Acute Stroke Mimicking as Postpartum Depression

1Quincy Medical Center, Quincy, MA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 151

Case Presentation:

A 31‐year‐old woman with history of depression was 7 days postpartum with no peripartum complications and presented with depressed mood and aphasia. Her family reported depressed mood, decreased verbal communication, and fatigue. She also had difficulty reading and was unable to write. No focal weakness, sensory loss, facial droop, or seizure activity was noted. She was initially admitted to psychiatry for postpartum depression. Her neurological examination was remarkable for aphasia: she could not speak fluently and had reduced word output and hesitant speech. Her comprehension was intact. Cranial nerves, reflexes, strength, and cerebellar examination were normal. She had decreased breath sounds in lung bases bilaterally. Vital signs were initially normal, but she developed tachycardia and tachypnea soon after her admission. Chest x‐ray revealed bilateral pleural effusions. Head CT revealed a poorly defined hypodense region near the sylvian fissure, involving cortex and subcortical white matter, compatible with an acute infarct. She was transferred to the intensive care unit for acute stroke and started on IV heparin. An echocardiogram demonstrated left ventricular ejection fraction < 25% with mild to moderate dilatation of the left ventricle. Therapy was initiated with fosinopril, metoprolol, spironolactone, furosemide, digoxin, and warfarin. Speech therapy was initiated for her aphasia. She remained clinically stable and was discharged. Follow‐up showed that her aphasia resolved gradually but completely over a course of 2 months.

Discussion:

This is a case of acute stroke secondary to dilated cardiomyopathy presenting with depressed mood and aphasia, mimicking postpartum depression. Women have a lifetime risk of 10% to 25% of developing postpartum depression. Peripartum cardiomyopathy is a rare cause of heart failure in women, with an incidence of 1:15,000 deliveries in the United States. It affects women late in pregnancy or in the early puerperium. These patients have a high risk for thromboembolic phenomena due to both the hypercoagulable state of pregnancy and stasis of blood in the left ventricle secondary to severe left ventricular dysfunction.

Conclusions:

Hospitalists can come across such patients, and this case illustrates the importance of considering alternate clinical diagnosis and additional workup in patients presenting with symptoms of postpartum depression. Acute stroke secondary to dilated cardiomyopathy should be kept in the differential of postpartum depression.

Author Disclosure:

H. Hora, none.

To cite this abstract:

Hora H. Acute Stroke Mimicking as Postpartum Depression. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 151. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/acute-stroke-mimicking-as-postpartum-depression/. Accessed May 26, 2019.

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