1988 Volume 28 Issue 5 Pages 477-480
A 20-year-old primigravida in the ninth month of pregnancy was hospitalized because of sudden onset of disturbance of consciousness. On admission, she was semicomatose, with right hemiplegia; leg edema and oliguria were also noted. Computed tomography showed a high-density area rimmed by a region of low density in the left putamen and a low-density area in the right putamen. The patient underwent a cesarean section, followed by emergency surgery for evacuation of intracerebral blood. On the 5th day of hospitalization, rebleeding in the left putamen, probably associated with disseminated intravascular coagulation, was detected and treated by aspiration and drainage. Cerebral angiography on day 35 showed diffuse vasospasm of both the anterior and posterior circulation. Three and one half months after admission, the patient was able to walk with a cane and was discharged.
Cerebrovascular accidents associated with toxemia of pregnancy are rare, and the pathogenesis is unclear. Ischemic change, with thrombosis and/or hemorrhage, is seen in the edematous brain. These changes may be due to vasospasm. Cerebral vasospasm and ischemic changes were observed in this case, as well as hemorrhage into the ischemic lesion. The findings in this case suggest that cerebral vasospasm may be the most important factor in the pathogenesis of cerebrovascular accidents in patients with toxemia of pregnancy.
