Miller Eliza C, Yaghi Shadi, Boehme Amelia K, Willey Joshua Z, Elkind Mitchell S V, Marshall Randolph S
Department of Neurology (ECM, SY, AKB, JZW, MSVE, RSM), College of Physicians and Surgeons, and Department of Epidemiology (AKB, MSVE), Mailman School of Public Health, Columbia University, New York, NY.
Neurol Clin Pract. 2016 Feb;6(1):29-39. doi: 10.1212/CPJ.0000000000000214.
Pregnancy-associated stroke remains incompletely characterized because of the rarity of these potentially devastating events. We investigated whether mechanism and outcome of ischemic pathophysiology stroke differ between young pregnant and nonpregnant women.
We identified 135 consecutive women ages 18-40 years admitted to our center from January 2008 through June 2014 with ischemic stroke, TIA, cerebral venous thrombosis, or nonaneurysmal subarachnoid hemorrhage due to reversible cerebral vasoconstriction syndrome (RCVS). We reviewed charts for pregnancy status, demographics, medical comorbidities, stroke severity, etiology, and discharge outcomes.
There were 33 women with pregnancy-associated stroke (PAS) and 102 with non-pregnancy-associated stroke (NPAS). Among women with PAS, 73% of strokes occurred postpartum. In the PAS group, the most common cause of cerebrovascular events was RCVS (n = 12), 11 postpartum and 4 in women with preeclampsia. There were no significant differences between the groups in demographics. Women with PAS were less likely to have vascular risk factors such as hyperlipidemia and history of thromboembolism but more likely to have cerebral venous thromboses (21% vs 7%, = 0.02). Women with PAS were more likely to have RCVS as stroke mechanism (36% vs 1%, odds ratio 57.7, 95% confidence interval 7-468, = 0.0001).
Compared with nonpregnant women of the same age group, women with PAS had fewer vascular risk factors. Cerebral venous thrombosis and RCVS were more common in PAS, most of which occurred postpartum. These results provide further evidence for the unique pathophysiology of pregnancy-related stroke, raising important questions for future investigation.
由于这些潜在的灾难性事件较为罕见，妊娠相关卒中的特征仍未完全明确。我们调查了年轻孕妇与非孕妇缺血性病理生理卒中的机制和结局是否存在差异。
我们确定了2008年1月至2014年6月期间连续入住我们中心的135名年龄在18 - 40岁之间的女性，她们因缺血性卒中、短暂性脑缺血发作（TIA）、脑静脉血栓形成或可逆性脑血管收缩综合征（RCVS）导致的非动脉瘤性蛛网膜下腔出血入院。我们查阅了病历，了解妊娠状态、人口统计学、合并症、卒中严重程度、病因及出院结局。
有33名患有妊娠相关卒中（PAS）的女性和102名患有非妊娠相关卒中（NPAS）的女性。在患有PAS的女性中，73%的卒中发生在产后。在PAS组中，脑血管事件最常见的原因是RCVS（n = 12），11例发生在产后，4例发生在先兆子痫女性中。两组在人口统计学方面无显著差异。患有PAS的女性患高脂血症和血栓栓塞病史等血管危险因素的可能性较小，但患脑静脉血栓形成的可能性较大（21%对7%，P = 0.02）。患有PAS的女性更有可能以RCVS作为卒中机制（36%对1%，优势比57.7，95%置信区间7 - 468，P = 0.0001）。
与同年龄组的非孕妇相比，患有PAS的女性血管危险因素较少。脑静脉血栓形成和RCVS在PAS中更常见，其中大多数发生在产后。这些结果为妊娠相关卒中独特的病理生理学提供了进一步证据，为未来的研究提出了重要问题。
