Cerebral Arteriovenous Malformation Diagnosed during Labor Induction with Headache and Convulsions as Presentations-A Case Report

孕婦在引產期間癲癇發作診斷出顱內動靜脈畸形之病例報告

蘇宏泰(Hung-Tai Su) ； 陳坤堡(Kuen-Bao Chen) ； 劉玉成(Yu-Cheng Liu) ； 潘健成(Kin-Shing Poon) ； 吳世銓(Rich Sai-Chuen Wu)

《Acta Anaesthesiologica Taiwanica》 43卷4期 (2005/12) Pp. 247-251

摘要

妊娠期間因顱內動靜脈畸形而導致的併發症並不常見。顱內動靜脈畸形可能以顱內出血、癲癇、頭痛或其他神經學症候來表現，而且會危及母親及胎兒的生命。我們報告了一位33歲的孕婦，她有室上性陣發心群過速因過期妊娠而住院。在接受了催生劑及硬脊膜外止痛治療後，發生了一次全身性痙攣。顱部磁核共振報告顯示左側額葉底有一顱內動靜脈畸形。在接續的剖腹生產中，維持血行動力學的穩定，對避免顱內出血及其他併發症的產生十分重要。我們成功的以全身麻醉完成了此次手術，並避免了併發症的產生。另外，我們還討論了此孕婦發生癲癇的可能原因和相關產科麻醉。

關鍵字

動靜脈畸形 ； 癲癇 ； 懷孕 ； 硬脊膜外止痛 ； 剖腹產 ； Oxytocin

並列摘要

The occurrence of complications of intracranial arteriovenous malformation (AVM) during labor induction is relatively uncommon. Intracranial AVM can cause convulsions, headache, focal neurological deficits and intracranial hemorrhage if ruptures. We present a 33-year-old parturient with history of paroxysmal supraventricular tachycardia, who was admitted for labor induction. She experienced a bout of convulsion following a 30-min oxytocin infusion, by which time it was three and half hours since she was given the test dose of epidural analgesic. She also denied having history of convulsions or preeclampsia. Magnetic resonance imaging (MRI) of brain demonstrated a cerebral AVM in the left frontal base without signs of intracranial hemorrhage or brain edema. The obstetrician opted for Cesarean section in order to avoid stress during vaginal delivery. The surgery was successfully performed under general anesthesia without hemodynamic fluctuations or neurological complications. We discuss the possible mechanisms of the convulsions attack in this patient and the ensuring anesthetic management for the Cesarean section she sustained.

並列關鍵字

Arteriovenous malformations ； Convulsions ； Pregnancy ； Analgesia ； epidural ； Cesarean section ； Oxytocin