-Case Reports-

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

Kohei Hironaka¹, Masanori Suzuki¹, Kojiro Tateyama¹, Tomohiro Ozeki¹, Koji Adachi¹ and Akio Morita²

¹Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
²Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan

Background: Aneurysmal subarachnoid hemorrhage is a rare but important cause of maternal death during pregnancy.
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.
Conclusions: A pregnant woman with severe headache should undergo brain CT or magnetic resonance imaging to rule out subarachnoid hemorrhage.

J Nippon Med Sch 2020; 87: 162-165

Keywords
warning headache, subarachnoid hemorrhage, pregnancy, cesarean section

Correspondence to
Kohei Hironaka, MD, PhD, Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
s9080@nms.ac.jp

Received, December 12, 2019
Accepted, February 26, 2020