ABSTRACT
INTRODUCTION Stroke is a relatively rare complication of pregnancy and the puerperium. However, it is potentially devastating due to the associated death and disability and it therefore represents a significant disease in this setting. Stroke is defined clinically by the World Health Organisation as rapidly developing clinical signs of focal (and sometimes global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin (1). This encompasses a heterogeneity of underlying pathophysiologic mechanisms, but is largely subdivided into ischaemic and haemorrhagic. Ischaemic strokes are further subdivided into thrombotic or embolic, while haemorrhagic strokes are further subdivided into subarachnoid haemorrhage (SAH) or intracerebral haemorrhage (ICH). This classification, however, does not fully take into account entities, which, while not as common, still fall under the umbrella of stroke and which take on particular importance in pregnancy. These include cerebral venous sinus thrombosis (CVST), cerebrovascular events related to pre-eclampsia and eclampsia and reversible vasospastic angiopathy. This chapter addresses the epidemiology of stroke in pregnancy, causes of ischaemic and haemorrhagic stroke and management in specific situations, before discussing general treatment considerations.
