A series of seven cases with hemorrhagic stroke during pregnancy and puerperium

Abstract

We reviewed 7 patients with intracranial hemorrhage who were admitted pre- and postpartum to our hospital. The mean age was 31.0 years old (range 24 to 38 years old). Intracerebral hemorrhage occurred in 5 patients, including 2 cases caused by ruptured arteriovenous malformation and 1 by Moyamoya disease. Two patients suffered subarachnoid hemorrhage. Four patients developed hemorrhage in their third trimester and 2 within one week after delivery. Only 1 was known to have had pregnancy-induced hypertension. Two patients suddenly suffered hemorrhage during their hospital stay for delivery, including 1 case diagnosed with subarachnoid hemorrhage more than 10 hours after onset because the condition was not serious. Four of 5 patients developed hemorrhage at home and were admitted within 3 hours after onset. Three patients were treated conservatively and 4 were treated surgically: 2 with hematoma removal, 1 with aneurysm clipping, and 1 with external ventricular drainage. Overall outcomes were good except for 1 patient with severe consciousness disturbance at admission. Prompt diagnosis and treatment are required to improve the clinical outcome of patients with intracranial hemorrhage during pregnancy and puerperium, even in patients with mild symptoms. This will require refinement of the emergency system for these cases.