open access

Vol 50, No 5 (2016)
Case reports
Submitted: 2016-04-17
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Cryptogenic postpartum stroke

Dániel Bereczki, Norbert Szegedi, Zoltán Szakács, István Gubucz, Zsolt May
DOI: 10.1016/j.pjnns.2016.05.001
·
Neurol Neurochir Pol 2016;50(5):370-373.

open access

Vol 50, No 5 (2016)
Case reports
Submitted: 2016-04-17

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.

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Keywords

Cryptogenic, Patent foramen ovale, Postpartum period, Stroke, Thrombectomy

About this article
Title

Cryptogenic postpartum stroke

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 50, No 5 (2016)

Pages

370-373

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

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