妊娠中の警告性頭痛後の重症くも膜下出血．症例報告

Severe Aneurysmal Subarachnoid Hemorrhage after Warning Headache during Pregnancy: A Case Report.

• Kohei Hironaka
• Masanori Suzuki
• Kojiro Tateyama
• Tomohiro Ozeki
• Koji Adachi
• Akio Morita

抄録

背景:

動脈瘤性くも膜下出血は，妊娠中の母体死亡の原因として，まれではあるが重要なものである．

BACKGROUND: Aneurysmal subarachnoid hemorrhage is a rare but important cause of maternal death during pregnancy.

症例説明:

急性頭痛を呈したが神経障害や頸部硬直は認められなかった34歳のプリミグラビダ（妊娠31週）が薬を処方されて帰宅した。4週後に激しい頭痛と意識障害を呈した。当院に入院し、深い昏睡状態に陥った。脳CT，三次元CT血管造影でくも膜下出血，右内頸動脈後連絡動脈瘤5mmを認めた．胎児心拍数は60拍/分であった。胎児の心拍数は60拍であった．術中検査の結果，動脈瘤は右後連絡動脈に発生していた．術後の神経学的障害はなかった。術後13日目に右前頭葉-後頭葉の遅発性脳虚血を発症した。術後36日目に左半眼症を呈して退院した．乳児に合併症はなく，生後17日目に退院した．

CASE DESCRIPTION: A 34-year-old primigravida (31 weeks of pregnancy) with acute headache but no neurological deficits or neck stiffness was prescribed medication and returned home. Four weeks later she presented with severe headache and consciousness disturbance. She was admitted to our hospital, where she fell into a deep coma. Brain CT and three-dimensional CT angiography showed subarachnoid hemorrhage and a 5-mm right internal carotid-posterior communicating artery aneurysm. Fetal heart rate was 60 beats per minute. Emergent cesarean section and surgical clipping were performed. Intraoperative examination revealed that the aneurysm originated at the right posterior communicating artery. There were no postoperative neurological focal deficits. On postoperative day 13 she developed delayed cerebral ischemia of the right temporo-parieto-occipital lobe. She was discharged home 36 days after surgery with left hemianopsia. The infant was free of complications and was discharged at age 17 days.

結論:

重度の頭痛を伴う妊婦は、くも膜下出血を除外するために脳CTまたは磁気共鳴画像検査を受けるべきである。

CONCLUSIONS: A pregnant woman with severe headache should undergo brain CT or magnetic resonance imaging to rule out subarachnoid hemorrhage.