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Postpartum rupture of an intracranial aneurysm.

Kanani N, Goldszmidt E

Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

BACKGROUND: The relative risk of intracerebral hemorrhage during pregnancy and 6 weeks postpartum is higher than that of the nongravid population. CASE: A 37-year-old multiparous, previously healthy woman appeared to have had a seizure on emergence from general anesthesia for cesarean delivery. Subsequent neuro-imaging revealed a giant unruptured internal carotid artery aneurysm. The day after discharge from the hospital, with planned outpatient neurosurgery follow-up, she re-presented with a subarachnoid hemorrhage. This ultimately resulted in her death. CONCLUSION: Given the significant morbidity and mortality associated with cerebral aneurysms in pregnancy, they should be considered in all cases of acute neurological deterioration. Also, given the increased risk of aneurysmal rupture in the gravid patient, expedited management of newly discovered cerebral aneurysms should be contemplated.

Published 1 February 2007 in Obstet Gynecol, 109(2): 572-4.
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