1/30. Postpartum cerebral angiopathy associated with the administration of sumatriptan and dihydroergotamine--a case report.Cerebral angiopathy of the postpartum period is a rare entity, sometimes promoted by vasoconstrictives drug prescription. Its clinical presentation includes headaches, seizures and focal neurological deficits, which develop shortly after a normal pregnancy. The diagnosis is based on clinical findings and angiography, showing multiple narrowing of the intracranial cerebral arteries. This neurological feature is reversible and the clinical outcome is good. We report a case of benign cerebral angiopathy in a 20-year-old woman in the postpartum period, occurring after administration of sumatriptan and ergot derivates.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
2/30. The ex utero intrapartum treatment procedure for a large fetal neck mass in a twin gestation.BACKGROUND: Large fetal neck masses can make it difficult or impossible to secure airways at birth, with associated risks of hypoxia, brain injury, and death. Based on a medline search from 1966 to June 1998, using the keywords EXIT procedure, placental support, twins, and neck mass, we report the first ex utero intrapartum treatment procedure performed in a twin gestation complicated by a large fetal neck mass. CASE: A giant fetal cervical mass was diagnosed in one fetus of a 20-week twin gestation by sonography and magnetic resonance imaging. At 35 weeks' gestation, the ex utero intrapartum treatment procedure was performed successfully for delivery of the normal twin, followed by intrapartum airway access of the twin with the neck mass. CONCLUSION: Even in twin gestations, the ex utero intrapartum treatment procedure is the delivery method of choice for fetuses with giant neck masses.- - - - - - - - - - ranking = 0.0025602806286593keywords = brain (Clic here for more details about this article) |
3/30. Endovascular treatment of cerebral artery aneurysms during pregnancy: report of three cases.Historically, surgical management of cerebral aneurysms during pregnancy has been controversial. Debate originally focused on early versus late intervention, before or after delivery of the fetus. More recently, treatment has centered on rapid intervention. We describe the endovascular treatment of cerebral artery aneurysms with Guglielmi detachable coils in three pregnant women.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
4/30. Acute circulatory and respiratory collapse in obstetrical patients: a case report and review of the literature.Venous air embolism is the entrapment of air into the venous system producing signs and symptoms due to obstruction of pulmonary arterial blood flow. We present a healthy, 27-year-old, full-term parturient admitted for postdate induction of labor. Cesarean delivery was required following fetal distress. During delivery, the mother became bradycardic and required advanced cardiac life support for resuscitation. Serial hemoglobin values, electrocardiograms, echocardiograms, and a magnetic resonance image of the head were all normal. No fetal squamous cells were found in the patient's blood. She required 6 days of ventilation, was successfully extubated, and was discharged 14 days after the cesarean delivery. The differential diagnosis in this patient's care centered on a pulmonary embolic event. thromboembolism was unlikely, based upon the patient's rapid clinical improvement without definitive therapy for thrombotic disease or detection of peripheral thrombosis. amniotic fluid embolus was unlikely, although not excluded, by the absence of fetal cells in the maternal circulation and the lack of an accompanying intravascular coagulopathy. air embolism may occur in up to 50% of women undergoing cesarean delivery. A lethal embolism may follow a bolus of 3 to 5 mL/kg of air. Chief among the many symptoms of air embolism are tachypnea, chest pain, and gasping. The diagnosis may be facilitated by precordial Doppler monitoring, transesophageal echocardiography, or by the identification of air when aspirating from a right heart catheter. Management includes optimum patient positioning, aspiration of air, discontinuation of nitrous oxide, administration of 100% oxygen, and flooding the surgical site with saline to avoid further air entry. Preventive strategies are also discussed.- - - - - - - - - - ranking = 161.22856128878keywords = embolism, thrombosis (Clic here for more details about this article) |
5/30. Traumatic hypopituitarism due to maternal uterine leiomyomas.hypopituitarism has been associated with different types of head trauma including traumatic delivery. We report a case of hypopituitarism in a boy with a history of induced traumatic labor associated with maternal uterine leiomyomas. He also had head and face deformations that were apparently caused by spatial restriction due to the enlarging leiomyomas while the patient was growing in utero. Trauma to the pituitary stalk could have occurred by cerebral entrapment and the pressures of labor. Although hypopituitarism has been associated with traumatic delivery and breech delivery, there are no reported cases related to uterine leiomyomas.- - - - - - - - - - ranking = 0.16666666666667keywords = cerebral (Clic here for more details about this article) |
6/30. Non-fatal amniotic fluid embolism after cervical suture removal.We describe a case of pulmonary oedema occurring at 37 weeks gestation, following the attempted removal of a cervical suture under general anaesthesia. The use of an ultrasound technique to demonstrate the patient's fluid status is described. Signs of amniotic fluid embolism and how it exerts its influence on the circulation are discussed.- - - - - - - - - - ranking = 160.86883311642keywords = embolism (Clic here for more details about this article) |
7/30. Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient.PURPOSE: To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation. Clinical features: A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths x min(-1), blood pressure 110/70 mmHg, pulse 120 beats x min(-1) and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40-45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody. CONCLUSION: General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation.- - - - - - - - - - ranking = 128.8617331598keywords = embolism, cerebral (Clic here for more details about this article) |
8/30. Hindbrain hernia masquerading as postpartum subarachnoid haemorrhage.A 29-year-old postpartum lady presented with a headache suggestive of subarachnoid haemorrhage. Investigations were negative for sources of haemorrhage, but revealed a hindbrain hernia. Hindbrain hernia should be considered as a cause of headache postpartum, as repeated Valsalva manoeuvres performed during vaginal delivery may further aggravate tonsillar decent.- - - - - - - - - - ranking = 0.015361683771956keywords = brain (Clic here for more details about this article) |
9/30. Contralateral cerebral infarction following vacuum extraction.cerebral infarction is a rare complication following a vacuum-assisted delivery occurring on the side of the vacuum application and often accompanied by a cephalhematoma. We report a case of cerebral infarction that was contralateral to the side of the vacuum application in a term baby. The baby presented with seizures in the immediate neonatal period. There was no fracture of the skull to account for a contusion injury. We discuss the mechanisms of intracranial vascular injuries during the process of natural and assisted birth.- - - - - - - - - - ranking = 0.83333333333333keywords = cerebral (Clic here for more details about this article) |
10/30. Acute massive pulmonary embolism treated with streptokinase during labor and the early puerperium.Acute massive pulmonary embolism occluding 60-70% of the pulmonary circulation occurred in a young primipara during the 28th week of pregnancy. She was critically ill despite 40 h of heparin infusion and thrombolytic therapy with streptokinase was initiated. After a 10-h infusion she went into labor and streptokinase treatment was stopped. One hour later she gave birth spontaneously to a preterm infant in footling breech delivery. The infant did well neonatally. streptokinase infusion was recommenced 8 h after delivery. Because of increasing blood loss on the second day after delivery, streptokinase was withdrawn after a total treatment time of 29 h. Total hemorrhage amounted to 8.9 litres. Serial perfusion lung scans showed complete resolution of the emboli and normal lung function was restored.- - - - - - - - - - ranking = 160.86883311642keywords = embolism (Clic here for more details about this article) |
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