# Therapeutic management in a pregnant patient with acute ischemic stroke in the revascularization window: A case report

## TL;DR

A pregnant woman with a stroke received emergency treatment including cesarean section and mechanical thrombectomy, highlighting the importance of considering genetic and cardiac factors in young stroke patients.

## Contribution

This case report highlights the evaluation of inherited genetic thrombophilia and patent foramen ovale in young stroke patients, particularly during pregnancy.

## Key findings

- The patient had a homozygous methylenetetrahydrofolate reductase gene mutation and a heterozygous plasminogen activator inhibitor-1 gene mutation.
- A patent foramen ovale was detected with a high risk of paradoxical embolism.
- Emergency cesarean section and mechanical thrombectomy were performed within the revascularization window.

## Abstract

Pregnancy is considered a relative contraindication for thrombolysis. Moreover, mechanical thrombectomy should be considered for pregnant patients, as it would be indicated in non-pregnant patients. The present study describes the clinical case of a 29-year-old female full-term pregnant patient who presented to the emergency room with a sudden onset symptomatology characterized by pronunciation disorder and motor impairment in the right arm with numbness at the same level, and with a National Institutes of Health Stroke Scale score of 7 points. The patient presented in the revascularization window, and the series of acute medical interventions were as follows: Clinical examination, native head computed tomography (CT) scan, emergency cesarean section, CT angiography of the cerebral arteries, and, eventually, mechanical thrombectomy. A brain MRI revealed a hyperintense lesion in diffusion sequence with low apparent diffusion coefficient correspondence at the frontal level of the left side, affecting the middle and precentral gyrus. A transesophageal ultrasound revealed a small patent foramen ovale with a risk of paradoxical embolism score of 8 points. Usual thrombophilia laboratory test results were negative; however, a homozygous methylenetetrahydrofolate reductase gene mutation and a heterozygous positive plasminogen activator inhibitor-1 gene mutation were detected. On the whole, the present case report emphasizes the importance of evaluating inherited genetic thrombophilia and PFO in young patients suffering a stroke. Moreover, the need for the psychological and psychiatric evaluation for possible reactive depression, anxiety and burnout in young patients suffering a stroke, and particularly in the peripartum period, is highlighted.