Puerperal hemiplegia

Abstract

Seven cases of puerperal hemiplegia were seen at the Peking Union Medical College Hospital within a period of four years. Six of the patients were Chinese women. Two cases were apparently due to cerebral hemorrhage, two to cerebral thrombophlebitis, and three to cerebral embolism.Puerperal hemiplegia from brain hemorrhage usually comes on during or shortly after labor, probably always as the result of a coexisting toxemia of pregnancy. The mechanism of the hemorrhage is best explained on the ground that the toxemias of pregnancy produce structural damage to the vessel walls which become so weakened that the elevated blood pressure and the bearing-down efforts incident to labor cause rupture.Puerperal hemiplegia from cerebral thrombosis, possibly the most common type of the condition, occurs most often in the second or third week of the puerperium. It is probably always secondary to a pelvic infection, although the latter may be so slight as to escape detection. In many instances the cerebral thrombosis is preceded by a toxemia of pregnancy and it is suggested that here, as in cerebral hemorrhage, vessel damage may play an important etiologic rôle. Certain changes in the colloidal state of the blood further augment the tendency to thrombosis in the puerperium.Puerperal hemiplegia from cerebral embolism may be due either to detached cardiac vegetations or to emboli of pelvic origin. The former probably represents a coincidence not directly related to the puerperal state. The mechanism by which detached pelvic thrombi may reach the brain through the pulmonary capillaries is obscure, but numerous necropsy studies attest its occurrence and its actuality must be conceded.Although the seven cases of this report all survived, the prognosis of puerperal hemiplegia is usually grave. Cerebral hemorrhage occurring during labor is particularly likely to prove fatal. Patients who survive the apoplectic seizure seldom escape a certain degree of permanent paralysis.