妊産婦脳出血 妊産婦脳出血の２症例

Abstract

We report 2 pregnant women with intracerebral hemorrhage. Patient 1 was a 26-year-old woman who presented with headache and consciousness disturbance. She was initially diagnosed with eclampsia. A Cesarean section was performed, but she subsequently developed left hemiparesis, and the disturbance of consciousness deteriorated; she was hence transferred to our hospital. A computed tomography (CT) scan revealed massive intracerebral hemorrhage at the right cerebral hemisphere. She could not be saved. Patient 2 was a 34-year-old woman who presented with headache. A neurological examination revealed disturbed consciousness and left hemiparesis. A CT scan showed intracerebral hemorrhage in the right frontal lobe. Magnetic resonance imaging (MRI) indicated posterior reversible encephalopathy syndrome (PRES). On the day after Cesarean section, the intracerebral hematoma was evacuated. Aggregated abnormal vessels were identified at the base of the hematoma cavity. The histopathological examination revealed that the lesion was an arteriovenous malformation. The association of pregnancy and stroke is rare, and it is difficult to distinguish between eclampsia and stroke-induced consciousness disturbance in pregnant women. Intracerebral hemorrhage in a pregnant woman may lead to serious consequences for both the mother and baby. We emphasize that immediate, appropriate diagnosis and treatment of intracerebral hemorrhage in a pregnant woman are crucial to save invaluable lives.