Thread by @WorldStrokeEd

#WeekendLecture
#PregnancyAndStroke

#Pregnancy and #puerperium confer an ⬆️ risk for ischemic as well as hemorrhagic stroke, with incidence rates being 3-fold higher as compared with nonpregnant women

👉doi.org/10.1016/j.ncl.…

a short 🧵

#WeekendLecture
#PregnancyAndStroke

@DrRickSwartz @patrice_lindsay et al metaanalysis
👉11 studies
👉>85 million #pregnancy and #postpartum admissions in various countries
👉overall incidence of #stroke was 30 per 100,000 hospitalizations👈
@IntJStroke

journals.sagepub.com/doi/10.1177/17…

#WeekendLecture
#PregnancyAndStroke
RFs:
☑️Age, >40yo OR3.1
☑️Race/ethnicity
☑️Migraine, thrombophilia, SLE, 🫀disease, HTN, thrombocytopenia, diabetes
☑️Pregnancy complications
✅For hemorrhagic stroke: aneurysms, AVM, Hypertensive Disorders of Pregnancy

journals.lww.com/greenjournal/F…

#WeekendLecture
#PregnancyAndStroke

It is good to know about the #timing of events during this period
Here, a nice visual approach from Dr Feske and @AneeshSinghalMD review via @ContinuumAAN

journals.lww.com/continuum/Abst…

#WeekendLecture
#PregnancyAndStroke

Pregnancy implies changes in:
-#Hemodinamics
-#Vascular and connective tissue
ahajournals.org/doi/full/10.11…

-#Coagulation system
thrombosisresearch.com/article/S0049-…

All contributing to an #increased risk of stroke

#WeekendLecture
#PregnancyAndStroke

The #types of strokes reported in various studies depend on:

☑️the #population studied
☑️the detail of stroke #evaluation
☑️the #classification system used

Be aware of “unusual” causes⤵️

#WeekendLecture
#PregnancyAndStroke
Pathologic conditions as:
-Hypertensive disorders of pregnancy (including pre/#eclampsia, HELLP
-#PRES
-#RCVS
should be revised, but are beyond the scope of this 🧵
Check it here👉pn.bmj.com/content/16/1/23

#WeekendLecture
#PregnancyAndStroke
☝️Obstetric #CVST is most commonly associated with hypertension/cesarean delivery/infection
ahajournals.org/doi/full/10.11…
☝️Risk of gestational CVST is mostly attributable to the #puerperium
ahajournals.org/doi/10.1161/ST…
Treatment of choice:UFH or #LMWH

#WeekendLecture
#PregnancyAndStroke

If a stroke is suspected neuroimaging should be obtained #expeditiously

✅NCCT, #CTA, MRI, MRA with #TOF are all safe in pregnancy

👉Iodinated contrast does not cross the #placenta, gadolinium does

thieme-connect.com/products/ejour…

#WeekendLecture
#PregnancyAndStroke
Pregnant women were excluded from rTPa RCTs
There are no clear evidence of harm or benefits
#AHA guide: administration may be considered when the anticipated benefits...outweigh the anticipated⬆️risks of uterine bleeding
doi.org/10.1016/j.ajog…

#WeekendLecture
#PregnancyAndStroke

Pregnant women were excluded from MT RCTs
But from 2016, several case report & series have demonstrated #safety and #feasibility in #ELVO, and most experts agree that should be considered

👉jnis.bmj.com/content/12/6/5…
👉strokejournal.org/article/S1052-…

#WeekendLecture
#PregnancyAndStroke
There is a lot more in this issue, and we give you selected works to start going deep in #pregnancy & #stroke

We would like to finish w/ @DrSaccoNeuro's words from his editorial in @JACCJournals when a raised incidence was noted in🇺🇸
#Thanks!