Aneurysmal Subarachnoid Hemorrhage After Cesarean Section Under Spinal Anesthesia: A Case Report

Abstract

Abstract Background The incidence of cerebral aneurysms in the pregnant population is similar to that of the non-pregnant population. Subarachnoid hemorrhage occurs in 5.8 per 100,000 deliveries among women between 15- and 44-year-old. Studies have found that the incidence of aneurysmal rupture is higher during the third trimester and lower during the first trimester. The risk of aneurysmal rupture and subarachnoid hemorrhage during general anesthesia or spinal anesthesia is unclear. We report a case of aneurysm rupture in the postpartum period. Case We describe a case of a 28-year-old woman, Gravida 3 Para 2, who went elective Cesarean delivery under spinal anesthesia at 39 weeks. She developed a headache, right-sided body weakness, and left-sided focal seizures postoperatively. Computed Tomography (CT) scan showed basal ganglia hemorrhage with intraventricular extension, subarachnoid hemorrhage, and midline shift to the right side. The World Federation of Neurological Surgeons (WFNS) grade was 4, and the modified Fischer grade was 4. A right frontal external ventricular drain was inserted, and the patient was admitted to the intensive care unit (ICU). Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) showed a small left supraclinoid aneurysm, and the patient underwent balloon-assisted coiling. Seven days later, the Glasgow Coma Scale (GCS) dropped again, the Computed Tomography (CT) scan showed brain edema, and decompressive craniectomy was done. The patient subsequently improved, and later the external ventricular drain (EVD) was removed, and the patient was referred to a rehabilitation center. Cranioplasty was done three months later. Glasgow Outcome Scale (GOS-E) after six months was 6 (moderate disability). Conclusion The use of vasopressors and cerebrospinal fluid (CSF) leakage may increase the risk of cerebral aneurysm rupture after spinal anesthesia.