Document Detail

Hemorrhagic moyamoya disease during pregnancy.
MedLine Citation:
PMID:  10676593     Owner:  NLM     Status:  MEDLINE    
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.
J C Sun; M Yakimov; I al-Badawi; C R Honey
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques     Volume:  27     ISSN:  0317-1671     ISO Abbreviation:  Can J Neurol Sci     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-04-05     Completed Date:  2000-04-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0415227     Medline TA:  Can J Neurol Sci     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  73-6     Citation Subset:  IM    
Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
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MeSH Terms
Cesarean Section*
Fatal Outcome
Intracranial Hemorrhages / diagnosis,  surgery*
Moyamoya Disease / diagnosis,  surgery*
Postoperative Care
Pregnancy Complications, Cardiovascular / diagnosis,  surgery*
Pregnancy Complications, Hematologic / diagnosis,  surgery*
Tomography, X-Ray Computed

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