Affiliation:
1. Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
Abstract
Aneurysms of the posterior cerebral artery (PCA) are extremely rare (1% of all intracranial aneurysms) and associated with a high mortality rate of around 20% during surgical repair. The prognosis can only be expected to be grave in the pregnant status with unruptured cerebral aneurysms having a prevalence of 1.8% in pregnancy. We report a case of a 23-year-old, multigravida, at 38 weeks of gestation with ruptured PCA aneurysm (P1 segment) with Hunt and Hess scale of 1. The case was unique, as aneurysm clipping and lower segment cesarean section were attempted in the same anesthesia setting. General anesthesia with multimodal analgesia was administered with drugs having safe and protective neuro-obstetric anesthetic implications. The multifactorial approach to minimize hemodynamic perturbations while keeping in mind maternal and fetal physiology was given prime importance. Teamwork of multidisciplinary specialties played a key role in the successful management of the case.