About this Journal Submit a Manuscript Table of Contents
Stroke Research and Treatment
Volume 2011 (2011), Article ID 606780, 13 pages
http://dx.doi.org/10.4061/2011/606780
Review Article

Ischemic Stroke during Pregnancy and Puerperium

1Dipartimento di Scienze Biomediche e Biotecnologie, Università degli Studi di Brescia, 25128 Brescia, Italy
2Dipartimento di Scienze Mediche e Chirurgiche, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25100 Brescia, Italy

Received 10 August 2010; Accepted 4 December 2010

Academic Editor: Halvor Naess

Copyright © 2011 Elisabetta Del Zotto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. W. Rosamond, K. Flegal, K. Furie et al., “Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee,” Circulation, vol. 117, no. 4, pp. e25–e46, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  2. J. Bogousslavsky and P. Pierre, “Ischemic stroke in patients under age 45,” Neurologic Clinics, vol. 10, no. 1, pp. 113–124, 1992. View at Scopus
  3. J. Putaala, A. J. Metso, T. M. Metso et al., “Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke the Helsinki young stroke registry,” Stroke, vol. 40, no. 4, pp. 1195–1203, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  4. K. A. Bremme, “Haemostatic changes in pregnancy,” Best Practice and Research: Clinical Haematology, vol. 16, no. 2, pp. 153–168, 2003. View at Publisher · View at Google Scholar · View at Scopus
  5. S. Hunter and S. C. Robson, “Adaptation of the maternal heart in pregnancy,” British Heart Journal, vol. 68, no. 6, pp. 540–543, 1992. View at Scopus
  6. K. Mackey, M. C. Meyer, W. S. Stirewalt, B. C. Starcher, and M. K. McLaughlin, “Composition and mechanics of mesenteric resistance arteries from pregnant rats,” American Journal of Physiology, vol. 263, no. 1, part 2, pp. R2–R8, 1992. View at Scopus
  7. T. Sharshar, C. Lamy, and J. L. Mas, “Incidence and causes of strokes associated with pregnancy and puerperium: a study in public hospitals of Ile de France,” Stroke, vol. 26, no. 6, pp. 930–936, 1995. View at Scopus
  8. J. N. Cross, P. O. Castro, and W. B. Jennett, “Cerebral strokes associated with pregnancy and the puerperium,” British medical journal, vol. 3, no. 612, pp. 214–218, 1968. View at Scopus
  9. D. O. Wiebers and J. P. Whisnant, “The incidence of stroke among pregnant women in Rochester, Minn, 1955 through 1979,” Journal of the American Medical Association, vol. 254, no. 21, pp. 3055–3057, 1985. View at Scopus
  10. C. C. Liang, S. D. Chang, S. L. Lai, C. C. Hsieh, H. Y. Chueh, and T. H. Lee, “Stroke complicating pregnancy and the puerperium,” European Journal of Neurology, vol. 13, no. 11, pp. 1256–1260, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  11. A. Awada, S. al Rajeh, R. Duarte, and N. Russell, “Stroke and pregnancy,” International Journal of Gynecology & Obstetrics, vol. 48, pp. 157–161, 1985.
  12. S. J. Kittner, B. J. Stern, B. R. Feeser et al., “Pregnancy and the risk of stroke,” New England Journal of Medicine, vol. 335, no. 11, pp. 768–774, 1996. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  13. A. G. Witlin, S. A. Friedman, R. S. Egerman et al., “Cerebrovascular disorders complicating pregnancy—beyond eclampsia,” American Journal of Obstetrics and Gynecology, vol. 176, no. 6, pp. 1139–1148, 1997. View at Publisher · View at Google Scholar · View at Scopus
  14. C. Jaigobin and F. L. Silver, “Stroke and pregnancy,” Stroke, vol. 31, no. 12, pp. 2948–2951, 2000. View at Scopus
  15. F. M. Skidmore, L. S. Williams, K. D. Fradkin, R. J. Alonso, and J. Biller, “Presentation, etiology, and outcome of stroke in pregnancy and puerperium,” Journal of Stroke and Cerebrovascular Diseases, vol. 10, no. 1, pp. 1–10, 2001. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  16. J. S. Jeng, S. C. Tang, and P. K. Yip, “Incidence and etiologies of stroke during pregnancy and puerperium as evidenced in Taiwanese women,” Cerebrovascular Diseases, vol. 18, no. 4, pp. 290–295, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  17. H. Salonen Ros, P. Lichtenstein, R. Bellocco, G. Petersson, and S. Cnattingius, “Increased risks of circulatory diseases in late pregnancy and puerperium,” Epidemiology, vol. 12, no. 4, pp. 456–460, 2001. View at Publisher · View at Google Scholar · View at Scopus
  18. A. H. James, C. D. Bushnell, M. G. Jamison, and E. R. Myers, “Incidence and risk factors for stroke in pregnancy and the puerperium,” Obstetrics and Gynecology, vol. 106, no. 3, pp. 509–516, 2005. View at Scopus
  19. C. D. Bushnell, M. Jamison, and A. H. James, “Migraines during pregnancy linked to stroke and vascular diseases: US population based case-control study,” BMJ, vol. 338, p. b664, 2009. View at Publisher · View at Google Scholar · View at Scopus
  20. D. J. Lanska and R. J. Kryscio, “Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis,” Stroke, vol. 31, no. 6, pp. 1274–1282, 2000. View at Scopus
  21. H. S. Ros, P. Lichtenstein, R. Bellocco, G. Petersson, and S. Cnattingius, “Pulmonary embolism and stroke in relation to pregnancy: how can high-risk women be identified?” American Journal of Obstetrics and Gynecology, vol. 186, no. 2, pp. 198–203, 2002. View at Publisher · View at Google Scholar · View at Scopus
  22. C. H. Tang, C. S. Wu, T. H. Lee et al., “Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan,” Stroke, vol. 40, no. 4, pp. 1162–1168, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  23. J. L. Mas and C. Lamy, “Stroke in pregnancy and the puerperium,” Journal of Neurology, vol. 245, no. 6-7, pp. 305–313, 1998. View at Publisher · View at Google Scholar · View at Scopus
  24. B. Sibai, G. Dekker, and M. Kupferminc, “Pre-eclampsia,” The Lancet, vol. 365, no. 9461, pp. 785–799, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  25. D. Leys, C. Lamy, C. Lucas et al., “Arterial ischemic strokes associated with pregnancy and puerperium,” Acta Neurologica Belgica, vol. 97, no. 1, pp. 5–16, 1997. View at Scopus
  26. S. K. Sharma, “Pre-eclampsia and eclampsia,” Seminars in Anesthesia, vol. 19, no. 3, pp. 171–180, 2000. View at Scopus
  27. D. W. Brown, N. Dueker, D. J. Jamieson et al., “Preeclampsia and the risk of ischemic stroke among young women: results from the stroke prevention in young women study,” Stroke, vol. 37, no. 4, pp. 1055–1059, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  28. P. Zunker, C. Hohenstein, and G. Deuschl, “Pathophysiology of Pre-eclampsia/eclampsia syndrome,” Journal of Neurology, vol. 248, no. 5, pp. 437–438, 2001. View at Publisher · View at Google Scholar · View at Scopus
  29. J. M. Roberts and D. W. Cooper, “Pathogenesis and genetics of pre-eclampsia,” The Lancet, vol. 357, no. 9249, pp. 53–56, 2001. View at Publisher · View at Google Scholar · View at Scopus
  30. B. M. Sibai, “Magnesium sulfate prophylaxis in preeclampsia: lessons learned from recent trials,” American Journal of Obstetrics and Gynecology, vol. 190, no. 6, pp. 1520–1526, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  31. A. Ilancheran, S. S. Ratnam, and G. Baratham, “Metastatic cerebral choriocarcinoma with primary neurological presentation,” Gynecologic Oncology, vol. 29, no. 3, pp. 361–364, 1988. View at Scopus
  32. N. Saad, Y. M. Tang, E. Sclavos, and S. L. Stuckey, “Metastatic choriocarcinoma: a rare cause of stroke in the young adult,” Australasian Radiology, vol. 50, no. 5, pp. 481–483, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  33. C. Y. Huang, C. A. Chen, C. Y. Hsieh, and W. F. Cheng, “Intracerebral hemorrhage as initial presentation of gestational choriocarcinoma: a case report and literature review,” International Journal of Gynecological Cancer, vol. 17, no. 5, pp. 1166–1171, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  34. S. L. Clark, G. D. V. Hankins, D. A. Dudley, G. A. Dildy, and T. Flint Porter, “Amniotic fluid embolism: analysis of the national registry,” American Journal of Obstetrics and Gynecology, vol. 172, pp. 1158–1169, 1995. View at Scopus
  35. J. Bogousslavsky, P. A. Despland, F. Regli, and P. Y. Dubuis, “Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds,” European Neurology, vol. 29, no. 2, pp. 102–105, 1989. View at Scopus
  36. T. L. Williams, T. G. Lukovits, B. T. Harris, and C. Harker Rhodes, “A fatal case of postpartum cerebral angiopathy with literature review,” Archives of Gynecology and Obstetrics, vol. 275, no. 1, pp. 67–77, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  37. D. Farine, J. Andreyko, and A. Lysikiewicz, “Isolated angiitis of brain in pregnancy and puerperium,” Obstetrics and Gynecology, vol. 63, no. 4, pp. 586–588, 1984. View at Scopus
  38. J. J. Geraghty, D. B. Hoch, M. E. Robert, and H. V. Vinters, “Fatal puerperal cerebral vasospasm and stroke in a young woman,” Neurology, vol. 41, no. 7, pp. 1145–1147, 1991. View at Scopus
  39. A. B. Singhal, “Postpartum angiopathy with reversible posterior leukoencephalopathy,” Archives of Neurology, vol. 61, no. 3, pp. 411–416, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  40. U. Elkayam, M. W. Akhter, H. Singh et al., “Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation,” Circulation, vol. 111, no. 16, pp. 2050–2055, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  41. J. Abboud, Y. Murad, C. Chen-Scarabelli, L. Saravolatz, and T. M. Scarabelli, “Peripartum cardiomyopathy: a comprehensive review,” International Journal of Cardiology, vol. 118, no. 3, pp. 295–303, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  42. G. D. Pearson, J. C. Veille, S. Rahimtoola et al., “Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review,” Journal of the American Medical Association, vol. 283, no. 9, pp. 1183–1188, 2000. View at Scopus
  43. A. Cenac and A. Djibo, “Postpartum cardiac failure in Sudanese-Sahelian Africa: clinical prevalence in western Niger,” American Journal of Tropical Medicine and Hygiene, vol. 58, no. 3, pp. 319–323, 1998. View at Scopus
  44. W. N. K. A. Van Mook and L. Peeters, “Severe cardiac disease in pregnancy, part II: impact of congenital and acquired cardiac diseases during pregnancy,” Current Opinion in Critical Care, vol. 11, no. 5, pp. 435–448, 2005. View at Publisher · View at Google Scholar · View at Scopus
  45. R. M. Lang, M. B. Lampert, and A. Poppas, “Peripartal cardiomyopathy,” in Cardiac Problems in Pregnancy, U. Elkayam and N. Gleicher, Eds., Wiley-Liss, New York, NY, USA, 3rd edition, 1998.
  46. A. L. Heider, J. A. Kuller, R. A. Strauss, and S. R. Wells, “Peripartum cardiomyopathy: a review of the literature,” Obstetrical and Gynecological Survey, vol. 54, no. 8, pp. 526–531, 1999. View at Publisher · View at Google Scholar · View at Scopus
  47. F. G. Cunningham, J. A. Pritchard, and G. D.V. Hankins, “Peripartum heart failure: idiopathic cardiomyopathy or compounding cardiovascular events?” Obstetrics and Gynecology, vol. 67, no. 2, pp. 157–168, 1986.
  48. M. T. Hodgman, M. S. Pessin, and D. C. Homans, “Cerebral embolism as the initial manifestation of peripartum cardiomyopathy,” Neurology, vol. 32, no. 6, pp. 668–671, 1982.
  49. R. C. Connor and J. H. Adams, “Importance of cardiomyopathy and cerebral ischaemia in the diagnosis of fatal coma in pregnancy,” Journal of Clinical Pathology, vol. 19, no. 3, pp. 244–249, 1966. View at Scopus
  50. A. G. Witlin, W. C. Mabie, and B. M. Sibai, “Peripartum cardiomyopathy: an ominous diagnosis,” American Journal of Obstetrics and Gynecology, vol. 176, pp. 182–188, 1997. View at Scopus
  51. E. J. Hall and A. J. Giaccia, Radiobiology for the Radiologist, Lippincott Williams and Wilkins, Philadelphia, Pa, USA, 2006.
  52. ACOG Committee on Obstetric Practice, “ACOG Committee Opinion Number 299. Guidelines for diagnostic imaging during pregnancy,” Obstetrics & Gynecology, vol. 104, pp. 647–651, 2004.
  53. D. A. Tyndall and K. K. Sulik, “Effects of magnetic resonance imaging on eye development in the C57BL/6J mouse,” Teratology, vol. 43, no. 3, pp. 263–275, 1991. View at Scopus
  54. Y. P. Yip, C. Capriotti, S. L. Talagala, and J. W. Yip, “Effects of MR exposure at 1.5 T on early embryonic development of the chick,” Journal of Magnetic Resonance Imaging, vol. 4, no. 5, pp. 742–748, 1994. View at Scopus
  55. J. A.W. Webb, H. S. Thomsen, S. K. Morcos et al., “The use of iodinated and gadolinium contrast media during pregnancy and lactation,” European Radiology, vol. 15, no. 6, pp. 1234–1240, 2005. View at Publisher · View at Google Scholar · View at PubMed
  56. E. Kanal, J. P. Borgstede, A. J. Barkovich et al., “American College of Radiology white paper on MR safety,” American Journal of Roentgenology, vol. 178, no. 6, pp. 1335–1347, 2002. View at Scopus
  57. E. Kanal, J. P. Borgstede, A. J. Barkovich et al., “American College of Radiology white paper on MR safety. 2004 Update and revisions,” American Journal of Roentgenology, vol. 182, no. 5, pp. 1111–1114, 2004. View at Scopus
  58. R. L. Sacco, R. Adams, G. Albers et al., “Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association council on stroke—co-sponsored by the council on cardiovascular radiology and intervention. The American Academy of Neurology affirms the value of this guideline,” Stroke, vol. 37, no. 2, pp. 577–617, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  59. J. Lepercq, J. Conard, A. Borel-Derlon et al., “Venous thromboembolism during pregnancy: a retrospective study of enoxaparin safety in 624 pregnancies,” British Journal of Obstetrics and Gynaecology, vol. 108, no. 11, pp. 1134–1140, 2001. View at Publisher · View at Google Scholar · View at Scopus
  60. T. E. Warkentin, M. N. Levine, J. Hirsh et al., “Heparin-induced thrombocytopenia in patients treated with low-molecular- weight heparin or unfractionated heparin,” New England Journal of Medicine, vol. 332, no. 20, pp. 1330–1335, 1995. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  61. J. S. Ginsberg, J. Hirsh, D. C. Turner, M. N. Levine, and R. Burrows, “Risks to the fetus of anticoagulant therapy during pregnancy,” Thrombosis and Haemostasis, vol. 61, no. 2, pp. 197–203, 1989. View at Scopus
  62. J. S. Ginsberg, G. Kowalchuk, J. Hirsh, P. Brill-Edwards, and R. Burrows, “Heparin therapy during pregnancy. Risks to the fetus and mother,” Archives of Internal Medicine, vol. 149, no. 10, pp. 2233–2236, 1989. View at Scopus
  63. J. G. Hall, R. M. Pauli, and K. M. Wilson, “Maternal and fetal sequelae of anticoagulation during pregnancy,” American Journal of Medicine, vol. 68, no. 1, pp. 122–140, 1980. View at Scopus
  64. I. A. Greer and C. Nelson-Piercy, “Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy,” Blood, vol. 106, no. 2, pp. 401–407, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  65. S. M. Bates, I. A. Greer, I. Pabinger, S. Sofaer, and J. Hirsh, “Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition),” Chest, vol. 133, no. 6, supplement, pp. 844S–886S, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  66. E. Kozer, S. Nikfar, A. Costei, R. Boskovic, I. Nulman, and G. Koren, “Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis,” American Journal of Obstetrics and Gynecology, vol. 187, no. 6, pp. 1623–1630, 2002. View at Publisher · View at Google Scholar · View at Scopus
  67. A. Coomarasamy, H. Honest, S. Papaioannou, H. Gee, and K. S. Khan, “Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review,” Obstetrics and Gynecology, vol. 101, no. 6, pp. 1319–1332, 2003. View at Publisher · View at Google Scholar · View at Scopus
  68. J. H. Schiff, A. Gries, R. Ehehalt, M. Elsaesser, H. A. Katus, and F. J. Meyer, “A pregnant woman with acute myocardial infarction due to coronary artery dissection: pre-hospital and in-hospital management,” Resuscitation, vol. 73, no. 3, pp. 467–474, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  69. P. Klinzing, U. R. Markert, K. Liesaus, and G. Peiker, “Case report: successful pregnancy and delivery after myocardial infarction and essential thrombocythemia treated with clopidrogel,” Clinical and Experimental Obstetrics and Gynecology, vol. 28, no. 4, pp. 215–216, 2001. View at Scopus
  70. G. Leonhardt, C. Gaul, H. H. Nietsch, M. Buerke, and E. Schleussner, “Thrombolytic therapy in pregnancy,” Journal of Thrombosis and Thrombolysis, vol. 21, no. 3, pp. 271–276, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  71. N. Kojima, M. Naya, H. Imoto, T. Hara, T. Deguchi, and H. Takahira, “Reproduction studies of GMK-527 (rt-PA). (III) Teratogenicity study in rabbits treated intravenously with GMK-527,” Japanese Pharmacology and Therapeutics, vol. 16, no. 5, pp. 107–123, 1988. View at Scopus
  72. E. Tanaka, F. Mizuno, T. Ohtsuka et al., “Reproduction studies of GMK-527 (rt-PA). (II) Teratogenicity study in rats treated intravenously with GMK-527,” Japanese Pharmacology and Therapeutics, vol. 16, no. 5, pp. 93–106, 1988. View at Scopus
  73. M. Dapprich and W. Boessenecker, “Fibrinolysis with alteplase in a pregnant woman with stroke,” Cerebrovascular Diseases, vol. 13, no. 4, p. 290, 2002. View at Publisher · View at Google Scholar · View at Scopus
  74. K. Elford, A. Leader, R. Wee, and P. K. Stys, “Stroke in ovarian hyperstimulation syndrome in early pregnancy treated with intra-arterial rt-PA,” Neurology, vol. 59, no. 8, pp. 1270–1272, 2002. View at Scopus
  75. D. M. Johnson, D. C. Kramer, E. Cohen, M. Rochon, M. Rosner, and J. Weinberger, “Thrombolytic therapy for acute stroke in late pregnancy with intra-arterial recombinant tissue plasminogen activator,” Stroke, vol. 36, no. 6, pp. e53–e55, 2005. View at Scopus
  76. K. M. Wiese, A. Talkad, M. Mathews, and D. Wang, “Intravenous recombinant tissue plasminogen activator in a pregnant woman with cardioembolic stroke,” Stroke, vol. 37, no. 8, pp. 2168–2169, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  77. A. Murugappan, W. M. Coplin, A. N. Al-Sadat et al., “Thrombolytic therapy of acute ischemic stroke during pregnancy,” Neurology, vol. 66, no. 5, pp. 768–770, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  78. J. C. Méndez, J. Masjuán, N. García, and M. De Leciñana, “Successful intra-arterial thrombolysis for acute ischemic stroke in the immediate postpartum period: case report,” CardioVascular and Interventional Radiology, vol. 31, no. 1, pp. 193–195, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  79. O. M. Rønning, A. Dahl, S. J. Bakke, A. I. Hussain, and E. Deilkås, “Stroke in the puerperium treated with intra-arterial rt-PA,” Journal of Neurology, Neurosurgery and Psychiatry, vol. 81, no. 5, pp. 585–586, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  80. C. Lamy, J. B. Hamon, J. Coste, and J. L. Mas, “Ischemic stroke in young women: risk of recurrence during subsequent pregnancies,” Neurology, vol. 55, no. 2, pp. 269–274, 2000. View at Scopus
  81. K. H. Coppage, A. C. Hinton, J. Moldenhauer, O. Kovilam, J. R. Barton, and B. M. Sibai, “Maternal and perinatal outcome in women with a history of stroke,” American Journal of Obstetrics and Gynecology, vol. 190, no. 5, pp. 1331–1334, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus