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Canadian Journal of Anesthesia

, Volume 47, Issue 10, pp 996–1000 | Cite as

Intracerebral hemorrhage and Moyamoya disease in pregnancy

  • Dary L. Williams
  • I. Lynn Martin
  • Robert M. Gully
Clinical Reports

Abstract

Purpose: To present a case of Moyamoya disease with intracranial hemorrhage complicating pregnancy.

Clinical Features: 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.

Conclusion: 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 technique are reviewed and discussed.

Keywords

Cerebral Ischemia Intracranial Hemorrhage Moyamoya Disease Transient Cerebral Ischemia Clin Neurol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Présenter un cas de maladie de Moyamoya accompagnée d’une hémorragie intracrânienne pendant la grossesse.

Éléments cliniques: Une parturiente de 36 ans, à 34 sem de grossesse, présentait une hémiparésie gauche, des céphalées, nausées et vomissements. Une détérioration subséquente du niveau de conscience et le développement d’une pupile droite dilatée ont nécessité une intubation immédiate. Une scanographie urgente, sans contraste, a révélé un gros hématome intracérébral droit et une hernie transtentorielle. La patiente a subi une césarienne d’urgence et une craniotomie simultanée. Un angiogramme postopératoire a mis en évidence des constations caractéristiques de la maladie de Moyamoya. Le nouveau-né a survécu, mais la patiente a développé un œdème céébral sévère et elle est décédée onze jours après la césarienne.

Conclusion: Les patients adultes atteints de la maladie de Moyamoya présentent souvent une hémorragie intracrânienne, donc des défis anesthésiques particuliers. Nous avons prêsenté un cas d’hémorragie intracérébrale pendant la grossesse, condition connue pour son taux élevé de morbidité et de mortalité. Les techniques anesthésiques ont été passées en revue et étudiées.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Dary L. Williams
    • 1
  • I. Lynn Martin
    • 1
  • Robert M. Gully
    • 1
  1. 1.From the Department of AnesthesiaUniversity of British ColumbiaVancouverCanada

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