Abstract
Cerebrovascular disease (CVD) is a neurological medical emergency and one of the main causes of death worldwide; it is classified as ischemic or hemorrhagic. The disease is one of the most severe clinical events related to pregnancy due to thrombogenesis and thrombophilia; there is an incidence of 25 to 34 CVD per 100 thousand births. The current research reports two cases of stroke episode, one previous and another during pregnancy, as well as their associated complications. The first patient had hereditary thrombophilia caused by PAI 4G/5G polymorphism and previous stroke; however, she had regular pregnancy. The second patient had hereditary thrombophilia caused by protein C deficit, had a stroke during pregnancy, and preeclampsia in the first gestational semester; therefore, she was subjected to the cesarean section on the 35th week of pregnancy. Stroke episodes during pregnancy can be very aggressive because it can lead to death or disabilities, not only in the mother but also in the fetus. Based on the association between thrombotic processes and complications, prophylactic anticoagulant therapy is recommended for women with thrombophilia who had a stroke and/or certain adverse pregnancy outcomes, such as recurrent miscarriages.
Highlights
Cerebrovascular disease (CVD) is a neurological medical emergency and one of the main causes of death worldwide; it is classified as ischemic or hemorrhagic. It is one of the most severe clinical events related to pregnancy, since it leads to maternal death rates close to 20% and incidence from 25 to 34 CVDs per 100 thousand births [1]
Hemorrhagic stroke can manifest itself as subarachnoid hemorrhage due to blood leakage commonly related to the rupture of an intracranial aneurysm or to intraparenchymal hemorrhage
A recent investigation has shown that the protein C deficit is the cause of thromboembolic events, and this outcome corroborates the hypothetical diagnostic of thrombophilia
Summary
Cerebrovascular disease (CVD) is a neurological medical emergency and one of the main causes of death worldwide; it is classified as ischemic (the most common type) or hemorrhagic. Hereditary (protein C S deficit, or antithrombin; plasminogen activator inhibitor - PAI, Factor V Leiden mutation – FVL, and mutation in the prothrombin gene) or acquired (antiphospholipid syndrome) changes in coagulation, which lead, to a prothrombotic state, are the causes of thrombophilia Such a state predisposes patients to venous or arterial thrombosis; both risk factors are mostly associated with stroke development [5,6,7]. NMRI identified thrombosis in the left internal cerebral vein (vein of Galen); she had to stay in the ICU (Intensive Care Unit) for 5 days to be treated with enoxaparin sodium anticoagulant supportive measures were provided She was discharged from hospitalization after full recovery and did not present any sequelae. Fig-1: Evolution of patient's clinical data 1 according to the weeks of pregnancy
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