Cerebral arteriovenous malformation diagnosed during labor induction with headache and convulsions as presentations--a case report.
The occurrence of complications of intracranial arteriovenous malformation (AVM) during labor induction is relatively uncommon. Intracranial AVM can cause convulsions, headache, focal neurological deficits and intracranial hemorrhage if ruptures. We present a 33-year-old parturient with history of paroxysmal supraventricular tachycardia, who was admitted for labor induction. She experienced a bout of convulsion following a 30-min oxytocin infusion, by which time it was three and half hours since she was given the test dose of epidural analgesic. She also denied having history of convulsions or preeclampsia. Magnetic resonance imaging (MRI) of brain demonstrated a cerebral AVM in the left frontal base without signs of intracranial hemorrhage or brain edema. The obstetrician opted for Cesarean section in order to avoid stress during vaginal delivery. The surgery was successfully performed under general anesthesia without hemodynamic fluctuations or neurological complications. We discuss the possible mechanisms of the convulsions attack in this patient and the ensuring anesthetic management for the Cesarean section she sustained.
Su
Hung-Tai
HT
Department of Anesthesia, Pain Service and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan, ROC.
Chen
Kuen-Bao
KB
Liu
Yu-Cheng
YC
Poon
Kin-Shing
KS
Wu
Rich Sai-Chuen
RS
D000328:Adult; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D007427:Intracranial Pressure; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000503:physiopathology; D012640:Seizures / Q000209:etiology*