Case reportHemorrhagic stroke following elective cesarean delivery
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
References (21)
- et al.
Hemorrhagic stroke after spinal anesthesia and minor surgery
J Clin Anesth
(2004) - et al.
Current updates in perioperative management of intracerebral hemorrhage
Neurol Clin
(2006) - et al.
Stroke and pregnancy
Stroke
(2000) - et al.
Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium
Review article Neurosurgery
(1990) - et al.
Incidence and risk factors for stroke in pregnancy and the puerperium
Obstet Gynecol
(2005) - et al.
The incidence of stroke among pregnant women in Rochester, Minn, 1955 through 1979
JAMA
(1985) - et al.
Risk of arterial thrombosis in relation to oral contraceptives (RATIO) study: oral contraceptives and the risk of ischemic stroke
Stroke
(2002) - et al.
Intracerebral hemorrhage and vasculitis related to ephedrine abuse
Ann Neurol
(1983) - et al.
Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids
N Engl J Med
(2000) - et al.
Stroke associated with ephedrine use
Neurology
(1993)
Cited by (8)
Intracerebral hemorrhage associated with oral phenylephrine use: A case report and review of the literature
2014, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Our case had angiographic evidence of RCVS further supporting the etiology of her ICH from PHE-induced RCVS. Phenylephrine (Fig 3) has similar pharmacologic characteristics and side effects to other adrenaline-like sympathomimetics4 and prior published case reports1,12-17 and animal studies18,19 suggest a relationship between administration—intravenous, intranasal, and topical—and occurrence of stroke. We performed a review of the literature to identify cases of stroke attributed to PHE use.
Haemodynamic effects of glycopyrrolate pre-treatment before phenylephrine infusion during spinal anaesthesia for caesarean delivery
2013, International Journal of Obstetric AnesthesiaCitation Excerpt :However, bolus administration of glycopyrrolate given in response to maternal bradycardia induced by phenylephrine have produced precipitous increases in BP and been associated with headache and other maternal symptoms.18 At worst, uncontrolled intraoperative hypertension can result in haemorrhagic stroke.19 In addition, the increased HR associated with anticholinergic administration may increase cardiac work and myocardial oxygen consumption,20 which may be detrimental in patients with cardiac disease.
Cerebral haemorrhage during caesarean section
2010, Revista Cientifica de la Sociedad Espanola de Enfermeria NeurologicaRecent advances and perspectives of postoperative neurological disorders in the elderly surgical patients
2022, CNS Neuroscience and TherapeuticsProtein c and s deficiencies
2018, Consults in Obstetric Anesthesiology