title: Spontaneous acute subdural hematoma and intracerebral hemorrhage in a patient with thrombotic microangiopathy during pregnancy.
abstract: Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The case of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.
authors.affiliation: Adult Intensive Care Unit, Hospital de Caridade de Ijuí- HCI - Ijuí RS, Brazil. swayhs@yahoo.com.br
authors.forename: Sâmia Yasin
authors.initials: SY
authors.lastname: Wayhs
authors.forename: Joise
authors.initials: J
authors.lastname: Wottrich
authors.forename: Douglas Prestes
authors.initials: DP
authors.lastname: Uggeri
authors.forename: Fernando Suparregui
authors.initials: FS
authors.lastname: Dias
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D002585:Cesarean Section; D005234:Fatty Liver / Q000150:complications / Q000503:physiopathology; D005260:Female; D005313:Fetal Death; D017359:HELLP Syndrome / Q000503:physiopathology; D020199:Hematoma, Subdural, Acute / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007362:Intensive Care Units; D011225:Pre-Eclampsia / Q000503:physiopathology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000503:physiopathology*; D057049:Thrombotic Microangiopathies / Q000209:etiology / Q000503:physiopathology*
references.citation: Br J Haematol. 2003 Feb;120(4):556-73
references.pmid: 12588343
references.citation: Obstet Gynecol. 2012 Aug;120(2 Pt 1):318-24
references.pmid: 22825091
references.citation: Arch Gynecol Obstet. 2005 Sep;272(3):207-10
references.pmid: 15690170
references.citation: QJM. 2002 Jun;95(6):343-57
references.pmid: 12037242
references.citation: Ther Apher. 2002 Aug;6(4):320-8
references.pmid: 12164804
references.citation: Curr Opin Cardiol. 2006 Jul;21(4):279-87
references.pmid: 16755195
references.citation: Indian J Anaesth. 2010 Sep;54(5):470-1
references.pmid: 21189889
references.citation: Acta Neurochir (Wien). 2009 Dec;151(12):1689-92
references.pmid: 19390778
references.citation: Curr Opin Anaesthesiol. 2009 Jun;22(3):347-51
references.pmid: 19318931