Abstract
Two cases presenting with subarachnod hemorrhage in pregnancy were reported, and verified ruptured intracranial aneurysms and arteriovenous malformations (AVM's) during pregnancy were reviewed in the Japanese literature. Case 1 : a primipara 27-year-old woman at 13 weeks of gestation was referred to the hospital after suddenly developed occipitalgia, nausea and vomiting. On admission the patient was stuporous, with stiffness of her neck and a dilated pupil on the right. There was also a left flaccid hemiparesis. A CT scan demonstrated evidences of subarachnoid hemorrhage associated with intracerebral as well as subdural hematomas at the right fronto-temporal region. Ventricular shift and deformity were prominent. Angiography revealed an arteriovenous malformation fed by the right anterior temporal artery and drained into the sphenoparietal sinus. In view of neurological signs indicative of impending herniation, an emergency operation was performed and the AVM was totally exstirpated with complete hematoma evacuation. Vital sings of the patient and the fetus were carefully monitored and found stable during surgery. The postoperative course was uneventful and the patient was discharged without neurological deficits. The fetus was, however, eventually aborted in three weeks after discharge. Case 2; a multipara 28-year-old woman was admitted to the hospital after the onset of a subarachnoid hemorrhage. No abnormality was disclosed on neurological examination except for nuchal rigidity. A CT scan showed areas of high density within the basal subarachnoid cisterns, consistent with the finding of subarachnoid hemorrhage. Angiography revealed a saccular aneurysm approximately 7 mm in diameter projecting inferiorly at the junction of the right internal carotid and posterior communicating arteries. Immediately after a 2900 g female was delivered by cesarean section, the patient underwent a right fronto-temporal cranitomy and the aneurysm was successfully clipped within 24 hours of onset. The patient was discharged without neurological deficits.
