妊娠中に発症したくも膜下出血の２例

Abstract

We report 2 pregnant women with subarachnoid hemorrhage (SAH). Patient 1 was a 24-year-old woman at 36 weeks of gestation who presented with a disturbance of consciousness and epilepsy. A right internal carotid angiography performed after an emergency Cesarean section showed an aneurysm at the junction of the posterior communicating artery. Although the aneurysm was successfully clipped, the patient died as a result of severe vasospasm. Patient 2 was a 31-year-old woman at 23 weeks of gestation who presented with headache and nausea. Although computed tomography and magnetic resonance angiography images obtained upon admission suggested SAH resulting from a right internal carotid aneurysm, the patient refused subsequent radiological examinations because of her concern regarding the adverse effect of the radiation and contrast medium on the fetus. An angiography performed after a Cesarean section revealed an aneurysm at the junction of the right internal carotid artery and the posterior communicating artery, which was successfully clipped. We concluded that the optimal treatment strategy for SAH during pregnancy should be established based on the gestational stage and the patient’s condition.