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Review
. 2020:172:3-31.
doi: 10.1016/B978-0-444-64240-0.00001-5.

Ischemic stroke and cerebral venous sinus thrombosis in pregnancy

Hannah J Roeder  1 , Jean Rodriguez Lopez  1 , Eliza C Miller  2
Affiliations
Review

Ischemic stroke and cerebral venous sinus thrombosis in pregnancy

Hannah J Roeder et al. Handb Clin Neurol. 2020.

Abstract

Maternal ischemic stroke and cerebral venous sinus thrombosis (CVST) are dreaded complications of pregnancy and major contributors to maternal disability and mortality. This chapter summarizes the incidence and risk factors for maternal arterial ischemic stroke (AIS) and CVST and discusses the pathophysiology of maternal AIS and CVST. The diagnosis, treatment, and secondary preventive strategies for maternal stroke are also reviewed. Special populations at high risk of maternal stroke, including women with moyamoya disease, sickle cell disease, HIV, thrombophilia, and genetic cerebrovascular disorders, are highlighted.

Keywords: Cerebral venous sinus thrombosis; Ischemic stroke; Maternal stroke; Postpartum stroke; Pregnancy.

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Figures

Fig 1.1.
Fig 1.1.
Many changes occur in the coagulation system during pregnancy. The red arrows represent changes that predispose toward a prothrombotic state, including increases in intrinsic and extrinsic clotting factors (factors VII, VIII, IX, X, XI and XII), decreases in intrinsic anticoagulation factors (protein C and protein S), and increases in PAI-1 and PAI-2, including placental production of PAI-2. Increases in von Willebrand factor and fibrinogen also increase clotting risk during pregnancy. However, other changes, indicated by green arrows, including pregnancy-related thrombocytopenia and increases in t-PA1 later in pregnancy also occur.
See this image and copyright information in PMC

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