Session Information
Session Title: AA 2022 Posters - Neurological Rehabilitation
Session Time: None. Available on demand.
Disclosures: Megan E. Wright, MSPAS, PA-C: No financial relationships or conflicts of interest
Case Diagnosis: A 24-year-old female with acute left middle cerebral artery (MCA) ischemic stroke during second trimester of pregnancy
Case Description or Program Description: The patient presented at 23 weeks gestation with sudden onset of severe headache, right-sided weakness, and left gaze preference accompanied by severe hypoxia requiring intubation in the context of recent cannabis use and upper respiratory infection symptoms. She was found to have an acute left MCA infarct secondary to paradoxical embolism. Hospital course was complicated by ventilator-dependent respiratory failure and acute bilateral lower extremity deep vein thrombosis (DVT). Continuous fetal monitoring was recommended starting at 25 weeks gestation. Physical medicine & rehabilitation (PM&R) was consulted to provide input on this patient’s complex rehabilitation needs in the setting of pregnancy. Acute inpatient rehabilitation was recommended, not only for functional deficits related to hemiplegia, expressive aphasia, and dysphagia, but also for closer medical monitoring in terms of high-risk pregnancy.
Setting: Urban academic medical center/comprehensive stroke center and standalone inpatient rehabilitation facility (IRF) within the same health system
Assessment/Results: Pregnancy beyond 22 weeks gestation was historically considered an exclusion criterion for admission to the health system’s IRF. However, PM&R facilitated an interdepartmental discussion, including Neurology and Maternal Fetal Medicine (MFM), ultimately reaching consensus among all providers that the patient could proceed with transfer to IRF with ongoing support from MFM. She underwent a comprehensive course of inpatient rehabilitation and was discharged home at a supervision level for ambulation and basic self-care activities. She had an uncomplicated spontaneous vaginal delivery at 39 weeks.
Discussion (relevance): This case exposed a significant gap in rehabilitation science and policy – specifically, the lack of admission and care standards for rehabilitating patients with pregnancy-related stroke.
Conclusions: Pregnancy should not be an exclusion criterion for admission to IRF.
Level of Evidence: Level IV
To cite this abstract in AMA style:
Wright ME, Gourab K, Braun RG, Lai TD, Kehs GJ. Acute Inpatient Rehabilitation Following Stroke During Later Stages of Pregnancy: A Case Report [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/acute-inpatient-rehabilitation-following-stroke-during-later-stages-of-pregnancy-a-case-report/. Accessed May 11, 2025.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-inpatient-rehabilitation-following-stroke-during-later-stages-of-pregnancy-a-case-report/