Pregnant women suffering a hypertensive intracranial hemorrhage

A 25-year-old young woman presented with a sudden onset of loss of consciousness and was drowsy and arousal but slept again quickly. She was highly disoriented while awake and had psychosis. The patient was 36 weeks pregnant with no history of raised blood pressure, edema, seizures, or headaches. 

Examination revealed raised blood pressure and heart rate. Brain CT diagnosed an intraventricular brain hemorrhage with associated hydrocephalus. The glucose level and CT angiography were normal. Other examinations revealed mild anemia and dyslipidemia. 

Urgent lower segment cesarean section (LSCS) was performed to rescue the infant, and neurosurgery was recommended for external ventricular drainage and ventriculoperitoneal, which was denied. The patient received conservative treatment with acetazolamide and dexamethasone for an intracerebral hemorrhage (ICH), which gradually improved her condition and resolved the brain hemorrhage. As her consciousness improved and drowsiness decreased, she experienced headaches and vertigo but did not exhibit any limb weakness. Over the next few days, her clinical condition and radiological findings continued to improve, and she was deemed fit for discharge.

After 15 days of hospitalization, the patient was discharged on a regimen of antibiotics, antiseizure medications, antihypertensives, angioedema management, and other supportive care, all of which were gradually tapered in the outpatient setting, except for antihypertensives. At a three-month follow-up, she showed no signs of weakness or slurred speech, and her CT scan was normal.

Mittal SH, Mittal S, Goel N. HYPERTENSIVE INTRACRANIAL HAEMORRHAGE IN ADVANCED PREGNANCY: A RARE CLINICAL ENTITY. Indian Obstetrics and Gynecology. 2024;14(1)