Two patients share their frightening story of suffering a stroke just days after having a baby for Stroke and Women’s Health Awareness Months
“I can’t believe it happened to me. I never expected that you could suffer postpartum from something as serious as a stroke. I was 33 years old when it happened,” Ann Osegura recounts. Yet, Ann and many other women suffer strokes in the weeks or months after having a baby, but few women know about this risk. All too frequently, concerning symptoms of a stroke are written off as exhaustion from taking care of the baby or postpartum hormones.
In fact, women are especially vulnerable to stroke at the end of pregnancy and during the first 12 weeks after giving birth. “Pregnancy-related stroke is one of the leading causes of disability in young women,” said Kaitlin Reilly-Kit, M.D., director of neurocritical care at the Hackensack Meridian Neuroscience Institute at Hackensack University Medical Center and assistant professor of neurology and neurosurgery at Hackensack Meridian Health School of Medicine. “During and immediately after pregnancy, a woman’s body goes through inflammatory and hormonal changes that increase the risk of blood clots. These clots can block blood flow to the brain or cause a brain hemorrhage that leads to stroke.”
A recent study estimates that at in least 30 in every 100,000 pregnancies a woman suffers a stroke.
A higher clotting risk is one cause for postpartum stroke, the other is an artery dissection or tear in the artery. “It’s a mechanical physical injury to the arterial wall that probably occurs during labor and delivery,” explains Reza Karimi, M.D., endovascular and vascular neurosurgeon at Hackensack University Medical Center. “Blood pressure spikes can cause dissections. But it can also be caused by a sports injury, trauma, even turning your head the wrong way, or straining whether that be at the gym or during labor. It is the most common cause of stroke in young people.”
Arianna Huergo’s stroke was caused by an artery dissection. At 36 years old, Arianna had a very easy pregnancy with her second daughter. She delivered her baby at another area hospital in March of 2022, and despite the typical exhaustion of having a newborn was feeling good until she woke up one morning and her entire right arm was numb. Thankfully Arianna’s husband was an EMT and recognized the symptoms of a stroke and acted fast. Arianna was brought to Hackensack Meridian Palisades Medical Center, where she was medevaced to the comprehensive stroke center at Hackensack University Medical Center, where she would have access to advanced neurosurgical techniques.
Arianna’s stroke resulted from a carotid artery dissection. “Think of the carotid artery as a multi-layered muscular tube, one of Arianna’s doctors, Kaitlin Reilly Kit, M.D., explains. “The inner part of the tube separated and that creates turbulent blood flow because it’s not going through a real nice pipe. It’s going through this bent area which increases your risk of developing a thrombus or a blood clot on that vessel. In Arianna’s case a clot formed in that area and went to the brain, cutting off the blood flow to her left middle cerebral artery. As soon as your blood clot goes to the brain and cuts off the blood flow it’s a medical emergency. You’ll start to see neurons dying within six minutes.”
Thankfully Arianna’s husband and doctors acted quickly, getting her to the hospital, transferred to Hackensack University Medical Center and into surgery for a complicated four hour surgery or to remove the clots on the brain or thrombectomy, and put in several stents to repair the carotid artery and restore blood flow to the brain.
“When Arianna arrived, we could see she had a lot of salvageable brain, if only we could reestablish blood flow,” Dr Karimi, Arianna’s endovascular neurosurgeon explains. “The problem was the only way for us to access the brain is the artery that was completely dissected. To do it, we had to get a very fine wire into the artery and gently curve it through blockage up to the brain but you can’t see where you are going because the artery is blocked and not visible on contrast scans. You just have to go on experience and feel. Thankfully we were able to get through the artery to her brain to suction the blockages, but that is only step one. Then we had to reconstruct her artery using several overlapping stents.”
Doctors believe Arianna’s artery dissection was the result of straining during labor, and Arianna agrees. “I think it’s probably the pain that I had in labor and the pushing,” Arianna said. “I held all the pain in my neck because I didn’t want to scream. I didn’t want to show that I was having pain.”
Arianna, who is multilingual, initially lost her speech from the stroke. After some rehabilitation and speech therapy, all three of the languages Arianna speaks fluently came back, allowing Arianna to return to her job as a foreign language teacher. She explains she had to relearn words in all three languages. “It’s definitely something that really helped me,” Arianna said. “I speak three languages, and the doctors said that it really helped with my brain recovery because we store languages in different parts of the brain and that really helped me to recover faster.”
Ann Osegura’s stroke was caused by the postpartum clotting risk. At 33 years old she had a healthy pregnancy. In late November 2023, she delivered her beautiful baby girl. In days after giving birth, Ann’s primary care doctor said her blood pressure seemed a little high, but wasn’t concerned. Given Ann typically has low blood pressure including while in labor, Ann felt something was wrong. She began taking her blood pressure regularly with a cuff she bought for her home. Ann then began experiencing migraines. She went to her local emergency department and was treated for what they thought at the time was postpartum preeclampsia. Ann was sent home after a day on a magnesium drip, but the migraines continued. A few days later she woke up and her entire left arm was numb. Ann went to the emergency department at Hackensack Meridian Palisades Medical Center, where it was discovered Ann was having a stroke as a result of both a blood clot and a brain bleed. Ann was immediately taken by ambulance to the comprehensive stroke center at Hackensack University Medical Center, in the event she needed surgery.
Ann suffered a cortical vein thrombosis which means that one of the veins that drains blood from her brain clotted and caused pressure to build up in a part of her brain, then bled, causing the hemorrhagic stroke. Because of other complications, she was treated with aspirin, small doses of lovenox, fluids, and observation, as some of the standard anticoagulation treatments could potentially cause further problems.
Today Ann is doing well. “I’m doing great. I’ve gained most of my function back in my left arm. In my hand, I’m just working on fine motor skills with my therapist,” Ann explained. “I’m able to care for my daughter which is the number one most important thing for me and so I’m just grateful. I’m happy that I survived this and that I can raise my daughter and take care of her.”
Both women didn’t know they were at risk for a stroke during pregnancy and in the months that followed. They feel it is important for women to be aware of this risk and monitor for symptoms and advocate for themselves. “I wish I said earlier, you guys need to check out what is going on in my head because this migraine isn’t normal,” Ann said. “It was kind of tricky because I have previously had migraines, and postpartum hormones could have also played a role.”
“When we become mothers, we tend to put ourselves last. That is what happened to me,” Arianna said. “You would never think someone young like me with no health issues would have a stroke. I was experiencing blurry vision, if I was more aware of myself I would have gone to the doctor sooner. As a mom you want to put your baby first, but if you don’t take care of yourself, who is going to take care of your babies?”
Doctors say patients need to advocate for themselves when something feels off and not dismiss symptoms as simply related to postpartum hormones. Although women with preeclampsia need to be especially careful, all women should be on the lookout for stroke symptoms during and after pregnancy — which could include nontraditional symptoms such as headaches, blurred vision and confusion.
Doctors say the risk of pregnancy related stroke is highest in the first week after delivery, but it can occur up to six months postpartum.
“The biggest driver of postpartum stroke is the risk of blood clotting in the immediate period from the time of birth until 12 weeks postpartum,” Dr. Reilly-Kit says. “We think this developed as an evolutionary response to the primary reason women die in childbirth, which is bleeding. As a result hormonally women are more at risk for clotting postpartum.”
Pregnancy-related strokes can affect anyone. However, some women are at higher risk than others, including those who:
• Have high blood pressure
• Have a history of migraines
• Smoke cigarettes
• Are overweight or obese
• Have a family history of stroke
• Have certain medical conditions, such as lupus or sickle cell disease
The symptoms of pregnancy-related stroke are similar to those of stroke in general. It’s important to know these risks as time is of the essence when it comes to treating a stroke:
• Sudden numbness or weakness on one side of the face, arm, or leg
• Sudden difficulty speaking or understanding speech
• Sudden vision problems in one or both eyes
• Sudden dizziness or loss of balance
• Sudden severe headache
The recovery from pregnancy-related stroke can vary depending on the severity of the stroke and the individual’s overall health. Some women may make a full recovery, while others may experience long-term disabilities.
There are a number of things pregnant women can do to potentially reduce their risk of pregnancy-related stroke, including:
• Maintaining a healthy weight
• Eating a healthy diet
• Exercising regularly
• Quitting smoking
• Managing high blood pressure
• Getting regular prenatal care
Interviews are available with both patients and their doctor. Photos of Arianna Huergo available here. Photos of Ann Osegura are available here.
Media Contacts:
Jessica Nussman
551-237-0984
[email protected]
SOURCE; Hackensack Meridian Health
