ABSTRACT NUMBER: ESOC2026A867 HYPERTENSIVE GESTATIONAL COMPLICATIONS AND POSTPARTUM HYPERCOAGULABILITY AS CATALYSTS FOR PARADOXICAL EMBOLIC CEREBRAL ISCHAEMIA IN YOUNG ADULTS

Abstract Background and aims Ischaemic cerebrovascular events in the immediate postpartum interval are exceedingly rare and frequently underrecognized, yet they carry profound morbidity. Hypertensive gestational disorders, notably pre-eclampsia and HELLP syndrome, engender a transient hypercoagulable state that predisposes to atypical embolic phenomena.Population-based studies report an incidence of approximately 112 per 100,000 deliveries, with early postpartum weeks conferring the highest risk due to physiologic hypercoagulability and hemodynamic fluctuations Methods A 39-year-old multiparous woman, two weeks post-caesarean section for HELLP-complicated pre-eclampsia, presented with acute left hemiparesis, facial weakness, and expressive dysphasia. Neuroimaging revealed right frontal-parietal ischemic lesions with embolic characteristics. Management entailed a structured, multidisciplinary paradigm integrating breastfeeding-compatible antithrombotic therapy, hemodynamic optimization, and a staged etiological evaluation encompassing cardiologic, vascular, and hematologic assessments.Investigations included targeted assessment for a patent foramen ovale and comprehensive thrombophilia profiling. Results The patient’s clinical trajectory underscores the enigmatic nature of postpartum embolic stroke, in which conventional evaluation may fail to identify a discrete embolic nidus. The plausible presence of a patent foramen ovale in the context of postpartum hypercoagulability constitutes a rare mechanistic substrate for paradoxical cerebral embolization. This constellation of risk factors—postpartum state, hypertensive pregnancy complications, and potential intracardiac shunt—represents an atypical and clinically consequential synergy rarely reported in young adults Conclusions This case exemplifies a confluence of postpartum hypercoagulability, hypertensive gestational disorders, and potential intracardiac shunting yielding embolic cerebral events. It underscores the imperative for heightened vigilance, systematic evaluation, and multidisciplinary orchestration in atypical postpartum strokes, informing acute management and long-term cerebrovascular risk mitigation. Conflict of interest No Disclosure Figure 1 - belongs to Results