Clinical case of hemorrhagic stroke in a pregnant woman

Relevance: Stroke is a potentially life-threatening condition for the patient. Hemorrhagic stroke due to the rupture of an arteriovenous malformation in pregnant women is a rare pathology, and its description is of practical interest.

Case report: A 26-year-old female patient N., primipara, at 30 weeks gestation, was transported by air ambulance with signs of haemorrhagic stroke. According to the case conference, the patient underwent the skull trepanation on the left side and ventriculostomy taking into account intraventricular haemorrhage with the development of ventricular tamponade, cerebral edema confirmed by CT scan; the next day the patient had bifrontal decompressive skull trepanation, excision of arteriovenous malformation, removal of hematomas of the right, left lateral and third ventricles. The pregnancy was complicated by chronic fetal hypoxia, with a tendency to progression, stage 2 placental disorder, low water supply, stage 2 anemia; the pregnancy ended at 32 weeks with operative delivery and birth of a live female child, weight 2140 g, height 46 cm with a score of 6–7 according to the Apgar scale. The postoperative period was uneventful. The patient was treated subsequently in accordance with the underlying disease and recommendations of narrow specialists regarding the persisting neurologic deficit and liquorodynamic disorders.

Conclusion: Hemorrhagic stroke due to the rupture of an arteriovenous malformation in a primigravida at 30 weeks is an extremely rare condition with a high risk of death but can be treated in case of timely diagnosis and emergency medical care. Timely neurosurgical treatment and subsequent operative delivery resulted in a favourable pregnancy outcome.