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Miller EC. Maternal Stroke Associated With Pregnancy. Continuum (Minneap Minn) 2022; 28:93-121. [PMID: 35133313 PMCID: PMC10101187 DOI: 10.1212/con.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article summarizes current knowledge of the epidemiology, pathophysiology, prevention, and treatment of cerebrovascular disease in pregnant and postpartum women. RECENT FINDINGS Stroke is a leading cause of maternal morbidity and mortality, and most fatal strokes are preventable. Adaptive physiologic changes of pregnancy, including hemodynamic changes, venous stasis, hypercoagulability, and immunomodulation, contribute to increased maternal stroke risk. The highest-risk time period for maternal stroke is the immediate postpartum period. Migraine and hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, are major risk factors for maternal stroke. Adverse pregnancy outcomes, including gestational hypertension, preeclampsia, preterm delivery, and fetal growth restriction, are important risk factors for cerebrovascular disease later in life. SUMMARY Many catastrophic maternal strokes could be avoided with targeted prevention efforts, early recognition of warning signs, and rapid evaluation of neurologic symptoms. Neurologists play a central role in the care of pregnant patients with cerebrovascular disease, whether acute or chronic, and should be familiar with the unique and complex physiology of pregnancy and its complications, particularly hypertensive disorders of pregnancy.
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Ruan CY, Gao BL, Pang HL, Zhang K, Zhang YH, Wei LP, Li TX, Wang ZL. Postpartum cerebral arterial dissections: Clinical features and treatment. Medicine (Baltimore) 2021; 100:e27798. [PMID: 34964745 PMCID: PMC8615341 DOI: 10.1097/md.0000000000027798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022] Open
Abstract
Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections.One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed.A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%).Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.
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Affiliation(s)
- Chun-Yun Ruan
- Luoyang Central Hospital, Zhengzhou University, China
| | - Bu-Lang Gao
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Hong-Li Pang
- Luoyang Central Hospital, Zhengzhou University, China
| | - Kun Zhang
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Yao-Hui Zhang
- Luoyang Central Hospital, Zhengzhou University, China
| | - Li-Ping Wei
- Luoyang Central Hospital, Zhengzhou University, China
| | - Tian-Xiao Li
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Zi-Liang Wang
- Henan Provincial People's Hospital, Zhengzhou University, China
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Woo HG, Ryu J, Oh CH, Lee JH, Lee JS. Postpartum reversible cerebral vasoconstriction syndrome confined to the bilateral cervical vertebral arteries. Neurol Sci 2020; 42:1603-1605. [PMID: 33099698 DOI: 10.1007/s10072-020-04845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/17/2020] [Indexed: 05/30/2023]
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea
| | - Jiwook Ryu
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea
| | - Chi Hyuk Oh
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea
| | - Jae Hong Lee
- Department of Neurology, Seosan Jungang General Hospital, Seosan, 32010, South Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea.
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Morales Vidal S, Lara C, Gordin A. Sequential Bilateral Vertebral Artery Dissections with Prompt Resolution of Initial Insult. Case Rep Neurol 2020; 12:189-198. [PMID: 32647525 PMCID: PMC7325214 DOI: 10.1159/000506766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022] Open
Abstract
Vertebral arterial dissection is a known cause of stroke in young adults. There has been a multitude of cases of bilateral vertebral dissections, including progression from one vertebral artery to another. This case reports the curious sequential nature of the healing of a previously dissected vertebral artery with subsequent dissection of the collateral vertebral artery. Follow-up neuroimaging evaluation performed several months later showed healed bilateral vertebral artery. The potential trigger was neck cracking.
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Affiliation(s)
- Sarkis Morales Vidal
- Department of Neurology, Loyola University Medical Center, Maguire Center, Maywood, Illinois, USA
| | - Carlos Lara
- Department of Neurology, Loyola University Medical Center, Maguire Center, Maywood, Illinois, USA
| | - Ari Gordin
- Department of Neurology, Loyola University Medical Center, Maguire Center, Maywood, Illinois, USA
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Mawet J, Debette S, Bousser MG, Ducros A. The Link Between Migraine, Reversible Cerebral Vasoconstriction Syndrome and Cervical Artery Dissection. Headache 2016; 56:645-56. [PMID: 27016026 DOI: 10.1111/head.12798] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Headache is the common thread of migraine, reversible cerebral vasoconstriction syndrome (RCVS) and cervical artery dissection (CeAD), three medical conditions that otherwise appear to be very different. However, epidemiological, clinical and genetic data suggest that these conditions share common and complex features and are, at least partly, linked. The purpose of this manuscript is to review existing evidence for an association between migraine, RCVS and CeAD and discuss the potential underlying mechanisms.
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Affiliation(s)
- Jérôme Mawet
- Emergency Headache Center, Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (J. Mawet)
| | - Stéphanie Debette
- Institut National de la Santé et de la Recherche Médicale (INSERM) U897 Epidemiology and Biostatistics and Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S. Debette)
| | - Marie-Germaine Bousser
- Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (M.-G. Bousser)
| | - Anne Ducros
- Department of Neurology, Montpellier University Hospital and Montpellier University, Montpellier, France (A. Ducros)
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Ducros A, Wolff V. The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers. Headache 2016; 56:657-73. [DOI: 10.1111/head.12797] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Anne Ducros
- Department of Neurology; Montpellier University Hospital, and Montpellier University; Montpellier France (A. Ducros)
| | - Valérie Wolff
- Stroke Unit, Department of Neurology; Strasbourg University Hospital; Strasbourg France (V. Wolff)
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Akazawa Y, Inaba Y, Hachiya A, Motoki N, Matsuzaki S, Minatoya K, Morisaki T, Morisaki H, Kosaki K, Kosho T, Koike K. Reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome in a boy with Loeys-Dietz syndrome. Am J Med Genet A 2015; 167A:2435-9. [DOI: 10.1002/ajmg.a.37202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/25/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Yohei Akazawa
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Yuji Inaba
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Akira Hachiya
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Noriko Motoki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Satoshi Matsuzaki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Kenji Minatoya
- Department of Vascular Surgery; National Cerebral and Cardiovascular Center; Suita Japan
| | - Takayuki Morisaki
- Department of Bioscience and Genetics; National Cerebral and Cardiovascular Center Research Institute; Suita Japan
| | - Hiroko Morisaki
- Department of Bioscience and Genetics; National Cerebral and Cardiovascular Center Research Institute; Suita Japan
| | - Kenjiro Kosaki
- Department of Pediatrics; Keio University School of Medicine; Tokyo Japan
| | - Tomoki Kosho
- Department Medical Genetics; Shinshu University School of Medicine; Matsumoto Japan
| | - Kenichi Koike
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
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Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course. AJNR Am J Neuroradiol 2015; 36:1392-9. [PMID: 25593203 DOI: 10.3174/ajnr.a4214] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reversible cerebral vasoconstriction syndrome is a clinical and radiologic syndrome that represents a common presentation of a diverse group of disorders. The syndrome is characterized by thunderclap headache and reversible vasoconstriction of cerebral arteries, which can either be spontaneous or related to an exogenous trigger. The pathophysiology of reversible cerebral vasoconstriction syndrome is unknown, though alterations in cerebral vascular tone are thought to be a key underlying mechanism. The syndrome typically follows a benign course; however, reversible cerebral vasoconstriction syndrome may result in permanent disability or death in a small minority of patients secondary to complications such as ischemic stroke or intracranial hemorrhage.
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Affiliation(s)
- T R Miller
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - R Shivashankar
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
| | - M Mossa-Basha
- Department of Diagnostic Radiology (M.M.-B.), Section of Neuroradiology, University of Washington, Seattle, Washington
| | - D Gandhi
- From the Department of Diagnostic Radiology (T.R.M., R.S., D.G.), Section of Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland
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Bien JY, Morel J, Demasles S, Abboud K, Molliex S. [Postoperative dissection of the vertebral artery in two steps]. ACTA ACUST UNITED AC 2014; 33:696-9. [PMID: 25447780 DOI: 10.1016/j.annfar.2014.07.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
The diagnosis of perioperative vertebral artery dissection can be difficult because of non-specific clinical signs. We report a case revealed by a tegmento-thalamic stroke after an abdominal second surgical look. The interest of this observation is related to a particular evolution in two steps separated by a 2-month-interval and an intercurrent cervical manipulation. After the second anesthesia, neck pain associated with a third cranial nerve palsy and a supranuclear ophtalmoplegia revealed a tegmento-thalamic ischemic stroke due to vertebral artery dissection. We discuss here the different factors possibly involved in the pathophysiology of postoperative vertebral artery dissection: positioning, cervical manipulation, subclavian central venous access and cisplatin toxicity. Vertebral artery dissection should be discussed in case of postoperative neck pain, especially with non-typical symptomatology.
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Affiliation(s)
- J-Y Bien
- Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France.
| | - J Morel
- Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
| | - S Demasles
- Service de neurologie, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
| | - K Abboud
- Service de chirurgie digestive et cancérologique, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
| | - S Molliex
- Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
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Kim JG, Choi JY, Kim SU, Jung JM, Kwon DY, Park MH, Oh K. Headache characteristics of uncomplicated intracranial vertebral artery dissection and validation of ICHD-3 beta diagnostic criteria for headache attributed to intracranial artery dissection. Cephalalgia 2014; 35:516-26. [DOI: 10.1177/0333102414547135] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/19/2014] [Indexed: 11/17/2022]
Abstract
Background and purpose Headache may be a warning sign of subsequent stroke in patients with vertebral artery dissection (VAD). Even though the headache characteristics of VAD have been described predominantly in patients with extracranial VAD and neurological complications, headache semiology is not well known in patients with uncomplicated intracranial vertebral artery dissection (ICVAD). In the present study, we attempt to identify the headache semiology that characterizes ICVAD and validate the revised version of the International Classification of Headache Disorders (ICHD-3 beta) criteria for headache attributed to intracranial artery dissection. Methods Six patients with neurologically uncomplicated ICVAD presented at a participating medical center, and eight similar patients were reviewed in the literature. Combining these data, we analyzed headache characteristics of patients with uncomplicated ICVAD according to their pain onset and duration, nature, intensity, location, aggravating and relieving factors, associated symptoms, response to medication, and prognosis. Results Headache in uncomplicated ICVAD usually has an acute mode of onset (11/14) and persistent (10/14) temporal feature. Pain that has a throbbing quality (nine of 14) and severe intensity (13/14) on the ipsilesional (10/14) and occipitonuchal area (12/14) is a headache prototype in ICVAD. Additionally, headache was intensified by head flexion and rotation (three of six), and relieved by head extension and supine positioning (five of six). Headache of all patients in the present study fulfilled the ICHD-3 beta criteria. Conclusion Headache semiology of uncomplicated ICVAD is mostly homogenous in the present study. These characteristics may be helpful in the diagnosis of uncomplicated ICVAD.
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Affiliation(s)
- Jae-Gyum Kim
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Republic of Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea
| | - Sung Un Kim
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea
| | - Moon Ho Park
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Republic of Korea
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Mehdi A, Hajj-Ali RA. Reversible Cerebral Vasoconstriction Syndrome: a Comprehensive Update. Curr Pain Headache Rep 2014; 18:443. [DOI: 10.1007/s11916-014-0443-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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