Spontaneous acute subdural hematoma and intracerebral hemorrhage in a patient with thrombotic microangiopathy during pregnancy

Wayhs, Sâmia Yasin; Wottrich, Joise; Uggeri, Douglas Prestes; Dias, Fernando Suparregui

doi:10.5935/0103-507x.20130030

Cited by 5 publications

(1 citation statement)

References 10 publications

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“…Neutrally, spontaneous aSDH may include all forms of aSDH caused by non-traumatic reasons. [ 2 – 9 , 19 , 21 , 22 , 23 , 28 , 29 ] There is a risk of missed diagnosis for aSDH caused by aneurysm. DSA has been considered the golden standard for diagnosing aneurysm, as it is capable of tracking the location of an aneurysm and identifying the relationship between the aneurysm and nearby artery.…”

Section: Discussionmentioning

confidence: 99%

Acute non-traumatic subdural hematoma induced by intracranial aneurysm rupture

Gao¹,

Yue²,

Zhang

et al. 2020

Medicine

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Rationale: Intracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH. Patient concerns: Here, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting. Diagnosis: Urgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery. Interventions: Emergent craniotomy with hematoma evacuation was performed. Outcomes: Due to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability. Lessons: This unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.

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Section: Discussionmentioning

confidence: 99%

Acute non-traumatic subdural hematoma induced by intracranial aneurysm rupture

Gao¹,

Yue²,

Zhang

et al. 2020

Medicine

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Spontaneous Intracranial Hemorrhage in Pregnancy: A Systematic Review of the Literature

et al. 2018

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Stroke in pregnant women has a mortality rate of 1.4 deaths per 100,000 deliveries. Vascular malformations are the most common cause of hemorrhagic stroke in this population; preeclampsia and other risk factors have been identified. However, nearly a quarter of strokes have an undeterminable cause. Spontaneous intracranial hemorrhage (ICH) is less frequent but results in significant morbidity. The main objective of this study is to review the literature on pregnant patients who had a spontaneous ICH. A systematic review of the literature was conducted on PubMed and the Cochrane library from January 1992 to September 2016 following the PRISMA guidelines. Studies reporting pregnant patients with spontaneous intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and subdural hemorrhage (SDH) were selected and included if patients had non-structural ICH during pregnancy or up to 6 weeks postpartum confirmed by imaging. Twenty studies were included, and 43 patients identified. Twenty-two patients (51.3%) presented with IPH, 15 patients (34.8%) with SAH, and five patients (11.6%) with SDH. The most common neurosurgical management was clinical in 76.7% of patients, and cesarean section was the most common obstetrical management in 28% of patients. The most common maternal outcome was death (48.8%), and fetal outcomes were evenly distributed among term delivery, preterm delivery, and fetal or neonatal death. Spontaneous ICH carries a high maternal mortality with IPH being the most common type, most frequently presenting in the third trimester. Diagnosis and management do not differ for the parturient compared to the non-pregnant woman.

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