抄録
Intracranial bleeding—especially subarachnoid hemorrhage (SAH)—is one of the commonest cerebrovascular complications encountered during pregnancy.
Eight patients with intracranial bleeding during pregnancy are reported in this paper: 2 patients with intracranial hematoma following eclampsia, and the other 6 patients with SAH in otherwise normal pregnancies. A ruptured intracranial aneurysm or aneurysms were the cause of SAH in 3 cases and an arteriovenous malformation (AVM) in 2 cases. The source of bleeding was undetermined in one case. All of these aneurysms were successfully clipped. Two newborn babies were delivered by cesarean section, one under local anesthesia, and the other under spinal anesthesia just prior to the intracranial operation.
The authors discuss the differences in clinical course and treatment between aneurysm and AVM during pregnancy. They emphasized that the incidence of aneurysmal rupture parallels the hemodynamic changes during pregnancy. Aneurysms should be treated surgically before delivery, irrespective of the stage of pregnancy. By contrast, AVM can be treated surgically after delivery. The delivery of untreated cases with SAH (either aneurysm or AVM) should be done by cesarean section under spinal or lumbar epidural anesthesia. If near the full term, newborn babies can be delivered by cesarean section, just prior to intracranial operation, as in the present cases.
