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Hemorrhagic stroke following elective cesarean delivery
J S Ranasinghe1, S Kafi, J Oppenheimer
1Department of Anesthesiology, Jackson Memorial Medical Center, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. jranasinghe@med.miami.edu
International Journal of Obstetric Anesthesia
|May 31, 2008
Summary
A rare case of hemorrhagic stroke occurred in a pregnant woman after cesarean delivery. Vasopressor therapy for spinal anesthesia-induced hypotension may have contributed to this serious complication.
Area of Science:
- Obstetrics and Gynecology
- Neurology
- Anesthesiology
Background:
- Combined spinal-epidural anesthesia is commonly used for cesarean deliveries.
- Protein C deficiency is a rare inherited thrombophilia requiring anticoagulant therapy.
- Intraoperative hypotension is a frequent complication managed with vasopressors.
Observation:
- A 35-year-old Hispanic patient with protein C deficiency on anticoagulants underwent cesarean delivery under combined spinal-epidural anesthesia.
- She experienced intraoperative hypotension requiring vasopressor therapy.
- Immediately after vasopressor administration, she developed a severe headache, indicative of a potential neurological event.
Findings:
- The patient developed a hemorrhagic stroke shortly after receiving vasopressor therapy for hypotension during cesarean delivery.
- This is the first reported case of stroke in a pregnant woman following vasopressor use for spinal anesthesia-induced hypotension.
- The stroke may be linked to a hypertensive response triggered by vasopressor agents, even at standard doses.
Implications:
- This case highlights a potential, albeit rare, risk of hemorrhagic stroke associated with vasopressor use in pregnant patients undergoing neuraxial anesthesia.
- Further research is needed to understand the precise mechanisms and risk factors involved.
- Clinicians should maintain vigilance for neurological complications in pregnant patients receiving vasopressors, especially those with underlying thrombophilia or risk factors for hypertension.
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