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Cryptogenic postpartum stroke
Affiliations- Department of Neurology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
- Department of Neurointervention, National Institute of Clinical Neurosciences, Budapest, Hungary
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Abstract
An estimated 25–40% of ischemic strokes are classified as cryptogenic, which means the cause of the cerebral infarction remains unidentified. One of the potential pathomechanisms – especially among young patients with no cardiovascular risk factors – is paradoxical embolism through a patent foramen ovale. Pregnancy, cesarean delivery and the postpartum period are associated with an increased risk of cerebrovascular events. Factors that may contribute to ischemic strokes during gestation and puerperium include classic cardiovascular risk factors, changes in hemostaseology/hemodynamics, and pregnancy-specific disorders such as pre-eclampsia, eclampsia, postpartum cerebral angiopathy or peripartum cardiomyopathy. In this case report, we present a 36-year-old thrombolysis candidate undergoing mechanical thrombectomy 3 weeks after a cesarean section due to HELLP-syndrome. After evaluation of anamnestic and diagnostic parameters, closure of the patent foramen ovale has been performed. In the absence of specific guidelines, diagnostic work-up for cryptogenic stroke should be oriented after the suspected pathomechanism based on patient history and clinical picture. As long as definite evidences emerge, management of cryptogenic stroke patients with pathogenic right-to-left shunt remains individual based on the mutual decision of the patient and the multidisciplinary medical team.
Abstract
An estimated 25–40% of ischemic strokes are classified as cryptogenic, which means the cause of the cerebral infarction remains unidentified. One of the potential pathomechanisms – especially among young patients with no cardiovascular risk factors – is paradoxical embolism through a patent foramen ovale. Pregnancy, cesarean delivery and the postpartum period are associated with an increased risk of cerebrovascular events. Factors that may contribute to ischemic strokes during gestation and puerperium include classic cardiovascular risk factors, changes in hemostaseology/hemodynamics, and pregnancy-specific disorders such as pre-eclampsia, eclampsia, postpartum cerebral angiopathy or peripartum cardiomyopathy. In this case report, we present a 36-year-old thrombolysis candidate undergoing mechanical thrombectomy 3 weeks after a cesarean section due to HELLP-syndrome. After evaluation of anamnestic and diagnostic parameters, closure of the patent foramen ovale has been performed. In the absence of specific guidelines, diagnostic work-up for cryptogenic stroke should be oriented after the suspected pathomechanism based on patient history and clinical picture. As long as definite evidences emerge, management of cryptogenic stroke patients with pathogenic right-to-left shunt remains individual based on the mutual decision of the patient and the multidisciplinary medical team.
Keywords
Cryptogenic, Patent foramen ovale, Postpartum period, Stroke, Thrombectomy
About this articleTitle
Cryptogenic postpartum stroke
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
370-373
Page views
322
Article views/downloads
682
DOI
10.1016/j.pjnns.2016.05.001
Bibliographic record
Neurol Neurochir Pol 2016;50(5):370-373.
Keywords
Cryptogenic
Patent foramen ovale
Postpartum period
Stroke
Thrombectomy
Authors
Dániel Bereczki
Norbert Szegedi
Zoltán Szakács
István Gubucz
Zsolt May
