Case report
Hemorrhagic stroke following elective cesarean delivery

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Abstract

We present a case of hemorrhagic stroke after cesarean delivery under combined spinal-epidural anesthesia in an 35-year-old Hispanic patient treated with anticoagulants for protein C deficiency. She required vasopressor therapy for intraoperative hypotension and developed severe headache immediately after administration. To our knowledge, this is the first case of stroke occurring in a pregnant woman following vasopressor therapy for spinal anesthesia-induced hypotension. Although the exact cause of her hemorrhagic stroke is uncertain, the hypertensive response that may have led to the hemorrhagic stroke occurred following administration of commonly used doses of vasopressor agents. We discuss the possible causes of stroke.

Introduction

Hemorrhagic strokes are rare during pregnancy, but may be caused by preeclampsia and rupture of cerebral vascular malformations.[1], [2] Other conditions that have been recognized as significant risk factors for pregnancy-related stroke include heart disease, smoking, non-white ethnic origin, age 35 years and older, sickle cell disease, thrombophilias, substance abuse (particularly cocaine), lupus anticoagulant, migraine headaches, anemia, and blood transfusion.3 We describe a case of hemorrhagic stroke in a parturient following elective cesarean delivery at term under regional anesthesia.

Section snippets

Case report

A 35-year-old, (G4 P0) ASA 2 Hispanic female was admitted for elective cesarean delivery at 37 weeks of gestation. She was 152 cm tall and weighed 61.4 kg (BMI 26.6 kg/m2). Three previous pregnancies had all resulted in spontaneous abortion, thought to be secondary to protein C deficiency. Her medical history was also significant for diet controlled gestational diabetes and panic disorders, which she described as anxiety attacks, with fear, palpitations and sweating. She was receiving

Discussion

Risk of stroke is greater among pregnant than among non-pregnant women. Webers et al.4 found the increase to be 13-fold. This is not surprising since oral contraceptives containing estrogen increase the risk of stroke two-fold.5 Pregnancy is also associated with elevated levels of estrogen, as well as altered hemodynamics. Thrombotic strokes are more likely in pregnancy, but pathological states such as preeclampsia may predispose to hemorrhagic stroke.

Although the exact cause of this patient’s

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