Clinical and Radiological Features of Intracerebral Hemorrhage in Pregnant and Postpartum Patients
Mehriban Sariyeva1, Noora Haghighi1, Whitney Booker2, Nils Petersen3, Randolph Marshall4, Eliza Miller1
1Columbia University Irving Medical Center, 2Columbia University Medical Center, 3Yale University, 4Columbia University
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 1st trimester, 6 (50%) in the 2nd, and 3 (25%) in the 3rd, 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.

10.1212/WNL.0000000000202955