A case of a pregnant woman with a subarachnoid hemorrhage caused by dissection of the distal region of the posterior cerebral artery

Abstract

Pregnancy-associated intracranial hemorrhage is a serious clinical condition; however, the pathophysiology and effective management method remain unclear, and only a few cases have been reported to date. We here report a case of a pregnant woman in her thirties without any past medical history. She presented with a sudden severe headache, and a head CT scan displayed a subarachnoid hemorrhage. We performed two cerebral angiographies but could not detect any cerebral aneurysms. Conservative management was hence performed, and she was discharged without any neurological deficits. Five months after the subarachnoid hemorrhage, she was admitted to our hospital again for the delivery of her infant. We checked the previous cerebral angiography images again and detected a dissecting aneurysm at the distal region of the right posterior cerebral artery. Owing to this finding, we performed a caesarean section under careful blood pressure monitoring and delivered the infant without any complications. Subsequently, we followed the patient by performing cerebral angiography several times, and the dissecting aneurysm gradually became smaller and eventually disappeared. The dynamic physiological changes that occur to a woman’s body during pregnancy can cause stroke, and it is hence important to cooperate with neurosurgeons and obstetricians for the management of this complicated and life-threatening condition.