Yoshida Kazumichi, Takahashi Jun C, Takenobu Yohei, Suzuki Norihiro, Ogawa Akira, Miyamoto Susumu
From the Stroke and Pregnancy Survey Committee of the Japan Stroke Society, Tokyo, Japan; Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (K.Y., Y.T., S.M.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan (J.C.T.); Department of Neurology, Keio University School of Medicine, Tokyo, Japan (N.S.); and Department of Neurosurgery, School of Medicine, Iwate Medical University, Japan (A.O.).
Stroke. 2017 Feb;48(2):276-282. doi: 10.1161/STROKEAHA.116.014406. Epub 2016 Dec 27.
The incidence and cause of strokes associated with pregnancy and the puerperium are still not fully understood. The aim of this study was to characterize pregnancy-related strokes in Japan using a large-scale survey with current imaging techniques.
A retrospective analysis was conducted based on clinical chart reviews in 736 stroke teaching hospitals certified by the Japan Stroke Society between 2012 and 2013, using a web-based questionnaire requesting the detailed clinical course without any personally identifying information. The collection rate of this questionnaire was 70.5%, with 151 pregnancy-associated strokes extracted.
Hemorrhagic strokes were observed in 111 cases (73.5%), ischemic strokes in 37 (24.5%), and mixed type in 3 cases (2.0%). The estimated incidence of pregnancy-associated stroke was 10.2 per 100 000 deliveries. Major causes of hemorrhage were aneurysm (19.8%), arteriovenous malformation (17.1%), pregnancy-induced hypertension (11.7%), and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) (8.1%). Preexisting cerebrovascular diseases responsible for hemorrhage were detected in 59 cases (53.1%). Among the ischemic strokes, 28 (75.7%) were arterial and 9 (24.3%) were venous infarctions. The most frequent cause of arterial infarctions was reversible cerebral vasoconstriction syndrome. Hemorrhagic stroke showed much poorer prognosis than ischemic stroke.
The incidence of pregnancy-associated stroke in Japan did not seem higher than that in other Asian and Western countries. The proportion of hemorrhagic stroke among Japanese women was much higher than that in white women. Preexisting cerebrovascular diseases and reversible cerebral vasoconstriction syndrome play a key role in hemorrhagic and ischemic stroke, respectively.
与妊娠和产褥期相关的中风的发病率及病因仍未完全明确。本研究旨在利用当前的成像技术，通过大规模调查对日本与妊娠相关的中风进行特征描述。
基于对2012年至2013年间日本中风学会认证的736家中风教学医院的临床病历回顾进行回顾性分析，使用基于网络的问卷，要求提供详细的临床病程，且不包含任何个人身份识别信息。该问卷的回收率为70.5%，共提取出151例与妊娠相关的中风病例。
观察到111例（73.5%）为出血性中风，37例（24.5%）为缺血性中风，3例（2.0%）为混合型中风。妊娠相关中风的估计发病率为每10万例分娩中有10.2例。出血的主要原因是动脉瘤（19.8%）、动静脉畸形（17.1%）、妊娠高血压（11.7%）和HELLP综合征（溶血、肝酶升高和血小板计数降低）（8.1%）。59例（53.1%）检测到存在导致出血的既往脑血管疾病。在缺血性中风中，28例（75.7%）为动脉梗死，9例（24.3%）为静脉梗死。动脉梗死最常见的原因是可逆性脑血管收缩综合征。出血性中风的预后明显比缺血性中风差。
日本妊娠相关中风的发病率似乎并不高于其他亚洲和西方国家。日本女性中出血性中风的比例远高于白人女性。既往脑血管疾病和可逆性脑血管收缩综合征分别在出血性和缺血性中风中起关键作用。
