Williams D L, Martin I L, Gully R M
Department of Anesthesia, University of British Columbia, Vancouver, Canada.
Can J Anaesth. 2000 Oct;47(10):996-1000. doi: 10.1007/BF03024873.
To present a case of Moyamoya disease with intracranial hemorrhage complicating pregnancy.
A 36-yr-old parturient at 34 wk gestation presented with left hemiparesis, headache, nausea and vomiting. Subsequent deterioration in level of consciousness and the development of a dilated right pupil necessitated immediate intubation. Urgent non-contrast CT scan revealed a large right intracerebral hematoma with transtentorial herniation. The patient underwent simultaneous emergency Cesarean section and craniotomy. A postoperative angiogram revealed findings consistent with Moyamoya disease. The neonate survived but the patient developed severe cerebral edema and died eleven days postoperatively.
Adult patients with Moyamoya disease often present with intracranial hemorrhage which poses unique anesthetic challenges. We report a case of intracerebral hemorrhage during pregnancy, which is known to be associated with high morbidity and mortality. The anesthetic techniques are reviewed and discussed.
报告一例伴颅内出血并发妊娠的烟雾病病例。
一名孕34周的36岁产妇出现左侧偏瘫、头痛、恶心和呕吐。随后意识水平恶化，右侧瞳孔散大，需要立即插管。紧急非增强CT扫描显示右侧大脑有一个巨大血肿并伴有小脑幕切迹疝。患者同时接受了急诊剖宫产和开颅手术。术后血管造影显示结果与烟雾病相符。新生儿存活，但患者出现严重脑水肿，术后11天死亡。
成年烟雾病患者常出现颅内出血，这带来了独特的麻醉挑战。我们报告了一例妊娠期脑出血病例，已知其与高发病率和死亡率相关。对麻醉技术进行了回顾和讨论。
