Ischaemic stroke and pre-eclampsia in the third trimester of pregnancy: a diagnostic and therapeutic challenge

A 23-year-old low-risk primiparous patient, who was 35 weeks pregnant, presented in the emergency department after collapsing at home. Her observations showed severe hypertension with proteinuria. On examination, she had left hemiparesis and was aphasic. Fetal monitoring was reassuring. Initial CT did not reveal any evidence of intracranial pathology. She was stabilised and delivered via emergency caesarean section. Subsequent MRI and CT showed an acute right-sided infarct involving the right middle cerebral artery territory, frontal and parietal regions, and increased mass effect. She was transferred to the nearest neurosurgical centre where she was conservatively managed and discharged home 3 weeks later for continuing rehabilitation. She achieved a good recovery.