Dramatic demise of a pregnant woman in third trimester after presenting with persistent headache: An iatrogenic

Abstract

A 31-years-old patient, pregnant at 32 weeks of gestation presented to our triage unit with complaint of gradually progressive persistent headache that started 1 day earlier and was unresponsive to all analgesics. Her history was insignificant for any major medical or surgical events and the pregnancy course was smooth as well. Her lab results and obstetric ultrasound were reassuring. During magnetic resonance imaging examination, the patient suddenly deteriorated after giving her an inhalational anaesthesia for sedation. She became unconscious. She was intubated, mechanically ventilated, and put-on cardiovascular support. Brain imaging then revealed Brain Stem (BS) herniation and diffuse brain oedema. She was announced dead with intrauterine foetal death. A late diagnosis of cerebral venous thrombosis was established. This caused BS herniation through increased intracranial pressure, which was iatrogenically augmented by administering inhalation anaesthesia. Keywords: cerebral vein; thrombosi; thrombophilia; pregnancy; headache; magnetic resonance imaging; brain stem herniation.