A review of stroke in pregnancy: incidence, investigations and management

AbstractKey contentThe incidence of stroke in young and middle ‐aged adults is increasing, with pregnancy‐related strokes occurring in 30 in 100 000 pregnancies; strokes are three times more common among pregnant than among nonpregnant individuals aged 15–44 years.The investigation and management of stroke is changing because of the time ‐sensitive benefits of thrombolysis and thrombectomy in the acute management of ischaemic stroke.The approach to clinical assessment and investigation of a pregnant woman presenting with suspected stroke is not different from that of a non ‐pregnant patient:; timely brain imaging and intervention is important to optimise long‐term outcome, and further investigations should be directed towards determining the aetiology and risk factors of stroke.The ‘time is brain’ approach to treatment is imperative: thrombolysis with recombinant tissue plasminogen activator (rt‐PA) administered within 4.5 hours of stroke onset significantly improves overall outcome.Mechanical thrombectomy is appropriate in only 10% of patients with acute ischaemic stroke, but has been shown to improve outcome if performed within 6 hours of onset and can be performed up to 24 hours in highly selected cases.Trials have largely excluded pregnant women, although thrombolysis can be performed to treat moderate to severe stroke in pregnancy if the benefits outweigh the risk of uterine bleeding.As recurrent strokes occur in 25 –30%...
Source: The Obstetrician and Gynaecologist - Category: OBGYN Authors: Tags: Reviews Source Type: research

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AbstractKey contentThe incidence of stroke in young and middle ‐aged adults is increasing, with pregnancy‐related strokes occurring in 30 in 100 000 pregnancies; strokes are three times more common among pregnant than among nonpregnant individuals aged 15–44 years.The investigation and management of stroke is changing because of the time ‐sensitive benefits of thrombolysis and thrombectomy in the acute management of ischaemic stroke.The approach to clinical assessment and investigation of a pregnant woman presenting with suspected stroke is not different from that of a non ‐pregnant patient:; timely...
Source: The Obstetrician and Gynaecologist - Category: OBGYN Authors: Tags: Reviews Source Type: research
Publication date: June 2019Source: Revista Portuguesa de Cardiologia (English Edition), Volume 38, Issue 6Author(s): Gonçalo J. Morgado, Inês R. Cruz, Ana Catarina Gomes, Ana Rita Almeida, Maria José Loureiro, Carlos Cotrim, Hélder PereiraAbstractA 24-year-old woman who was 11 weeks pregnant and had a mechanical mitral valve presented at the emergency department with ischemic stroke. Although treatment with aspirin and unfractionated heparin was initially successful, subsequent management was almost impossible, as she eventually suffered a right hemispheric stroke, requiring percutaneous interven...
Source: Revista Portuguesa de Cardiologia - Category: Cardiology Source Type: research
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
We present a 37-year-old female in the first trimester that developed recurrent proximal middle cerebral artery (MCA) occlusion after previous thrombolysis and underwent MT via transradial access.
Source: World Neurosurgery - Category: Neurosurgery Authors: Tags: Case Report Source Type: research
CONCLUSIONS: There is insufficient evidence to demonstrate benefit or harm of using anticoagulants with or without ASA versus ASA alone in people with aPL antibodies and a history of recurrent pregnancy loss and with no such history; ASA versus placebo in people with aPL antibodies; and ASA with LMWH versus placebo or IVIG, and ASA with high-dose LMWH versus ASA with low-dose LMWH or UFH, in women with aPL antibodies and a history of recurrent pregnancy loss, for the primary prevention of thrombotic events. In a mixed population of people with a history of previous pregnancy loss and without such a history treated with ant...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
CONCLUSIONS: There is not enough evidence for or against NOACs or for high-intensity VKA compared to the standard VKA therapy in the secondary prevention of thrombosis in people with APS. There is some evidence of harm for high-intensity VKA regarding minor and any bleeding. The evidence was also not sufficient to show benefit or harm for VKA plus antiplatelet agent or dual antiplatelet therapy compared to a single antiplatelet drug. Future studies should be adequately powered, with proper adherence to treatment, in order to evaluate the effects of anticoagulants, antiplatelets, or both, for secondary thrombosis prevention...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Authors: Hvas AM, Favaloro EJ Abstract INTRODUCTION: Many aspects of hemostasis, both primary and secondary, as well as fibrinolysis display sex differences. From a clinical viewpoint, certain differential phenotypic presentations clearly arise within various disorders of thrombosis and hemostasis. Areas Covered: The present mini-review summarizes selected clinical entities where sex differences are reflected in both frequency and clinical presentation of hemostasis disorders. Sex differences are discussed within the settings of cardiovascular disease, including coronary artery disease and ischemic stroke, venous t...
Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research
Last night ’s CNN duel between Senators Bernie Sanders and Ted Cruz on the future of Obamacare was pretty illuminating for a recent arrival to the United States, with Senator Sanders’ playbook all-too-familiar to those of us from the UK.Sanders wants a single-payer socialized healthcare system in the United States, just as we have in Britain. Any objection to that is met with the claim that you are “leaving people to die.” The only alternatives on offer, you would think, are the U.S. system as it exists now, or the UK system. Sanders did not once acknowledge that the UK structure, which is free at t...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
Time limit: 0 Quiz-summary 0 of 30 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
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