Table 1.2.

Mechanisms of arterial ischemic stroke in pregnancy

Mechanism	Presentation	Risk factors
Cardiogenic embolism	Acute onset focal deficit determined by vessel distribution, more likely to have cortical signs (e.g., aphasia, neglect) More frequently associated with altered mental status given involvement of cortical structures	Cardiac arrhythmia (e.g., atrial fibrillation) Mechanical heart valves Reduced ejection fraction Cardiac thrombus or vegetation Congenital heart disease
Paradoxical embolism	Similar to cardiogenic embolism	Patent foramen ovale Pulmonary shunt (may be associated with hereditary hemorrhagic telangiectasia syndrome)
Artery-to-artery embolism	Acute onset focal deficit determined by vessel distribution, more likely to have cortical signs (e.g., aphasia, neglect) Limited to single artery territory	Hypertension Hyperlipidemia Diabetes Tobacco use Prior head and neck radiation (radiation vasculopathy)
Cerebral small vessel disease	Acute onset Less frequently associated with altered mental status	Hypertension Hyperlipidemia Diabetes Tobacco use
Cervical artery dissection (carotid or vertebral)	Similar to artery-to-artery embolism Often associated with neck pain or headache	Atherosclerosis Hypercholesterolemia Prior head and neck radiation (radiation vasculopathy) Connective tissue abnormalities: Ehlers-Danlos syndrome IV (EDS IV) Marfan syndrome   Osteogenesis imperfecta type I Fibromuscular dysplasia Head or neck trauma – Victim of domestic violence – Chiropractic manipulation – Motor vehicle accident
Reversible cerebral vasoconstriction syndrome (RCVS)	Recurrent, sudden onset, severe thunderclap headache Transient acute onset focal deficits that may resolve within minutes or hours Persistent acute onset focal deficits if infarction occurs Seizure may be initial symptom	Migraines Hypertension Exposure to serotonergic and adrenergic drugs Postpartum state