Abstract
IntroductionHypertensive syndromes in pregnancy are one of the leading causes of obstetric admissions into intensive care units. They are related to changes in the central nervous system caused by a decrease in cerebral perfusion pressure, indicated by an increase in intracranial pressure. These changes in pressure usually result from acute injuries or a decrease in the mean arterial pressure due to iatrogenic action or shock. However, other vascular disorders may contribute to similar occurrences.Case presentationA 15-year-old girl was admitted to our hospital complaining of severe headaches since the eighth month of pregnancy, and presented with an arterial blood pressure of 180/120 mmHg. The diagnostic hypothesis was pre-eclampsia. Our patient's blood pressure levels remained elevated, and she was submitted to a cesarean section. After the procedure, she was referred to our infirmary, presenting with a blank distant look and with no interaction with the environment, dyslalia, and labial and upper and lower right limb paresis. She was confused and unable to speak, but responded to painful stimuli as she conveyed abdominal pain at superficial and deep palpation. The hypothesis of post-partum psychosis was suggested. She was then transferred to our intensive care unit, maintaining an impassive attitude in bed but reacting to external stimuli. Results of a computed tomography scan revealed ischemic infarction of the territory of her left middle cerebral artery. A selective cerebral arteriography showed bilateral occlusion of her internal carotid artery in the intracranial position, prebifurcation and angiodysplasia in the cervical segments of her internal carotid artery. Sixteen days after hospital admission, our patient died.ConclusionThis data shows the need for careful monitoring of hypertensive syndromes in pregnancy cases, especially in cases with a history of chronic hypertension or with vascular alterations, It also highlights the need for constant supervision of blood pressure levels during the use of anti-hypertensive medications.
Highlights
Hypertensive syndromes in pregnancy are one of the leading causes of obstetric admissions into intensive care units
Sixteen days after hospital admission, our patient died. This data shows the need for careful monitoring of hypertensive syndromes in pregnancy cases, especially in cases with a history of chronic hypertension or with vascular alterations, It highlights the need for constant supervision of blood pressure levels during the use of anti-hypertensive medications
In the current study we present the case of a pregnant woman with altered blood pressure levels, signs of loss of cerebral autoregulation and impairment of cerebral de Paula et al Journal of Medical Case Reports 2011, 5:415 http://www.jmedicalcasereports.com/content/5/1/415 perfusion pressure, related to the manipulation of mean arterial pressure (MAP) and previous presence of carotid angiodysplasia
Summary
The present study demonstrated a case of a hypertensive pregnant patient with carotid angiodysplasia and decompensation of cerebral autoregulation possibly caused by the use of anti-hypertensive drugs. This data shows the need for careful monitoring of HSP cases, especially in cases with a history of chronic hypertension or with vascular alterations, as well as constant supervision of the blood pressure levels during the use of anti-hypertensive medications. Author details 1Discipline of General Pathology, Department of Biological Sciences, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. MAR and RRMC were involved in drafting the manuscript and revising it critically for important intellectual content, providing general supervision for the research group and approved the final version to be published. Competing interests The authors declare that they have no competing interests
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