Tratamiento perioperatorio de una gestante con infarto cerebral reciente secundario a miocardiopatía no compactada / Perioperative treatment of a pregnant woman with recent cerebral infarction secondary to noncompaction cardiomyopathy

La miocardiopatía no compactada (MNC) es una entidadde reciente acuñamiento, de presentación infrecuentepero con manifestaciones clínicas importantes y pronósticosombrío. El infarto cerebral es una de sus formasde presentación; y el embarazo, estado de hipercoagulabilidad,lo favorece. Se presenta el caso de una mujerembarazada que fue llevada a urgencias con un infartocerebral isquémico, en cuyo estudio se demostró etiologíacardioembólica, con diagnóstico de MNC. Días después,tras su estabilización, fue sometida a cesárea electivabajo anestesia general. La intervención transcurriósin incidencias, al igual que el postoperatorio, tras elcual fue trasladada al Servicio de Rehabilitación. Esobligatorio en estos casos evitar el daño miocárdico y laprogresión del accidente cerebrovascular; para ello previoa la cirugía se debe estabilizar al paciente e iniciartratamiento antiagregante y/o anticoagulante. Es necesariomantener la estabilidad hemodinámica durante todoel perioperatorio, evitando en lo posible la depresión delneonato tras su extracción. Para ello existen diferentesestrategias, que deben adecuarse al estado y al momentoen el que se encuentre la paciente

Recent-onset noncompaction of the myocardium is arare but serious entity with uncertain prognosis. Cerebralinfarction is among the forms of presentation, andpregnancy and hypercoagulability increase risk. Wereport the case of a pregnant woman brought to theemergency department with ischemic cerebral infarction.Investigation demonstrated the cause to be cardiac embolism,and noncompaction of the myocardium was diagnosed.She was stabilized and a few days later underwentelective cesarean section under general anesthesia. Surgeryand postoperative recovery were uneventful, and shewas transferred for rehabilitation. Myocardial injury andprogression to cerebrovascular accident must beprevented in such cases; the patient must be stabilizedand antiplatelet and/or anticoagulant therapy initiatedbefore surgery. Hemodynamic stability must be maintainedthroughout the perioperative period and neonataldepression avoided after delivery. Various approaches areavailable to be adapted to the patient's situation

[Perioperative treatment of a pregnant woman with recent cerebral infarction secondary to noncompaction cardiomyopathy]. / Tratamiento perioperatorio de una gestante con infarto cerebral reciente secundario a miocardiopatía no compactada.

Recent-onset noncompaction of the myocardium is a rare but serious entity with uncertain prognosis. Cerebral infarction is among the forms of presentation, and pregnancy and hypercoagulability increase risk. We report the case of a pregnant woman brought to the emergency department with ischemic cerebral infarction. Investigation demonstrated the cause to be cardiac embolism, and noncompaction of the myocardium was diagnosed. She was stabilized and a few days later underwent elective cesarean section under general anesthesia. Surgery and postoperative recovery were uneventful, and she was transferred for rehabilitation. Myocardial injury and progression to cerebrovascular accident must be prevented in such cases; the patient must be stabilized and antiplatelet and/or anticoagulant therapy initiated before surgery. Hemodynamic stability must be maintained throughout the perioperative period and neonatal depression avoided after delivery. Various approaches are available to be adapted to the patient's situation.

Siringomielia y malformación de Chiari tipo I, con parálisis bilateral de cuerdas vocales y síndrome de apnea obstructiva del sueño asociadas / Syringomyelia and Chiari type 1 malformation with associated bilateral vocal cord paralysis and obstructive sleep apnea syndrome

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