Beyond the womb: pontine hemorrhage's impact on maternal and fetal outcomes: a case report from Nepal

Strokes cause 37% of cardiovascular-related deaths in women, with 40% during delivery and 50% postpartum. Pontine hemorrhage, a rare cerebrovascular disease, can occur during pregnancy and postpartum, requiring complex diagnosis and management. A 33-year-old primipara female presented with headache, vomiting, and altered consciousness at 15 weeks and 5 days gestation. She had no history of head trauma, involuntary urine passage, cough, shortness of breath, palpitation, or per vaginal bleeding. Psychiatric and neurology consultations were conducted to address her symptoms. Pontine hemorrhage is a rare condition affecting pregnant women, causing mild symptoms like vertigo, ataxia, and dysphagia. Our patient underwent an initial blood investigation with imaging of her brain (CT and MRI) to establish the diagnosis of pontine hemorrhage. It is believed to be caused by hormonal fluctuations, but studies have not proven it. Stroke during pregnancy is rare, with only 10% occurring during the antepartum period. Diagnosis requires a multidisciplinary approach with history, clinical examination, and radiological imaging like CT and MRI. Treatment involved antiplatelet therapy, which ensured favorable maternal and fetal outcomes for our patient. In summary, this case demonstrates the rare incidence of pontine hemorrhage during pregnancy. It highlights the diagnostic challenges and successful treatment with antiplatelet therapy, emphasizing the necessity for a comprehensive approach to ensure favorable maternal and fetal outcomes.