ABSTRACT
La hemorragia intracerebral en el embarazo, aunque es un evento raro, puede tener consecuencias catastróficas tanto para la madre como para el feto. El manejo de las malformaciones arteriovenosas no rotas en el embarazo genera una gran controversia en la literatura actual, ya que siempre existe la posibilidad de sangrado espontáneo y de convertirse en una verdadera urgencia. Presentamos el caso de una paciente secundigesta de 35 semanas diagnosticada de una malformación arteriovenosa cerebral conocida, que desarrolló un cuadro súbito de cefalea, convulsiones tónico-clónicas generalizadas, pérdida de conciencia y hemiparesia, con imágenes radiológicas de hematoma intracraneal con efecto de masa y signos de herniación. Discutimos el tratamiento multidisciplinario, haciendo énfasis en el abordaje perioperatorio de cesárea más craneotomía, drenaje del hematoma, el manejo posterior en Cuidados Intensivos y el definitivo por Neurorradiología, con buen resultado (AU)
The intracerebral hemorrhage in pregnancy is a rare event, but can have catastrophic consequences for both mother and fetus. The management of non-ruptured arteriovenous malformations in pregnancy is not free of controversy in the current literature, as there is the possibility of spontaneous bleeding and becoming a true emergency. We report the case of a pregnant patient of 35 weeks with a diagnosis of a cerebral arteriovenous malformation, who developed a sudden onset of headache, generalized tonic-clonic seizures, loss of consciousness, and hemiparesis with radiological images of an intracranial hematoma with a mass effect, and signs of herniation. The multidisciplinary management is discussed, emphasizing perioperative cesarean approach plus craniotomy and drainage of the hematoma, and subsequent management in intensive care, and definitive management by neuroradiology, with a successful outcome (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Arteriovenous Shunt, Surgical/instrumentation , Arteriovenous Shunt, Surgical , Intracranial Arteriovenous Malformations/complications , Intracranial Arteriovenous Malformations/surgery , Intracranial Arteriovenous Malformations , Anesthesia, Obstetrical/instrumentation , Anesthesia, Obstetrical/methods , Decompressive Craniectomy/instrumentation , Decompressive Craniectomy/methods , Arteriovenous Shunt, Surgical/methods , Anesthesia, Obstetrical/standards , Anesthesia, Obstetrical/trends , Anesthesia, Obstetrical , Neurosurgery/methods , Neurosurgery/trends , Cesarean Section/methods , Cesarean SectionABSTRACT
The intracerebral hemorrhage in pregnancy is a rare event, but can have catastrophic consequences for both mother and fetus. The management of non-ruptured arteriovenous malformations in pregnancy is not free of controversy in the current literature, as there is the possibility of spontaneous bleeding and becoming a true emergency. We report the case of a pregnant patient of 35 weeks with a diagnosis of a cerebral arteriovenous malformation, who developed a sudden onset of headache, generalized tonic-clonic seizures, loss of consciousness, and hemiparesis with radiological images of an intracranial hematoma with a mass effect, and signs of herniation. The multidisciplinary management is discussed, emphasizing perioperative cesarean approach plus craniotomy and drainage of the hematoma, and subsequent management in intensive care, and definitive management by neuroradiology, with a successful outcome.
Subject(s)
Anesthesia, Obstetrical/methods , Cesarean Section , Decompressive Craniectomy , Hematoma, Subdural, Intracranial/etiology , Intracranial Arteriovenous Malformations/surgery , Pregnancy Complications, Cardiovascular/surgery , Adult , Aneurysm, Ruptured/etiology , Aneurysm, Ruptured/surgery , Combined Modality Therapy , Drainage , Embolization, Therapeutic , Emergencies , Female , Hematoma, Subdural, Intracranial/surgery , Humans , Infant, Newborn , Intracranial Aneurysm/etiology , Intracranial Aneurysm/surgery , Intracranial Arteriovenous Malformations/complications , Intracranial Arteriovenous Malformations/therapy , Intracranial Hypertension/drug therapy , Intracranial Hypertension/etiology , Intracranial Hypertension/surgery , Pregnancy , Pregnancy Complications, Cardiovascular/drug therapy , Rupture, SpontaneousABSTRACT
El objetivo de este trabajo es analizar la epidemilogía de las complicaciones más graves que pueden presentarse durante la asistencia de pacientes obstétricas, valorando su incidencia, la demanda asistencia que generan y los principales factores de riesgo. Se analizan también los aspectos más generales de la planificación en anestesiología obstétrica, con ejemplos concretos para algunas situaciones
The aim of this piece of work is to analyse the epidemiology of the most serious complications which may appear during the anaesthesia of obstetric patients, assessing their incidence, the health care demand they develop and the main risk factors. The most general aspects in planning obstetric anaesthesia area analysed as well, with some particular examples of certain situations
