Sappenfield Elisabeth Christine, Jha R Tushar, Agazzi Siviero, Ros Stephanie
Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA.
Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
BMJ Case Rep. 2019 Jul 23;12(7):e225811. doi: 10.1136/bcr-2018-225811.
A 30-year-old nulliparous woman at 38 5/7 weeks of gestation developed a sudden, severe headache at work and subsequent loss of consciousness. She underwent evaluation in the emergency department. CT and CT angiogram head revealed a large intraparenchymal haematoma with intraventricular extension secondary to ruptured cerebral arteriovenous malformation (cAVM). She was intubated and transferred to a tertiary care centre. The patient underwent caesarean section followed by partial embolisation of the cAVM with planned second embolisation and resection 1 week later. Due to drowsiness and headache, the planned repeat embolisation and cAVM resection were performed 3 days earlier. The patient had a full recovery. Emergency medicine physicians and obstetrician-gynaecologists should be familiar with differential diagnosis of sudden headache in pregnancy and signs of a ruptured cAVM to facilitate early diagnosis, multidisciplinary team approach and timely treatment. Early diagnosis and management of ruptured cAVM are important due to associated morbidity and mortality.
一名30岁未生育的女性，孕38⁵/₇周，在工作时突然出现剧烈头痛，随后失去意识。她在急诊科接受了评估。头部CT及CT血管造影显示，继发于脑动静脉畸形（cAVM）破裂的脑实质内大血肿并破入脑室。她被插管并转至三级护理中心。患者接受了剖宫产，随后对cAVM进行了部分栓塞，计划在1周后进行第二次栓塞及切除术。由于嗜睡和头痛，计划中的重复栓塞及cAVM切除术提前3天进行。患者完全康复。急诊医学医生和妇产科医生应熟悉孕期突发头痛的鉴别诊断及cAVM破裂的体征，以便于早期诊断、多学科团队协作及及时治疗。由于cAVM破裂相关的发病率和死亡率，早期诊断和处理非常重要。
