as well as risk factors related to or independent from pregnancy contribute to the increased stroke-risk during gestation and the puerperium. Potential teratogenic effects make diagnostics, acute therapy and prevention challenging. Because randomized, controlled trials are not available, a multicenter registry of patients with gestational stroke would be desirable. Until definite guidelines emerge, management of acute ischemic stroke during pregnancy remains individual, involving experts and weighing the risks and benefits. Rövidítések CT = komputertomográfia; DWI = diffusion-weighted imaging; LMWH = low molecular weight heparin; MRI = mágne-sesrezonancia-vizsgálat; rtPA = rekombináns humán szöveti plazminogén aktivátor; TOF = time-of-flight; UFH = unfractionated heparin Ischaemiás stroke-ról beszélünk, ha a neurológiai funkció zavar hátterében fokális agyi, gerincvelői vagy retinalis infarktus áll [1]. A terhesség alatt jelentkező agyi érka-tasztrófa ugyan ritka esemény, mégis az egyébként alacsony rizikójú fiatal populációban bekövetkező strokeok 12-35%-áért és az anyai mortalitás 12%-áért felelős [2,3]. A gesztáció során a legnagyobb kockázatot a szü-lés körüli és gyermekágyi időszak jelenti [4]. Az ischaemiás stroke-ok 100 000 szülésre vonatkoztatott gyakorisága 4,3 és 210 közötti [5], azonban a szülési átlagéletkor elmúlt három évtizedben 24,6 évről 27,2 évre történő növekedésével [6] -és ezzel párhuzamosan a társuló cardiovascularis rizikófaktorok gyarapodásával [7] -össz-hangban emelkedő tendenciát mutat: az Amerikai Egyesült Államokban 1994 és 2007 között az antenatalis és post partum stroke miatti hospitalizációk 47%-kal, illetve 83%-kal nőttek [8]. Patogenezis és kockázati tényezőkA terhesség során észlelt emelkedett stroke-kockázathoz több tényező is hozzájárul. Ezek egyfelől a graviditással ÖSSZEFOGLALÓ KÖZLEMÉNY

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Cerebral Strokes Associated with Pregnancy and the Puerperium

Cited by 127 publications

References 23 publications

Strokes Associated With Pregnancy and Puerperium

Strokes Associated With Pregnancy and Puerperium

Stroke and Pregnancy

Terhesség és akut ischaemiás stroke

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