妊娠高血圧症候群に合併した産褥期脳出血の1例

A Case of Postpartum Intracerebral Hemorrhage due to Pregnancy Induced Hypertension

Ⅰ．はじめに

　妊産婦に脳出血が発症することは妊娠合併症として認識すべき重要な病態である．脳出血の原因としては，既存の脳血管障害によるもやもや病^15），脳動静脈奇形^10），脳動脈瘤^21）などが挙げられるが，その他にも妊娠特有の病態として妊娠高血圧症候群（pregnancy induced hypertension：PIH）^{3-6,8,9,11,16-18,22）}に続発するものなど多岐にわたる．今回われわれはPIHに合併した産褥期脳出血を来した1例を経験したので，文献的考察を踏まえて報告する．

　A 32-year-old woman,gravida 0,para 0,was admitted to the obstetrics department of our hospital after a cesarean section at 35 weeks of gestation. The cesarean section was performed because pregnancy induced hypertension (PIH) had worsened. The next day,she suddenly became drowsy and developed right hemiparesis and anisocoria. Computed tomography of the brain showed intracerebral hemorrhage in the parietal lobe with uncal herniation. She underwent an urgent craniotomy and removal of the hematoma. Five days later,magnetic resonance angiography (MRA) of the brain showed vasospasm of the bilateral intracranial internal carotid arteries,middle cerebral arteries,and anterior cerebral arteries. Thirteen days later,cerebral angiography showed cessation of vasospasm and vascular abnormalities such as moyamoya disease,arteriovenous malformation and cerebral aneurysm were not observed. Twenty-one days later,MRA showed the absence of vasospasm in those arteries,but her right hemiparesis and sensory aphasia persisted. Twenty-six days later,she was transferred to another hospital for further rehabilitation. Neurosurgeons should be aware of the possibility of intracerebral hemorrhage caused by PIH. In this manuscript,we provide a case presentation and review of the literature.