Prof A Bryer, speaking at the Physician’s Refresher Conference in Cape Town during February 2018, speaks on strokes during pregnancy and strokes before pregnancy. A stroke in a pregnant women is distinct from a stroke in the non-pregnant woman. The presentation provides information on the potential mechanisms for strokes in pregnancy. It examines peripartum cardiomyopathy; pre-eclampsia and eclampsia; reversable cerebral vasoconstrictive syndrome; APS; Prof Bryer talks to the treatment of acute ischaemic stroke, including thrombolytic treatment with iv tPA; anticoagulation in acute IS; and, mechanical thrombectomy. The presentation also examines a haemorrhagic stroke; primary intercranial haemorrhage and treatment of PICH; cerebral venous thrombosis; and anticoagulation of pregnant women with mechanical heart valves.