Pregnancy and puerperium related strokes in Asian women

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Khan, Maria; Wasay, Mohammad; Menon, Bindu; Saadatnia, Mohammad; Kaul, Subhash
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Background: Despite an increased risk of stroke in pregnancy and puerpurium, the overall incidence of the condition in this population is low. Therefore, there is limited data pertaining to these patients particularly from Asian countries. Our objective was to describe the risk factors and outcomes of 110 pregnancy related ischemic strokes from four Asian countries.Methods: Data was collected by retrospective chart review in most cases, and prospectively in the rest. Inclusion criteria for this sub-analysis was women aged 15-45 years, pregnant or within one month post partum, presenting to the study center with acute ischemic stroke (arterial or venous) confirmed by neuro-imaging. Intracranial hemorrhage other than the ones associated with cerebral venous thrombosis or hemorrhagic infarct were excluded. Risk factors were diagnosed based on already published criteria. Outcomes were measured using modified Rankin score. Statistical analysis was done using SPSS version 19.Results: 110 women with mean age of 27.94 years presented with pregnancy related ischemic strokes. 58.2% of the strokes occurred post partum and 49.1% were secondary to cerebral venous thrombosis. Venous strokes were significantly more likely to occur post partum compared to arterial strokes (p=0.01), to have underlying hypercoagulable state (p<0.001), less likely to have traditional stroke risk factors (p<0.001), to have hemorrhagic conversion of stroke (p<0.001), and to have lesser stroke severity and better functional outcome at 3 months (p<0.001 for each).Conclusion: Cerebral venous thrombosis is a significant contributor to pregnancy related strokes in Asian women. Both traditional and pregnancy specific risk factors should be addressed to control ischemic stroke risk in these women.