Spontaneous subdural hematoma associated with preeclampsia: a case report and litterature review
Nezha Oudghiri, Mehdi Behat, Nada Elchhab, Mouhssine Doumiri, Anas Saoud Tazi
The Pan African Medical Journal. 2014;19:213. doi:10.11604/pamj.2014.19.213.5451

Create an account  |  Sign in
Case studies in Public health Supplement 2 Supplement
"Better health through knowledge sharing and information dissemination "

Case report

Spontaneous subdural hematoma associated with preeclampsia: a case report and litterature review

Cite this: The Pan African Medical Journal. 2014;19:213. doi:10.11604/pamj.2014.19.213.5451

Received: 19/09/2014 - Accepted: 21/10/2014 - Published: 28/10/2014

Key words: spontaneous subdural hematoma, pre-eclampsia, neurologic,

© Nezha Oudghiri et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/19/213/full

Corresponding author: Nezha oudghiri, Department of Obstetrics Intensive Care Unit and Anesthesia, Maternity Souissi Hospital, University Mohamed V, Rabat, Morocco (nezhaoudghiri@yahoo.fr)


Spontaneous subdural hematoma associated with preeclampsia: a case report and litterature review

 

Nezha Oudghiri1,&, Mehdi Behat1, Nada Elchhab1, Mouhssine Doumiri1, Anas Saoud Tazi1

 

1Department of Obstetrics Intensive Care Unit and Anesthesia, Maternity Souissi Hospital, University Mohamed V, Rabat, Morocco

 

 

&Corresponding author
Nezha oudghiri, Department of Obstetrics Intensive Care Unit and Anesthesia, Maternity Souissi Hospital, University Mohamed V, Rabat, Morocco

 

 

Abstract

A patient with pre-eclampsia at 31 weeks' gestation developed neurologic signs. Computerized tomography revealed a large cranial subdural hematoma. This diagnostic should be considered in any pre-eclamptic patient demonstrating neurological symptoms and must be treated effectively because of the poor maternel and fetal prognosis. Our patient was succesfully treated.

 

 

Introduction

Intracranial hemorrhage is a rare complication during pregnancy, but potentially fatal, which contributes significantly to maternal mortality. The main causes are ruptured aneurysm, arteriovenous malformations's (MAV) and pregnancy-induced hypertension. The aneurysm or AVM usually causes a subarachnoid hemorrhage; intracranial hemorrhage while associated with pre-eclampsia is usually intra- parenchymal. Subdural hemorrhage associated with pregnancy has been reported in post trauma or as a complication of epidural anesthesia during labor. A spontaneous subdural hematoma associated with preeclampsia, have been reported in some cases in the literature. We now describe such a case.

 

 

Patient and observation

A 30-year old primigravid woman with no particular history was hospitalized for management of preeclampsia in pregnancy at 31weeks' gestation. On admission the patient was sleepy with the the glascow coma scale at 13, eye examination revealed pupils to be equal and reactive to light bilaterally, blood pressure was 150/100 mmHg with 4+proteinuria without signs of trauma, no concept of convulsions, or tongue biting, the patient denied any headache, visual disturbances or epigastric pain. The cardiopulmonary examination was unremarkable. The obstetric examination note long neck and posterior closed and intact membrane. Obstetric ultrasound reveale an estimated fetal age of 27 weeks' with adequate fluid volume. Laboratory studies included a hemoglobin of 13,6g/l, platelet count 178000/mm3, serum glutamic oxaloacetic transaminanse (SGOT): 11 IU/L, glutamic puryvate transaminase (SGPT): 15IU/L, urea: 0, 4 g/l, créatinine: 6.6mg/dl, total bilirubin: 8mg/dl. The brain scan objective a subdural hematoma (Figure 1). A first dose of betamethasone was administrated to enhance fetal lung maturity. The patient was admitted on the same day in the operating room and the hematoma was evacuated. The evolution was marked by neurological improvement without any motor or sensory deficit; she was well oriented and responsive to questions and commands. At the fifth day the parturient has delivered naturelly a 32 weeks' newborn who died in the ICU because of respiratory distress and prematurity.

 

 

Discussion

Intracranial hemorrhage is a rare complication occuring in 0.01-0.05 per cent in pregnancies. The aneurysm or arterio-venous malformations are the most common causes of intracranial hemorrhage. Pregnancy-induced hypertension is also a factor of intra parenchymal hemorrhage [1]. The subdural hematoma is a rare form of intracranial hemorrhage associated with pregnancy. Some cases subdural hematoma resulting from a head injury during pregnancy has been reported [2]. Other cases of subdural hematoma have been reported in post- partum in association with epidural anesthesia [3].

The clinical symptoms described in these patients in post partum presented by: headache, dizziness, disorientation, memory loss, ophthalmoplegia, papilledema, stupor, coma, and psychosis. The onset of these symptoms varies from the first to the fourth day after delivery [3]. It seems clear that it exists an association between trauma, whether related to a direct head injury or secondary to regional anesthesia and the development of a subdural hematoma. An association between pre-eclampsia and spontaneous subdural hematoma has not been previously reported. Gregg Giannina and al described a subdural hematoma during pregnancy in a patient with preeclampsia without notion of trauma. The exact etiology of the hematoma in this patient is not clear. However, thrombocytopenia may have been a predisposing factor for the development of intracranial hemorrhage and / or the inhibition of platelet function due to magnesium sulfate [4]. In our case the patient had a normal count of platelet and did not receive magnesium sulfate before.

 

 

Conclusion

The hemorrhagic cerebrovascular accidents during pregnancy are rare, possibly involving maternal and fetal prognosis. They must be detected early and treated effectively, and often requires a multidisciplinary approach.

 

 

Competing interests

Authors declare no competing interests.

 

 

Authors’ contributions

N. Oudghiri is the main corresponding author. All authors participated on the conception, design, acquisition and interpretation of data and declare approving the final version of the manuscript.

 

 

Figure

Figure 1: computerized tomography scan of the head demonstrating a midline shift and a large left sided subdural hematoma

 

 

References

  1. Sharshar T, Lamy C, Mas JL. Incidence and causes of strokes associated with pregnancy and puerperium: A study in public hospitals of Ile de France. Stroke in Pregnancy Study Group. Stroke 1995; June 26(6): 930-936. PubMed | Google Scholar

  2. Amias AG. Cerebral vascular disease in pregnancy: I Haemorrhage. J Obstet Gynaecol Br Commonw.1970 Feb; 77(2):100-20. PubMed | Google Scholar

  3. Vaughan DJ, Stirrup CA, Robinson PN. Cranial subdural haematoma associated with dural puncture in labour. British Journal of Anaesthesia. 2000;Apr 84(4): 518-520. PubMed | Google Scholar

  4. Giannina G, Smith D, Belfort MA, Moise KJ Jr. Atraumatic subdural hematoma associated with pre-eclampsia. J Matern Fetal Med. 1997 Mar-Apr; 6(2): 93-5. PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 28 (September - December 2017)

Article tools

Rate this article

Altmetric

PAMJ is a member of the Committee on Publication Ethics
Next abstract

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2017 - Pan African Medical Journal. All rights reserved