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Reversible cerebral vasoconstriction syndrome during caesarean section
Szilard Laszlo Safran1,2, Christian Balmer1, Georges Savoldelli3,4
1Service d'anesthésiologie et de réanimation du CHVR, Hopital du Valais, Sion, Switzerland.
BMJ Case Reports
|December 8, 2019
Summary
A severe headache during a cesarean section was caused by reversible cerebral vasoconstriction syndrome (RCVS). Phenylephrine, used for hypotension, triggered this rare condition, highlighting the need for obstetric and anesthesia awareness.
Area of Science:
- Neurology
- Obstetrics
- Anesthesiology
Background:
- Reversible cerebral vasoconstriction syndrome (RCVS) is a condition affecting cerebral arterial tone, leading to vasospasms.
- It can be triggered by various factors including vasoactive drugs, illicit substances, pregnancy, and the postpartum state.
Observation:
- A 25-year-old parturient experienced sudden, severe headache during an emergency cesarean section.
- The headache was attributed to RCVS, triggered by intravenous phenylephrine administered to manage hypotension post-spinal anesthesia.
Findings:
- Phenylephrine, a common treatment for hypotension during anesthesia, can precipitate RCVS.
- RCVS diagnosis and management are complicated in pregnant and postpartum patients due to medication restrictions.
Implications:
- This case underscores the importance of recognizing RCVS in obstetric patients, particularly when vasoactive drugs are used.
- Increased awareness among anesthesiologists and obstetricians is crucial for timely diagnosis and appropriate management of this rare but serious condition.
