J Korean Neurosurg Soc.  2014 May;55(5):273-276. 10.3340/jkns.2014.55.5.273.

Endovascular Treatment of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm during Pregnancy

Affiliations
  • 1Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Daegu, Korea. jyjns@yu.ac.kr

Abstract

Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is quite rare, however it has a high maternal mortality rate. A pregnant woman in the 16th gestational week was admitted to our hospital with a drowsy level of consciousness. A brain magnetic resonance (MR) image showed hemorrhage on the prepontine cistern, and both sylvian fissures, and MR angiography and cerebral digital subtraction angiography demonstrated an aneurysm at the left posterior inferior cerebellar artery (PICA). We performed endovascular coil embolization attempting to minimize radiation exposure. She was discharged with no neurologic deficit and delivered a healthy baby by cesarean section at the 38th week of gestation. This case study reported the shortest gestational period and this is the first report on an aneurysmal rupture arising from PICA which was treated using an endovascular method. Using an appropriate technique for reduced radiation exposure to the fetus and limited alterations in maternal-fetal physiology, endovascular coil embolization could guarantee good results in treatment of aneurysmal SAH in pregnant women.

Keyword

Embolization; Posterior inferior cerebellar artery; Pregnancy; Radiation; Subarachnoid hemorrhage

MeSH Terms

Aneurysm*
Angiography
Angiography, Digital Subtraction
Arteries*
Brain
Cesarean Section
Consciousness
Embolization, Therapeutic
Female
Fetus
Hemorrhage
Humans
Maternal Mortality
Neurologic Manifestations
Physiology
Pica
Pregnancy*
Pregnant Women
Rupture
Subarachnoid Hemorrhage

Figure

  • Fig. 1 Magnetic resonance image (fluid attenuated inversion recovery image) showing high signal intensity on the prepontine cistern (A) and both sylvian fissures (B). Magnetic resonance angiography showing an aneurysm on the left posterior inferior cerebellar artery (C).

  • Fig. 2 Preprocedural vertebral angiogram, it shows an aneurysm on the anterior medullary segment of the left posterior inferior cerebellar artery.

  • Fig. 3 Post-embolization vertebral angiogram, it shows complete coiling of a ruptured aneurysm with intact distal flow.


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