Intracerebral hemorrhage and Moyamoya disease in pregnancy

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
D L WilliamsR M Gully

Abstract

To present a case of Moyamoya disease with intracranial hemorrhage complicating pregnancy. A 36-yr-old parturient at 34 wk gestation presented with left hemiparesis, headache, nausea and vomiting. Subsequent deterioration in level of consciousness and the development of a dilated right pupil necessitated immediate intubation. Urgent non-contrast CT scan revealed a large right intracerebral hematoma with transtentorial herniation. The patient underwent simultaneous emergency Cesarean section and craniotomy. A postoperative angiogram revealed findings consistent with Moyamoya disease. The neonate survived but the patient developed severe cerebral edema and died eleven days postoperatively. Adult patients with Moyamoya disease often present with intracranial hemorrhage which poses unique anesthetic challenges. We report a case of intracerebral hemorrhage during pregnancy, which is known to be associated with high morbidity and mortality. The anesthetic techniques are reviewed and discussed.

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Citations

Jun 5, 2004·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Tae-Sun KimSam-Suk Kang
Jun 24, 2008·Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology·M PrabhuA Ikomi
Aug 25, 2012·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Kotaro FukushimaNorio Wake
Oct 29, 2011·Neurologic Clinics·Peter W Kaplan
Jan 10, 2009·The Australian & New Zealand Journal of Obstetrics & Gynaecology·Jennifer J ConnPeter A Jurcevic
Feb 8, 2006·Seminars in Arthritis and Rheumatism·Mariko L IshimoriMichael H Weisman
Aug 28, 2013·Neurologia Medico-chirurgica·Miki FujimuraTeiji Tominaga
Mar 26, 2015·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Kimitoshi SatoToshihiro Kumabe
Jun 20, 2018·Acta neurochirurgica·Georgios A MaragkosEkkehard M Kasper

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