Neurological outcomes 30 days after cesarean delivery under spinal anesthesia in women with moyamoya disease: A single-center retrospective case-control study (2005-2021).

BACKGROUND

Moyamoya disease may increase vulnerability to peripartum hemodynamic changes. We hypothesized a higher 30-day incidence of stroke or transient ischemic attack after cesarean delivery under spinal anesthesia in women with moyamoya disease than in those without.

METHODS

This single-center retrospective case-control study included cesarean deliveries under spinal or combined spinal epidural anesthesia (2005-2021). Moyamoya disease was confirmed from medical records and neuroimaging. The primary outcome was confirmed stroke or transient ischemic attack within 30 days. The secondary outcome was any neurological diagnosis or symptom; sensitivity analysis excluded postdural puncture headache. Outcomes were described at the delivery level, with a woman-level sensitivity analysis restricted to the index cesarean delivery.

RESULTS

Among 1,910 cases screened, 1,750 were analyzed (moyamoya disease: 73 deliveries/48 women; no moyamoya disease: 1,677 deliveries/1,445 women). At the delivery level, stroke or transient ischemic attack occurred in 9/73 (12.3%) versus 1/1,677 (0.1%) (crude odds ratio, 235.7; 95% confidence interval, 29.3-1892.2; P < 0.001). The secondary outcome occurred in 31/73 (42.5%) versus 214/1677 (12.8%) (crude odds ratio, 5.0; 95% confidence interval, 3.1-8.2; P < 0.001); excluding postdural puncture headache, it occurred in 25/73 (34.2%) versus 207/1677 (12.3%) (crude odds ratio 3.7, 95% confidence interval 2.2-6.1; P < 0.001). In the woman-level analysis, stroke or transient ischemic attack occurred in 8/48 (16.7%) versus 1/1,445 (0.07%). All events occurred within 7 days.

CONCLUSIONS

Moyamoya disease was associated with early neurological events after cesarean delivery under spinal or combined spinal epidural anesthesia; this association does not imply causality but supports early postpartum neurological surveillance.