Missed Diagnostic Opportunities Common Among Patients With Pregnancy-Associated Stroke

More than 1 in 4 pregnant or postpartum individuals with acute stroke experienced a missed diagnostic opportunity (MDO), according to a retrospective multicenter study published in Stroke. The findings highlight frequent diagnostic delays, which according to the study authors, suggest the need for improved physician education in diagnosing stroke during pregnancy and the postpartum period, especially for nonneurologists.

Investigators reviewed cases of pregnancy-associated stroke treated at 5 US comprehensive stroke centers between 2012 and 2021. The study included patients aged 18 to 50 years who were pregnant or within 1 year postpartum and had a confirmed diagnosis of arterial ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral venous thrombosis. Vascular neurologists at each site independently assessed cases using the validated Safer Stroke-Dx tool to determine whether an MDO occurred.

Key findings from the study included the following:

• Among 135 patients with pregnancy-related stroke (mean age, 32.4 years), 27% (n=37; 95% CI, 20.6% to 35.5%) experienced an MDO.
• Hemorrhagic stroke was more common among patients with vs without an MDO (59% vs 43%; P=.05).
• Presenting symptoms included focal neurologic deficits (57%), headache (53%), systemic symptoms (26%), and altered mental status (19%).
• Among patients with an MDO, 92% had ≥1 documented medical encounter in the month prior to stroke diagnosis, compared with 59% of patients without an MDO (P<.001).
• Failure to recognize stroke symptoms (84%) and omission of appropriate neuroimaging (81%) were the most frequently identified contributing factors among patients with an MDO, despite presentations judged typical of the final stroke diagnosis in 95% of MDO cases.

The authors note that many prestroke encounters occurred in obstetrics or emergency medicine settings, suggesting a need for increased stroke awareness among nonneurologists caring for pregnant and postpartum patients.

Source: Haghighi N, Bourscheid RM, Shang C, et al. Identifying Missed Diagnostic Opportunities in Maternal Stroke. Stroke. 2026;57(2):292-300. doi:10.1161/STROKEAHA.125.052995