title: [Emergency cesarean section and craniectomy in a patient with rupture of a cerebral arteriovenous malformation].
abstract: The intracerebral hemorrhage in pregnancy is a rare event, but can have catastrophic consequences for both mother and fetus. The management of non-ruptured arteriovenous malformations in pregnancy is not free of controversy in the current literature, as there is the possibility of spontaneous bleeding and becoming a true emergency. We report the case of a pregnant patient of 35 weeks with a diagnosis of a cerebral arteriovenous malformation, who developed a sudden onset of headache, generalized tonic-clonic seizures, loss of consciousness, and hemiparesis with radiological images of an intracranial hematoma with a mass effect, and signs of herniation. The multidisciplinary management is discussed, emphasizing perioperative cesarean approach plus craniotomy and drainage of the hematoma, and subsequent management in intensive care, and definitive management by neuroradiology, with a successful outcome.
authors.affiliation: Departamento de Anestesiología y Reanimación, Clínica El Rosario, Medellín, Colombia. Electronic address: gerafomejia@yahoo.com.
authors.forename: G
authors.initials: G
authors.lastname: Monsalve-Mejía
authors.affiliation: Departamento de Anestesiología y Reanimación, sección Anestesia Cardiovascular, Clínica El Rosario, Medellín, Colombia.
authors.forename: W
authors.initials: W
authors.lastname: Palacio
authors.affiliation: Servicio Anestesiología y Reanimación, Universidad de Antioquia, Medellín, Colombia.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D017542:Aneurysm, Ruptured / Q000209:etiology / Q000601:surgery; D002585:Cesarean Section; D003131:Combined Modality Therapy; D056424:Decompressive Craniectomy; D004322:Drainage; D004621:Embolization, Therapeutic; D004630:Emergencies; D005260:Female; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D002532:Intracranial Aneurysm / Q000209:etiology / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000601:surgery* / Q000628:therapy; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy / Q000601:surgery*; D012422:Rupture, Spontaneous
keywords: Anestesia obstétrica; Arteriovenous cerebral malformation; Cesarean section; Cesárea; Craneotomía descompresiva; Decompressive craniectomy; Embarazo; Malformación arteriovenosa cerebral; Neurocirugía; Neurosurgery; Obstetrical anesthesia; Pregnancy