CEREBRAL VASCULAR DISEASE IN PREGNANCY 2—OCCLUSION

Abstract

Summary A report on 18 patients with occlusive lesions completes a study of 70 cases of cerebral vascular disease associated with pregnancy and the puerperium. Cortical venous thrombosis has traditionally been accepted as the chief cause of strokes during pregnancy but full neurological investigation demonstrates a high proportion of arterial lesions. In the present series there were 9 cases of arterial occlusion; 6 presenting during pregnancy and 3 in the puerperium. The nine cases of cortical venous thrombosis all occurred in the puerperium. The presentation, clinical course and outcome differed markedly between patients with arterial and venous lesions but it would be erroneous to rely on clinical features alone to distinguish them. Cerebral vascular occlusions may be confused with haemorrhagic lesions, intracranial infection, idiopathic epilepsy and psychosis. The occurrence of a sudden fit in the puerperium may lead to the mistaken diagnosis of postpartum eclampsia although this did not arise here. Active treatment by operation or with anticoagulants was carried out in half the cases; the other patients being treated symptomatically. The nature and extent of the pathological process appeared to be more significant in determining the outcome than the method of treatment employed. Venous lesions carried a higher initial mortality than arterial occlusions but recovery amongst the patients who survived was more rapid and complete than that following arterial strokes. The method of management of a stroke occurring during pregnancy should be selected chiefly on neurosurgical grounds and the obstetric requirements considered secondarily.