Cesárea urgente y craneotomía en una paciente con rotura de una malformación arteriovenosa cerebral / Emergency cesarean section and craniectomy in a patient with rupture of a cerebral arteriovenous malformation

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)

[Emergency cesarean section and craniectomy in a patient with rupture of a cerebral arteriovenous malformation]. / Cesárea urgente y craneotomía en una paciente con rotura de una malformación arteriovenosa cerebral.

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.