Abstract Details

Title Clinical and Radiological Features of Intracerebral Hemorrhage in Pregnant and Postpartum Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-007

Objective

To characterize intracerebral hemorrhage (ICH) in pregnant and postpartum patients.

Background ICH is a leading cause of maternal morbidity and mortality. Detailed data are limited regarding clinical and radiological features of ICH in pregnancy and postpartum.

Design/Methods We retrospectively reviewed medical records and brain imaging from pregnant or postpartum patients admitted to the neurological intensive care unit at one center with ICH between 1/01/2012 and 12/31/2021. We described clinical characteristics and ICH radiological features including presence of a culprit vascular lesion, and deep or lobar location in those patients without vascular lesions.

Results

A total of 23 patients were identified (median age 34 years, IQR 8), of whom 11 (48%) were pregnant and 12 (52%) were postpartum. Among pregnant patients, 3 (25%) ICH occurred in the 1^st trimester, 6 (50%) in the 2^nd, and 3 (25%) in the 3^rd, with median gestational age of 22 weeks at time of the index event. Among postpartum patients, 58% of events occurred within 1 week after delivery. Radiological features were as follows: 6 (26%) had a culprit vascular lesion identified (5 AVM, 1 aneurysm), and 1 (4%) had hemorrhagic venous infarction. Of the 16 primary ICH, 11 (69%) were lobar (frontal, parietal or occipital); 3 (19%) were deep (cerebellar, brainstem, thalamus or basal ganglia), and 2 (13%) had both lobar and deep hemorrhage. Among patients with primary ICH, none had pre-existing hypertension, 4 (25%) had pre-pregnancy obesity, 1 (6%) had pre-gestational diabetes, and 5 (31%) had preeclampsia/eclampsia. Among patients with preeclampsia/eclampsia, 3 had lobar hemorrhages and 2 had deep hemorrhages.

Conclusions

Among pregnant or postpartum patients admitted to an academic medical center with ICH, the majority (70%) had no culprit vascular lesion. These hemorrhages were predominantly lobar and occurred in patients with and without preeclampsia/eclampsia, suggesting an underlying pregnancy-related small vessel vasculopathy.

Authors/Disclosures
Mehriban Sariyeva (Columbia University Irving Medical Center) PRESENTER	Mrs. Sariyeva has nothing to disclose.
Noora C. Haghighi, MS	Miss Haghighi has nothing to disclose.
	No disclosure on file
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.
Randolph S. Marshall, MD, FAAN (Columbia University)	The institution of Dr. Marshall has received research support from NIH. Dr. Marshall has received publishing royalties from a publication relating to health care.
Eliza C. Miller, MD (University of Pittsburgh)	Dr. Miller has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for medical malpractice cases. The institution of Dr. Miller has received research support from National Institutes of Health. Dr. Miller has a non-compensated relationship as a member of ASA Advisory Council with American Heart Association/American Stroke Association that is relevant to AAN interests or activities.

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