title: Carotid angiodysplasia complicated by the use of anti-hypertensive drugs during pregnancy: a case report.
abstract: BACKGROUND
  Hypertensive syndromes in pregnancy are one of the leading causes of obstetric admissions into intensive care units. They are related to changes in the central nervous system caused by a decrease in cerebral perfusion pressure, indicated by an increase in intracranial pressure. These changes in pressure usually result from acute injuries or a decrease in the mean arterial pressure due to iatrogenic action or shock. However, other vascular disorders may contribute to similar occurrences.
  
  
  METHODS
  A 15-year-old girl was admitted to our hospital complaining of severe headaches since the eighth month of pregnancy, and presented with an arterial blood pressure of 180/120 mmHg. The diagnostic hypothesis was pre-eclampsia. Our patient's blood pressure levels remained elevated, and she was submitted to a cesarean section. After the procedure, she was referred to our infirmary, presenting with a blank distant look and with no interaction with the environment, dyslalia, and labial and upper and lower right limb paresis. She was confused and unable to speak, but responded to painful stimuli as she conveyed abdominal pain at superficial and deep palpation. The hypothesis of post-partum psychosis was suggested. She was then transferred to our intensive care unit, maintaining an impassive attitude in bed but reacting to external stimuli. Results of a computed tomography scan revealed ischemic infarction of the territory of her left middle cerebral artery. A selective cerebral arteriography showed bilateral occlusion of her internal carotid artery in the intracranial position, prebifurcation and angiodysplasia in the cervical segments of her internal carotid artery. Sixteen days after hospital admission, our patient died.
  
  
  CONCLUSIONS
  This data shows the need for careful monitoring of hypertensive syndromes in pregnancy cases, especially in cases with a history of chronic hypertension or with vascular alterations, It also highlights the need for constant supervision of blood pressure levels during the use of anti-hypertensive medications.
authors.affiliation: Discipline of General Pathology, Department of Biological Sciences, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil. rosana@patge.uftm.edu.br.
authors.forename: Viviane Ribeiro
authors.initials: VR
authors.lastname: de Paula
authors.forename: Laura Penna
authors.initials: LP
authors.lastname: Rocha
authors.forename: Giovanni Carlos
authors.initials: GC
authors.lastname: Tiveron
authors.forename: Camila Souza
authors.initials: CS
authors.lastname: de Oliveira Guimarães
authors.forename: Marlene Antônia
authors.initials: MA
authors.lastname: Dos Reis
authors.forename: Beatriz Barco
authors.initials: BB
authors.lastname: Tavares
authors.forename: Rosana Rosa Miranda
authors.initials: RR
authors.lastname: Corrêa