Neuroradiological pattern of peripartum cerebro vascular disease medicating transfer to determine care unit

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Published Mar 30, 2012
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Vol. 90 No. 3 (2012): Issue Mar 2012

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Rim Lakhdar
Nader Baffoun
Nadia Hammami
Sonia Nagi
Kamel Baccar
Syrine Drissi
Chokri Kaddour

Abstract

Background: Pregnancy and puerperium are considered a period of a high risk of stroke responsible in a part of the morbidity and mortality in women. Imaging is the pivotal tool to diagnostics and care.
Aim: To investigate the clinical and imaging features cerebrovascular complications during pregnancy and in post partum period.
Methods: We report a retrospective analysis of forty four patients (November 2002 - October 2010) admitted in the intensive car department of the national institute of neurology for cerebro-vascular complications during pregnancy and in post partum period.
Results: Cerebro-vascular imaging modalities included cerebral computed tomography (CCT) with and without contrast in 94% of cases, magnetic resonance imaging (MRI) in 30.6% of cases completed by venous angiography MRI in 27.2% of cases and angiography MRI of Willis polygon in 11.3% of cases and by cerebral angiography in 13.6% of cases. Posterior reversible encephalopathy syndrome (PRES) is diagnosed in 61.4 % of cases followed by meningo-cerebral haemorrhage (MCH) in 29.5% and finally cerebral venous thrombosis (CVT) and arterial ischemia in 4.5% of cases each one. The cerebro-vascular complications are revelled in 86.3 % of the cases during the postpartum and were associated with the eclampsia or preeclampsia in 90.9 % of the cases (n=40). CCT showed typical lesions of PRES in 23 patients. It confirms the presence of hematoma in the 13 patients with MCH and find hypodense lesion in one case with ischemic stroke. CCT show direct (delta sign) and indirect signs of CVT. MRI confirms the diagnostic of PRES, when done (11 of 12 cases) and show cortical sub cortical hyper signal on T2 and FLAIR and hypo signal on T1 sequences. MRI was normal in one case. It shows hemorrhagic lesion in the 2 cases of MCH, thrombosis in the cases of CVT and ischemic lesion in the cases of ischemic stroke. CCT and MRI done within 48 hours from admission were decisive for early diagnostic and for fast and adequate care.
Conclusion: Early recognition of stroke in peri partum by cerebral imaging is of paramount importance for prompt diagnosis and treatment to improve maternal morbidity and mortality.

Keywords:

Sciatica - epidural injection - corticosteroid - pain - visual analogue scale.

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