We retrospectively analyzed 12 cases of stroke associated with pregnancy and the puerperium. All cases were surgically treated. We thoroughly discussed outcome of mother and fetus and appropriate treatment. We gave priority to the maternal treatment, resulting in a maternal mortality rate of 8. 3% and a fetal mortality rate of 42%. Seven cases of intracranial hemorrhage due to arteriovenous malformation and moyamoya disease were surgically treated after delivery by cesarean section, with good outcome. On the other hand, outcome of the 3 cases of subarachnoid hemorrhage and cerebral infarction was poor because of the emergency surgical treatment. Management of stroke associated with pregnancy and the puerperium requires comprehensive discussion between neuro-surgeons, obstetricians and anesthesiologists, considering factors such as gestational weeks, emergency surgical indication, possibility of delivery, and social norms.
