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Antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease: a case report

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Abstract

Purpose

Moyamoya (meaning a “hazy puff of smoke” in Japanese) disease is a rare cerebrovascular occlusive disease. Moyamoya disease may become symptomatic for the first time during pregnancy. We report a case of antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease, which was subsequently diagnosed as HELLP syndrome during the postpartum period.

Study design

A case report of a 29-year-old Japanese primigravida who was transported to our hospital at 39 weeks of gestation because of sudden loss of consciousness and left hemiplegia. On arrival, her blood pressure was 143/94 mmHg with 1+ proteinuria by dipstick. Brain computed tomography revealed a right putaminal hemorrhage with intraventricular hemorrhage. The patient delivered a neonate by emergency cesarean section, and an intracranial hematoma was subsequently evacuated. Approximately 3 h postoperatively, she was diagnosed with HELLP syndrome and the following were initiated: IV magnesium sulfate, antihypertensive agents, and transfusion of 10 units of platelets. Angiographic findings were consistent with unilateral moyamoya disease.

Conclusions

Moyamoya disease is a rare entity that must be considered in the differential diagnosis of hemorrhagic stroke during pregnancy. It is important to perform careful monitoring and adequate management with cooperation between obstetricians and other specialists when serious complications arise.

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References

  1. Fukui M (1997) Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (‘moyamoya’ disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (moyamoya disease) of the Ministry of Health and Welfare, Japan. Clin Neurol Neurosurg 99(Suppl 2):S238–S240

    PubMed  Google Scholar 

  2. Komiyama M, Yasui T, Kitano S, Sakamoto H, Fujitani K, Matsuo S (1998) Moyamoya disease and pregnancy: case report and review of the literature. Neurosurgery 43(2):360–368

    Article  PubMed  CAS  Google Scholar 

  3. Haram K, Svendsen E, Abildgaard U (2009) The HELLP syndrome: clinical issues and management. A review. BMC Pregnancy Childbirth 9:8

    Article  PubMed  Google Scholar 

  4. Sibai BM (1990) The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing? Am J Obstet Gynecol 162(2):311–316

    PubMed  CAS  Google Scholar 

  5. Kim A, Choi CH, Han CH, Shin JC (2009) Consecutive pregnancy with chorea gravidarum associated with moyamoya disease. J Perinatol 29(4):317–319

    Article  PubMed  CAS  Google Scholar 

  6. Conn JJ, Champion De Crespigny PJ, Davis SM, Laidlaw JD, Moriarty K, Jurcevic PA (2008) Successful pregnancy outcome in a patient with moyamoya disease. Aust N Z J Obstet Gynaecol 48(6):608–609

    Article  PubMed  Google Scholar 

  7. Montiel V, Grandin C, Goffette P, Fomekong E, Hantson P (2009) Refractory high intracranial pressure following intraventricular hemorrhage due to moyamoya disease in a pregnant caucasian woman. Case Rep Neurol 1(1):1–7

    Article  PubMed  Google Scholar 

  8. Vaughan CJ, Delanty N (2000) Hypertensive emergencies. Lancet 356(9227):411–417

    Article  PubMed  CAS  Google Scholar 

  9. Yamashita M, Oka K, Tanaka K (1983) Histopathology of the brain vascular network in moyamoya disease. Stroke 14(1):50–58

    PubMed  CAS  Google Scholar 

  10. Burke GM, Burke AM, Sherma AK, Hurley MC, Batjer HH, Bendok BR (2009) Moyamoya disease: a summary. Neurosurg Focus 26(4):E11

    Article  PubMed  Google Scholar 

  11. Isler CM, Rinehart BK, Terrone DA, Martin RW, Magann EF, Martin JN Jr (1999) Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 181(4):924–928

    Article  PubMed  CAS  Google Scholar 

  12. Kittner SJ, Stern BJ, Feeser BR, Hebel R, Nagey DA, Buchholz DW, Earley CJ, Johnson CJ, Macko RF, Sloan MA, Wityk RJ, Wozniak MA (1996) Pregnancy and the risk of stroke. N Engl J Med 335(11):768–774

    Article  PubMed  CAS  Google Scholar 

  13. Gliemroth J, Knopp U, Kehler U, Felberbaum R, Nowak G (2000) HELLP syndrome with haemaglobin vasospasm. Clin Neurosci 7(1):59–62

    Article  CAS  Google Scholar 

  14. Magann EF, Martin JN Jr (1999) Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol 42(3):532–550

    Article  PubMed  CAS  Google Scholar 

  15. Turan TN, Stern BJ (2004) Stroke in pregnancy. Neurol Clin 22(4):821–840

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors have no conflict of interest and financial support for this work.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Jun Kakogawa, Miyuki Sadatsuki, Norio Masuya, Hideto Gomibuchi & Shigeki Minoura

  2. Department of Neurosurgery, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, 162-8655, Japan

    Hiroyasu Ohno & Tetsuo Hara

  3. Department of Emergency Medicine and Traumatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, 162-8655, Japan

    Hiroko Oda & Akio Kimura

Authors
  1. Jun Kakogawa
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  2. Miyuki Sadatsuki
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  3. Norio Masuya
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  4. Hideto Gomibuchi
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  5. Hiroyasu Ohno
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  6. Tetsuo Hara
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  7. Hiroko Oda
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  8. Akio Kimura
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  9. Shigeki Minoura
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Corresponding author

Correspondence to Jun Kakogawa.

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Kakogawa, J., Sadatsuki, M., Masuya, N. et al. Antepartum intracranial hemorrhage due to unrecognized unilateral moyamoya disease: a case report. Arch Gynecol Obstet 283 (Suppl 1), 19–22 (2011). https://doi.org/10.1007/s00404-010-1654-3

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  • DOI: https://doi.org/10.1007/s00404-010-1654-3

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