J Neurol Neurosurg Psychiatry 81:585-586 doi:10.1136/jnnp.2009.186965
  • PostScript

Stroke in the puerperium treated with intra-arterial rt-PA

  1. Ellen Deilkås1
  1. 1Department of Neurology, Akershus University Hospital, Lørenskog, Norway
  2. 2Department of Neurology, The National Hospital, Oslo, Norway
  3. 3Department of Radiology, The National Hospital, Oslo, Norway
  4. 4Department of Medicine, Akershus University Hospital, Lørenskog, Norway
  1. Correspondence to Professor Ole Morten Rønning, Department of Neurology, Akershus University Hospital, Lørenskog 1478, Norway; omro{at}
  • Received 23 June 2009
  • Revised 22 July 2009
  • Accepted 23 July 2009

Pregnancy and the puerperium are prothrombotic states. Stroke is rare in pregnancy and the puerperium but is the cause of death in 12% of all maternal deaths.1

Pregnancy-related strokes occur late in pregnancy or in the postpartum period, with the highest risk after delivery.2 Hypercoagulopathy, venous stasis, endothelial injury, postpartum angiopathy, cerebral aneurysms, paradox embolism and cerebral venous thrombosis are all known possible aetiologies of pregnancy-associated stroke. One rare cause of acute ischaemic stroke in young women is cardiac thromboembolism caused by peripartum cardiomyopathy (PPCM). Cardiomyopathy is a known cause of cardioembolic stroke. PPCM is a cardiomyopathy that presents in the peripartum period in patients without a known pre-existing heart disease. The diagnosis is based on exclusion of other possible causes of cardiomyopathy. PPCM presents most often within the last months of pregnancy and the first 6 months after.

Pregnancy and the first 4 weeks after delivery are considered exclusion criteria for thrombolysis following acute stroke. More …