Ischemic cerebrovascular complications of pregnancy
D. O. Wiebers
Pregnancy increases the risk of focal ischemic cerebrovascular events,
apparently to about 13 times the expected rate outside of pregnancy in the
case of cerebral infarction. The distribution of the underlying
pathophysiologic mechanisms causing the cerebrovascular symptoms in
pregnant patients differs considerably from the distribution in the general
population. Although most focal ischemic lesions that occur during
pregnancy seem to be the result of arterial occlusion, cerebral venous
thrombosis is still a prominent factor in causing such lesions. Arterial
occlusions tend to occur during the second and third trimesters of
pregnancy and during the first week after delivery, whereas the venous
occlusions tend to occur one to four weeks after childbirth. When possible,
treatment of patients with focal ischemic neurologic symptoms is based on a
precise definition of the underlying pathophysiologic mechanism and its
appropriate treatment. When this is not possible, patients are treated
according to categorization based on the temporal profile of the focal
deficit.
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