Anaesthesia for caesarean delivery in a parturient following a recent cerebrovascular event

Ischaemic cerebrovascular events in pregnancy are uncommon. The anaesthetic management of a pregnant patient within six weeks of an ischaemic cerebrovascular event has not previously been reported. Issues raised include consent and minimising further neurological insult. Changes in regional blood flow, cerebral metabolic rate and integrity of the blood brain barrier must be considered although evidence to support regional in preference to general anaesthesia is lacking. We report the case of a woman with known systemic lupus erythematosis and antiphospholipid syndrome who developed idiopathic thrombocytopenic purpura in pregnancy and suffered a thrombotic cerebral vascular accident at 32 weeks of gestation. Ten days later she required urgent caesarean delivery, which was performed under general anaesthesia. There was no deterioration in neurological function following surgery and eight days postoperatively she was transferred to a neuro-rehabilitation centre for further care. The idiopathic thrombocytopenic purpura did not respond to medical therapy following delivery and a second anaesthetic was required for splenectomy four weeks later.