1/47. Anaesthesia for caesarean section in a patient with an intracranial arteriovenous malformation.Intracranial haemorrhage from an arteriovenous malformation (AVM) during pregnancy is rare but may result in significant maternal and fetal morbidity and mortality. In the untreated patient with an AVM, the best mode of delivery remains debatable with most obstetricians preferring a caesarean section in order to avoid Valsalva manoeuvres associated with vaginal delivery. We describe the administration of epidural anaesthesia for such a parturient undergoing Caesarean section and the anaesthetic implications.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/47. Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance.Cerebral arteriovenous malformations infrequently complicate pregnancy. We sought to determine the neurologic, obstetric, and ethical significance of such malformations. We present the clinical course of 2 pregnant women with arteriovenous malformations who experienced cerebral hemorrhage and a loss of capacity for decision making. We also review the neurologic and obstetric significance of arteriovenous malformations in pregnancy. Various treatment options with concern for pregnancy and the prognosis for arteriovenous malformations are outlined. The ethical issues involved for pregnant patients whose decisional capacity is compromised as a result of cerebral injury are explored. A review of persistent vegetative state and brain death (death by neurologic criteria) occurring in pregnancy allows us to explore many issues that are applicable to decisionally incapacitated but physiologically functioning pregnant women. We outline a document, the purpose of which is to obtain advance directives from pregnant women regarding end-of-life decisions and to appoint a surrogate decision maker. We believe that evaluation and treatment of the arteriovenous malformation may be undertaken without regard for the pregnancy and that the pregnancy should progress without concern for the arteriovenous malformation.- - - - - - - - - - ranking = 0.00084655243139115keywords = brain (Clic here for more details about this article) |
3/47. Anaesthesia for caesarean section in a patient with recent subarachnoid haemorrhage and severe pre-eclampsia.Subarachnoid haemorrhage is a leading 'indirect' cause of maternal death in the UK. We describe the case of a 43-year-old woman who presented with headache, photophobia and neck stiffness of sudden onset at 32 weeks' gestation. Cerebral computed tomography demonstrated subarachnoid blood in the cisterns around the midbrain, and oral nimodipine was started to prevent vasospasm. Preparations were made for endovascular coil embolisation in the event of identification of a posterior circulation aneurysm. However, angiography under general anaesthesia failed to reveal any vascular abnormality. On emergence from anaesthesia, headache persisted, and over the next 24 h severe pre-eclampsia developed. Magnesium sulphate was started, and urgent Caesarean section performed under general anaesthesia without incident. The rationale for the neuroradiological, obstetric and anaesthetic management is discussed.- - - - - - - - - - ranking = 5.0008465524314keywords = haemorrhage, brain (Clic here for more details about this article) |
4/47. Hemorrhagic moyamoya disease during pregnancy.BACKGROUND: Intracranial hemorrhage in pregnant patients with moyamoya disease is rare. We review the case of one such patient who presented with pre-eclampsia and a catastrophic intracerebral hemorrhage in order to highlight the associated management difficulties. methods: A case of a pregnant (31 weeks) female brought to the emergency department with hypertension and a progressive decrease in her level of consciousness is presented. She rapidly developed a dilated right pupil and left extensor posturing. A CT scan of her head showed a large putamenal intracerebral hemorrhage. She was intubated, ventilated and given intravenous mannitol and magnesium sulfate. She underwent a simultaneous craniotomy and cesarean section. Post-operatively the patient's ICP and jugular venous saturation were monitored in the intensive care unit. RESULTS: The patient delivered a 1185 g infant who did well. The patient's ICP was well controlled until the tenth post-operative day when she developed malignant brain edema and died. CONCLUSION: This case highlights three important points. First, simultaneous craniotomy and cesarean section can be performed. Second, intraoperative control of bleeding Moyamoya vessels is described. Third, the difficult post-operative management of these cases is highlighted. The literature regarding moyamoya disease and pregnancy is reviewed and some recommendations for the management of this rare but potentially deadly condition are presented.- - - - - - - - - - ranking = 0.00084655243139115keywords = brain (Clic here for more details about this article) |
5/47. Irreversible maternal brain injury during pregnancy: a case report and review of the literature.Maternal brain death or massive injury leading to persistent vegetative state during pregnancy is a rare event. Since 1979, 11 cases, including the current one, of irreversible maternal brain damage in pregnancy have been reported. In all but one, the pregnancies were prolonged with a goal of achieving delivery of a viable infant. Current advances in medicine and critical care enable today's physician to offer prolonged life-support to maximize the chances for survival in the neonate whose mother is technically brain dead. We present a case at our institution and review all previously published cases in the English literature for comparison as well as make management recommendations.- - - - - - - - - - ranking = 0.0059258670197381keywords = brain (Clic here for more details about this article) |
6/47. Bilateral thalamic lesions in a newborn with intrauterine asphyxia after maternal cardiac arrest--a case report with literature review.Hypoxic-ischemic brain damage in preterm and term infants is one major cause of neonatal neurologic morbidity. Depending on the gestational age and the extent of hypoxia, different pathologic findings have been observed. Hypoxic-ischemic lesion of the thalamus is the least common form of cerebral injury. Although long-term outcome with spastic or extrapyramidal cerebral palsy is known, clinical features in the neonatal period are not well described.We report an infant with bilateral hypoxic-ischemic thalamic lesions after maternal cardiac arrest at 28 weeks of gestation. Clinical features and diagnostic results of our patient are compared to information given in the literature to define the clinical entity of hypoxic-ischemic thalamic lesions in neonates better.- - - - - - - - - - ranking = 0.00084655243139115keywords = brain (Clic here for more details about this article) |
7/47. Peripartum management of a patient with Glanzmann's thrombasthenia using Thrombelastograph.We describe the perioperative management of a 31-yr-old primipara with Glanzmann's thrombasthenia, who required urgent Caesarean delivery at 33 weeks' gestation. Peripartum haemorrhage was inevitable and was pre-empted by transfusion of multiple blood products, the effects of which were monitored by Thrombelastograph. The blood products given are discussed.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
8/47. A case of pregnancy with a history of paradoxical brain embolism.Brain embolisms in younger persons are rare but are often caused by a paradoxical embolism, the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. A 27-year-old pregnant woman presented with hemiplegia that had been treated with an antiplatelet agent since the occurrence of a paradoxical brain embolism via the pulmonary arteriovenous fistula. A tendency of hypercoagulation is generally observed during pregnancy, so a patient with this condition has a strong risk factor for venous thromboembolism during pregnancy and even more so for arterial thromboembolism under the intense strain of labor, which is much stronger than that of the valsalva maneuver. This case had been controlled well with an antiplatelet agent and an anticoagulant while the levels of coagulation and fibrinolytic factors were monitored and was followed by a successful pregnancy outcome.- - - - - - - - - - ranking = 0.0042327621569558keywords = brain (Clic here for more details about this article) |
9/47. Early dialysis in a neonate with intrauterine lisinopril exposure.In general, angiotensin converting enzyme (ACE) inhibitors should be discontinued in pregnancy, as they can induce an ACE fetopathy. For the treatment of the latter, early peritoneal dialysis is recommended for in utero exposure to captopril and enalapril, although the outcome is poor. Early peritoneal dialysis has not previously been reported for lisinopril induced multiorgan failure. A case is reported in which treatment was given on postnatal day 3. The patient recovered from oligoanuria to almost normal renal function, and heart, brain, and musculoskeletal injury was reversible. This is despite relatively poor clearance of the drug through peritoneal dialysis. Analysis of the pharmacokinetic data suggests that haemodialysis or haemofiltration would be more efficacious for removal of the drug, and these treatments should be performed if available.- - - - - - - - - - ranking = 0.00084655243139115keywords = brain (Clic here for more details about this article) |
10/47. Probable dystonic reaction after a single dose of cyclizine in a patient with a history of encephalitis.A patient underwent an emergency Caesarean section under general anaesthesia for an antepartum haemorrhage. Following delivery of a live infant, cyclizine was administered in accordance with departmental anti-emetic protocol. On awakening she was confused, slow to articulate and had slurred speech. A computed tomography (CT) scan, which was performed to exclude an intracranial event, was normal. Her symptoms were suggestive of a lingual-facial-buccal dyskinesia as seen with dopamine antagonists. A presumptive diagnosis of a dystonic reaction to cyclizine was made. She received two doses of procyclidine before her symptoms completely resolved. cyclizine has had a resurgence in popularity owing to the recent withdrawal of droperidol and anaesthetists should be aware that, although extremely rare, dystonic reactions may occur with this agent.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
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