Hemorragia intracraniana na gravidez e puerpério: experiência com quinze casos

Abstract

RESUMO -A hemorragia intracraniana que acontece na gravidez é um fenômeno raro, porém, apresenta mortalidade e morbidades elevadas. Analisamos 15 pacientes com hemorragia intracraniana que ocorreu durante a gravidez ou puerpério. Em cinco casos a hemorragia decorria da ruptura de aneurisma, em 6, de malformação. A mortalidade materna foi 20%, e a fetal 33%. Quando a causa do sangramento é proveniente de ruptura de um aneurisma, deve-se realizar a oclusão cirúrgica do aneurisma durante a gravidez o que aconteceu em 4 pacientes desta série. Entretanto, se a hemorragia decorre de uma malformação arteriovenosa, o melhor tratamento ainda não está estabelecido.PALAVRAS-CHAVE: aneurisma cerebral, hemorragia intracraniana, hemorragia sub-aracnoideia, gravidez, malformação arteriovenosa e puerpério. Intracranial hemorrhage during pregnancy and puerperium: experience with fifteen casesABSTRACT -Intracranial hemorrhage due to arteriovenous malformation or intracranial aneurysms is a rare but grave complication of pregnancy. We analyse 15 cases. Among these, aneurysms ruptures were responsible for the bleending in 5 instances. Arteriovenous malformation was diagnosed in other 6 patients. The maternal and fetal mortality was 20% and 33% respectively. Four aneurysm patients were operated on before delivery. We conclue that surgical management of the aneurysms is associated with lower maternal and fetal mortality than the conservative treatment. The management of angiomatous hemorrhage during pregnancy remains controversial.

Abordagem anestésica de grávida com malformação arteriovenosa cerebral e hemorragia subaracnoidea durante a gravidez: relato de caso

“…Risks to the fetus should also be considered during the intervention, either by embolization, surgical, or other techniques. Although the best strategy for management of symptomatic AVM during pregnancy is not yet defi ned, one can say that the postponement of angiography to the postpartum period has the obvious advantage of minimizing fetal exposure to radiation and contrast medium, aside from avoiding the signifi cant risk of complications during intervention 3,12 . In most cases, the risk-benefi t analysis seems not to support the elective treatment of AVM during pregnancy 3 .…”

Tumor cerebral e gravidez

“…A aldosterona se encontra elevada durante a gravidez com o aumento concomitante do sódio e, principalmente, da água corporal . A dosagem da osmolaridade plasmática orienta o anestesista em relação à reposição dos líquidos administrados durante a cirurgia 7,22,23 .…”

“…Todos os anticonvulsivantes possuem efeitos teratogênicos, principalmente quando utilizados entre a 5 e11 semanas. Uma convulsão produz hipóxia e acidose fetal e, assim sendo, o benefi cio do uso dos anticonvulsivantes é provavelmente maior do que os possíveis efeitos teratogênicos e devem ser empregados como tratamento ou mesmo profi laxia em pacientes que estão em risco de desenvolver crise convulsiva 22 .…”

Ruptura de aneurisma intracraniano gigante em gestante tratado por embolização endovascular: relato de caso

“…The spontaneous subarachnoid hemorrhage may be caused by vasculitis, tumors, coagulation disorders, arteriovenous malformations or aneurysms, the latest ones accounting for about 50% of cases (4,6,7) . In pregnant women, arteriovenous malformations are more frequent in the age range 3 between 20 and 25 year and usually bleed between the 15th and 20th gestational weeks.…”

“…The prevalence of intracranial hemorrhage during gestation ranges from 0.01% to 0.05% (1,2) , with an incidence between 1/10,000 to 1/2,000 (2-6) , similar to the incidence in the rest of the population (6) . This disease causes a high maternal mortality 2 (40%-83%), corresponding to 5% to 12% of all deaths (1,2,7,8) , and is the third major cause of indirect death (non-obstetric) (1,2,5,6) . The endovascular treatment with platinum coils is one of the methods utilized, is minimally invasive and quite effective for the aneurysm occlusion, although there are few cases reported in the literature (1,2,3,9) .…”