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Parturient with Cerebral Cavernoma
Abstract Number: T-46
Abstract Type: Case Report/Case Series
This case report describes a 29 year old G1P0 who presented to the labor and delivery suite for a primary cesarean section due to a cerebral cavernoma located at the right temporal lobe. The patient was first diagnosed with the cavernoma 4 years prior during a workup for severe headache which revealed a cavernous hemangioma with subarachnoid hemorrhage. Cavernous malformations, also known as cerebral CMs, cavernous angiomas, cavernous hemangiomas, or cavernomas are vascular malformations found commonly in the central nervous system. Cavernomas are one of the most common vascular malformations with an incidence of 1 in 200 people. The danger of these lesions is the risk of rupture that may consequently lead to a stroke or death. There are no clear guidelines for the anesthetic management during pregnancy for a patient with a cavernoma. Case reports of patients presenting with urgent cesarean section in which general anesthetics have been used have been noted with successful results. Regional anesthesia may be ideal as this minimizes the potential hemodynamic stresses associated with a rapid-sequence general anesthetic technique. For our management, a spinal anesthetic was performed with a 24 g sprotte spinal needle. A total of 1.6cc of hyperbaric bupivacaine 0.75%, fentanyl 10µg and duramorph 0.2mg were injected into the subarachnoid space. A healthy infant was delivered, and the patient’s intraoperative and postoperative courses were uneventful.
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(2) Kalani MY, Zabramski JM. Risk for symptomatic hemorrhage of cerebral cavernous malformations during pregnancy. J Neurosurg. 2013 Jan;118(1):50-5.
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(5) Witiw CD, Abou-Hamden A, Kulkarni AV, Silvaggio JA, Schneider C, Wallace MC. Cerebral cavernous malformations and pregnancy: hemorrhage risk and influence on obstetrical management. Neurosurgery. 2012 Sep;71(3):626-31.