A pregnant case on which EC-IC bypass was successfully performed in the acute phase of brain infarction
Katsuta, T.; Kanata, A.; Nakamura, K.; Tsukamoto, H.; Tazaki, Y.; Hirakawa, S.; Inoue, S.; Takashima, T.
No Shinkei Geka. Neurological Surgery 40(2): 181-186
2012
ISSN/ISBN: 0301-2603 PMID: 22281472 Document Number: 663733
A 30 year-old, 28 weeks-pregnant woman (gravida 2, para 2) suffered from a sudden onset of aphasia when she was having a chat in the upright position. Although the initial symptom soon disappeared, transient attacks of aphasia combined with weakness in the right arm occurred intermittently, particularly when she uprose. MR image disclosed a small acute infarcted focus at the genu of the left internal capsule, while MRA showed an occlusion of the intracranial portion of the left internal carotid artery. She was treated conservatively, but the transient attack continued and her consciousness was slightly lowered. Since repeated examination revealed no recanalization of the occluded artery, treatment was reinforced by using heparin and dopamine on day 1. However, her consciousness was not improved, and dopamine evoked nausea and vomiting. On day 2, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was carried out. Soon after surgery, she regained alertness and the transient attack subsided. Examinations could not clarify the course of the occlusion. She was treated with heparin until she delivered a sound baby in the 37th week. Although STA-MCA anastomosis for acute ischemic stroke is still debatable, it may be a good option even for a pregnant woman when suffering from intractable progressing stroke.