title: Antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease: a case report.
abstract: OBJECTIVE
  Moyamoya (meaning a "hazy puff of smoke" in Japanese) disease is a rare cerebrovascular occlusive disease. Moyamoya disease may become symptomatic for the first time during pregnancy. We report a case of antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease, which was subsequently diagnosed as HELLP syndrome during the postpartum period.
  
  
  METHODS
  A case report of a 29-year-old Japanese primigravida who was transported to our hospital at 39 weeks of gestation because of sudden loss of consciousness and left hemiplegia. On arrival, her blood pressure was 143/94 mmHg with 1+ proteinuria by dipstick. Brain computed tomography revealed a right putaminal hemorrhage with intraventricular hemorrhage. The patient delivered a neonate by emergency cesarean section, and an intracranial hematoma was subsequently evacuated. Approximately 3 h postoperatively, she was diagnosed with HELLP syndrome and the following were initiated: IV magnesium sulfate, antihypertensive agents, and transfusion of 10 units of platelets. Angiographic findings were consistent with unilateral moyamoya disease.
  
  
  CONCLUSIONS
  Moyamoya disease is a rare entity that must be considered in the differential diagnosis of hemorrhagic stroke during pregnancy. It is important to perform careful monitoring and adequate management with cooperation between obstetricians and other specialists when serious complications arise.
authors.affiliation: Department of Obstetrics and Gynecology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. jkakogaw@hosp.ncgm.go.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Kakogawa
authors.forename: Miyuki
authors.initials: M
authors.lastname: Sadatsuki
authors.forename: Norio
authors.initials: N
authors.lastname: Masuya
authors.forename: Hideto
authors.initials: H
authors.lastname: Gomibuchi
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ohno
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hara
authors.forename: Hiroko
authors.initials: H
authors.lastname: Oda
authors.forename: Akio
authors.initials: A
authors.lastname: Kimura
authors.forename: Shigeki
authors.initials: S
authors.lastname: Minoura
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000927:Anticonvulsants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis* / Q000628:therapy; D006261:Headache / Q000209:etiology; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000628:therapy; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D009072:Moyamoya Disease / Q000175:diagnosis*; D017713:Platelet Transfusion; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000209:etiology
chemical_list: D000927:Anticonvulsants; D000959:Antihypertensive Agents; D008278:Magnesium Sulfate; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase