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Neurochirurgie
Vol 46, N° 2  - mai 2000
p. 105
Doi : JNG-05-2000-46-2-0028-3770-101019-ART97
Table ronde Neurochirurgie et grossesse

Thromboses vasculaires cérébrales au cours de la grossesse et du post-partum
 

P. François [1], M. Fabre [2], E. Lioret [1], M. Jan [1]
[1] Service de Neurochirurgie, CHU, 37044 Tours Cedex 01.
[2] Service d'Anesthésie-Réanimation, CHU, 37044 Tours Cedex 01.

Abstract
Vascular cerebral thrombosis during pregnancy and post-partum.

Pregnancy and puerperium are associated with a number of cerebrovascular conditions that may result in stroke. Those include cerebral venous thrombosis and cerebral arteries occlusions. Comparing stroke rates during pregnancy with those of non-pregnant women showed only a marginal excess risk during pregnancy and puerperium.

Strokes due to cerebral venous thrombosis represent 10-20 per 100 000 deliveries in western countries. The cause of intracranial venous thrombosis is usually unknown. However, better understanding of abnormalities in coagulation leading to intravascular clotting in the early puerperium is resulting in better understanding of this disease. Nevertheless, an etiological work up should be performed, particularly when the thrombosis occurs during pregnancy. Its clinical manifestations often include focal neurological signs, seizures and headache. Alterations in consciousness occur as intracranial pressure increases.

Arterial occlusions account for about 60 % to 80 % of cerebral ischemic lesions. A probable cause of ischemic stroke is diagnosed on the basis of clinical, biological and radiological data. Eclampsia is the main cause of nonhemorrhagic stroke. A search for rare causes of stroke linked to pregnancy such as post-partum cardiomyopathy, paradoxical embolism, choriocarcinoma, cardiac and hematological disorders may be appropriate.

Abstract

La grossesse et le post-partum s'accompagnent de modifications cérébro-vasculaires qui prédisposeraient à la survenue d'accidents cérébraux ischémiques par thrombose artérielle ou veineuse. Cependant, hormis certaines situations pathologiques spécifiques à la grossesse, l'accouchement et le post-partum modifient peu l'incidence de ces événéments.

L'incidence des accidents vasculaires cérébraux secondaires aux thromboses veineuses cérébrales représente dans les pays occidentaux 10 à 20 accouchements sur 100 000. La symptomatologie clinique associe des signes focaux déficitaires, des crises d'épilepsie et des céphalées, alors que les troubles de la conscience apparaissent lorsqu'il existe une hypertension intracrânienne. Le bilan étiologique est souvent négatif. Néanmoins, une meilleure connaissance des modifications de la coagulation au cours de la grossesse et du post-partum aboutiront à une meilleure compréhension de la physiopathologie des thromboses veineuses cérébrales. Les investigations complémentaires sont indispensables à la recherche d'une étiologie, notamment lorsque ces thromboses veineuses cérébrales surviennent pendant la grossesse.

Les thromboses artérielles représentent 60 à 80 % des accidents vasculaires cérébraux ischémiques. Les données cliniques, biologiques, et radiologiques orientent le diagnostic étiologique. L'éclampsie représente la principale cause d'accident vasculaire cérébral ischémique. Le bilan étiologique doit chercher d'autres causes propres à la grossesse telles que la cardiomyopathie du post-partum, les embolies paradoxales, le choriocarcinome, ou encore des pathologies cardiaques ou hématologiques.

Keywords: pregnancy. , post-partum. , brain. , thrombosis. , embolism. , anticoagulants.






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