Abstract Body: Introduction: Stroke is a leading cause of maternal morbidity and mortality, and the incidence of maternal stroke is triple that of age-matched, non-pregnant counterparts. Mechanisms of pregnancy-related stroke differ compared to those of the non-pregnant population, but few data exist regarding presenting signs and symptoms of maternal stroke, which is often missed at initial presentation. We characterized presenting signs and symptoms by stroke subtype in a large retrospective multicenter case series.
Methods: We reviewed cases of pregnant and postpartum stroke patients at 5 stroke centers. Eligible patients were between ages 18-50 years, with a confirmed diagnosis of arterial ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) or cerebral venous thrombosis (CVT) between 01/01/2012 and 12/31/2021. Presenting signs and symptoms were reviewed and aggregated into 6 categories: altered mental status (AMS), seizure, headache, focal neurological deficits, systemic symptoms, and dizziness/imbalance. We show the distribution of presenting symptoms for each stroke subtype and for all strokes.
Results: A total of 121 cases of maternal stroke were reviewed, of which 37% had AIS, 17% had SAH, 31% had ICH, and 15% had CVT. Characteristics of the study population are shown in the Table. Focal neurological deficits were the most common presenting sign/symptom, overall (59%), followed by headache (51%), systemic symptoms (26%), AMS (16%), and dizziness (16%). The distribution of symptoms varied by stroke subtype (p<0.000001; Figure): AIS had the highest proportion of focal neurological deficits (91%) whereas headache was the most common presenting symptom in all other stroke subtypes. Systemic symptoms were present in 42% of ICH cases, 33% of SAH, and 25% of CVT, compared with 11% of AIS.
Conclusions: This is the largest case series to date of maternal stroke in the United States. The characteristics of strokes in the cohort are consistent with those observed in previous studies, in which up to half of maternal strokes were hemorrhagic and most occurred postpartum. Given the high proportion of non-focal symptoms observed in non-AIS subtypes, stroke should be considered in the differential diagnosis for pregnant and postpartum women presenting acutely with headache, particularly if accompanying systemic symptoms or focal neurological deficits are present.