Pregnancy-related strokes in southeast Turkey

OBJECTIVE: To evaluate the presentation, timing, etiology, risk factors, mortality, and outcome of ischemic stroke (IS), intracerebral hemorrhagic stroke (ICH/HS), and cerebral venous thrombosis (CVT) occurring during pregnancy and the postpartum period in southeast Turkey.

METHODS: The study was carried out from September 2003 to September 2005 at the emergency department of Dicle University Hospital in the southeast part of Turkey. Thirty-eight stroke patients, 18-42 years of age with a diagnosis of stroke during pregnancy or within 6 weeks of delivery were included. The records were retrospectively reviewed for presentation, gestational ages, strokes subtypes and time, stroke sort, stroke place, etiology, risk factors, hospital stay, mortality, and outcome.

RESULTS: Thirty-eight patients were identified, including 18 with IS, 15 with ICH, and 5 patients with CVT. Most events (89.5%) occurred in the third trimester and the postpartum period. A definable cause was identified in 61.1% of IS and 60% of CHS. Causes of IS include pre-eclampsia or eclampsia (22.2%), hypercoagulable states (16.7%), and a diverse array of other causes, including cardio embolism (5.5%) and hypotension (16.7%). Pre-eclampsia/eclampsia (46.7%) and ruptured atriovenous malformation (6.7%) were the primary causes of ICH. The mortality rate for all patients was 34.2%.

CONCLUSION: The etiology of stroke in pregnancy and the postpartum period is diverse. Strokes are most likely to occur in the third trimester and postpartum period and cluster in the first postpartum week. Mortality is high in patients with ICH. Pre-eclampsia and eclampsia are common causes of strokes.