Cerebrovascular Disorders Complicating Pregnancy

Purpose of Review This article discusses the physiologic changes of pregnancy and how they affect risk of ischemic and hemorrhagic stroke and then reviews epidemiology, diagnosis, and treatment of ischemic and hemorrhagic stroke in pregnancy and the puerperium.

Recent Findings This article updates our understanding of the relationship of preeclampsia/eclampsia to the posterior reversible encephalopathy syndrome and the reversible cerebral vasoconstriction syndrome, emphasizing their shared pathogenesis. It reviews the most recent data and offers recommendations concerning the use of thrombolytic and other revascularization therapies for pregnancy-related strokes.

Summary Although cerebrovascular complications are uncommon occurrences during pregnancy and the puerperium, stroke is still the most common seriously disabling complication of pregnancy. Therefore, stroke and other vascular issues raise questions about the best evaluation and management that is safe for mother and child.

Address correspondence to Dr Steven K. Feske, Neurology Department, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, [email protected].

Relationship Disclosure: Dr Feske has received royalties from Elsevier for his role as editor of Office Practice of Neurology, 2nd Edition, and receives research support from the National Institute of Neurological Disorders and Stroke. Dr Singhal has served as a consultant for Biogen Idec and as a medical expert witness in cases of stroke. Dr Singhal’s spouse holds stock or stock options greater than 5% of the company or greater than $10,000 in value in Biogen Idec and Vertex Pharmaceuticals Incorporated. Dr Singhal has received research support from the National Institute of Neurological Disorders and Stroke, and his institution has received research support from Pfizer Inc and PhotoThera, Inc, for clinical trial participation.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Feske and Singhal report no disclosures.