{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:45:28Z","timestamp":1790149528685,"version":"4.0.1"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Pregnancy-associated stroke may present with nonfocal symptoms, leading to missed diagnostic opportunities (MDO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We conducted a retrospective study including patients aged 18 to 50 years and pregnant or within 1 year of delivery, treated at 5 US comprehensive stroke centers from 2012 to 2021 for confirmed arterial ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral venous thrombosis. Vascular neurologists at each site reviewed cases using a validated tool, Safer Stroke-Dx. We determined the proportion of cases with MDO and estimated 95% CIs based on a binomial distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      We identified 135 patients with pregnancy-related stroke (mean age, 32.4 [SD, 6.0] years), of whom 37 (27%) had MDO (95% CI, 20.6%\u201335.5%). Presenting symptoms included focal neurological deficits (57%; n=77), headache (53%; n=71), systemic symptoms (26%; n=35), and altered mental status (19%; n=25). More patients with MDO had hemorrhagic strokes (22 of 37 [59%] versus 34 of 79 [43%] patients with no MDO, and 10 of 19 [53%] with insufficient information to determine [\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.05]). Among patients with MDO, 34 of 37 (92%) had \u22651 documented medical encounter in the month preceding stroke diagnosis compared with 47 of 79 (59%) individuals without MDO and 9 of 19 (47%) with insufficient information to determine (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Of the 86 patients with prestroke encounters, most were evaluated by obstetricians (49%; n=42) or emergency medicine clinicians (29%; n=25). Among patients with MDO, contributing factors included failure to recognize symptoms (84%; n=31) and omission of appropriate neuroimaging studies (81%; n=30), despite that the clinical presentation was judged typical of the final stroke diagnosis in 35 of the 37 (95%) patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In this retrospective cohort, &gt;1 in 4 pregnant or postpartum patients with acute stroke experienced MDO. Our results suggest a need for enhanced clinician education, particularly for nonneurologists, in diagnosing stroke during pregnancy and the postpartum period.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.052995","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T19:00:30Z","timestamp":1769454030000},"page":"292-300","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Identifying Missed Diagnostic Opportunities in Maternal Stroke"],"prefix":"10.1161","volume":"57","author":[{"given":"Noora","family":"Haghighi","sequence":"first","affiliation":[{"name":"Department of Neurology, Columbia University, New York, NY (N.H., R.M.B., C.S., E.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raeann Marie","family":"Bourscheid","sequence":"additional","affiliation":[{"name":"Department of Neurology, Columbia University, New York, NY (N.H., R.M.B., C.S., E.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7541-5513","authenticated-orcid":true,"given":"Catherine","family":"Shang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Columbia University, New York, NY (N.H., R.M.B., C.S., E.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elida","family":"Romo","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Chicago, IL (E.R., S.J., J.H., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5958-6881","authenticated-orcid":true,"given":"Farhan","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Brown University, Providence, RI (F.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6270-2377","authenticated-orcid":true,"given":"Samantha","family":"Jankowski","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Chicago, IL (E.R., S.J., J.H., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7451-4608","authenticated-orcid":true,"given":"Alison","family":"Seitz","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Washington, Seattle (A. Seitz)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Shapouran","sequence":"additional","affiliation":[{"name":"Department of Neurology, Montefiore Medical Center, Bronx, NY (S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7253-1340","authenticated-orcid":true,"given":"Lauren E.","family":"Mamer","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (L.E.M., W.J.M.) and University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1158-5302","authenticated-orcid":true,"given":"William J.","family":"Meurer","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (L.E.M., W.J.M.) and University of Michigan, Ann Arbor."},{"name":"Department of Neurology (W.J.M.), University of Michigan, Ann Arbor."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0184-6035","authenticated-orcid":true,"given":"Ava L.","family":"Liberman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Weill Cornell Medical Center, New York, NY (A.L.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6729-503X","authenticated-orcid":true,"given":"Andrea","family":"Shields","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Connecticut, Farmington (A. Shields)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Holl","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Chicago, IL (E.R., S.J., J.H., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0724-1694","authenticated-orcid":true,"given":"Shyam","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Chicago, IL (E.R., S.J., J.H., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7108-8906","authenticated-orcid":true,"given":"Eliza C.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pittsburgh, PA (E.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","unstructured":"Centers for Disease Control and Prevention. Data from the pregnancy mortality surveillance system. Maternal mortality prevention. 2025. Accessed November 25 2025. https:\/\/www.cdc.gov\/maternal-mortality\/php\/pregnancy-mortality-surveillance-data\/index.html"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493017723271"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017374"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2020.02.029"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.10.056"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873231170096"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2021.1941851"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12543"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.0048"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/neurolint14020040"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.034032"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25813"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2022.2122799"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.023017"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-15-0297"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.2769"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/jog.14786"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2017.02.046"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003290"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2013.09.021"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003814"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.108139"},{"key":"e_1_3_3_24_2","unstructured":"American Heart Association. Get With the Guidelines\u00ae \u2013 Stroke. American Heart Association. 2025. Accessed November 25 2025. https:\/\/www.heart.org\/en\/professional\/quality-improvement\/get-with-the-guidelines\/get-with-the-guidelines-stroke"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcw222"},{"key":"e_1_3_3_26_2","unstructured":"Centers for Disease Control and Prevention. Preventing pregnancy-related deaths. Maternal mortality prevention. 2024. Accessed November 25 2025. https:\/\/www.cdc.gov\/maternal-mortality\/preventing-pregnancy-related-deaths\/index.html"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e318296aeca"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000456"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.007758"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1214\/ss\/1009213286"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1336222"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000151116.84113.56"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12082908"},{"key":"e_1_3_3_34_2","unstructured":"National Institute of Neurological Disorders and Stroke. NIH stroke scale. NINDS. 2025. Accessed November 25 2025. https:\/\/www.ninds.nih.gov\/health-information\/stroke\/assess-and-treat\/nih-stroke-scale"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000287"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-020-01940-9"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.790553"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005349"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.45295"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2024.101135"},{"key":"e_1_3_3_41_2","unstructured":"American College of Obstetricians and Gynecologists. Safe motherhood initiative. ACOG district II programs & resources. 2025. Accessed November 25 2025. https:\/\/www.acog.org\/community\/districts-and-sections\/district-ii\/programs-and-resources\/safe-motherhood-initiative"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493018786617"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221078696"},{"key":"e_1_3_3_44_2","unstructured":"iSCAD Registry. Spontaneous coronary artery dissection \u2014 iSCAD registry. BIDMC. 2025. Accessed November 25 2025. https:\/\/iscadregistry.bidmc.org\/index.php?title=Main_Page"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.032819"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2025.101854"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.118.023118"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000200944"},{"key":"e_1_3_3_49_2","unstructured":"Centers for Disease Control and Prevention. About Maternal Mortality Review Committees (MMRCs). Maternal mortality prevention. 2024. Accessed November 25 2025. https:\/\/www.cdc.gov\/maternal-mortality\/php\/mmrc\/index.html"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.125.052995","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T19:01:04Z","timestamp":1769454064000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.125.052995"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":48,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1161\/STROKEAHA.125.052995"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.125.052995","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2025-07-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-28","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}