Anesthesia and hemorrhagic stroke in pregnancy: case report and literature review

Hemorrhagic stroke during pregnancy is a rare but life-threatening condition, commonly resulting from ruptured cerebrovascular malformations or aneurysms that lead to intracerebral or subarachnoid hemorrhage (SAH). This case demonstrates favorable maternal and neonatal outcomes following rapid multidisciplinary coordination and timely delivery, adding valuable insight into decision-making in late-pregnancy intracerebral hemorrhage (ICH).

We report a case of a 39-year-old woman at 35 weeks of gestation who presented with sudden-onset neurological symptoms and was diagnosed with spontaneous ICH. On admission, a multidisciplinary team including obstetricians, anesthesiologists, and neurologists was involved. Due to the lesion's anatomical distribution, endovascular intervention was deemed unsuitable. An emergency cesarean section under general anesthesia was performed to optimize both maternal and fetal outcomes. Postoperatively, the patient was closely monitored, and both maternal and neonatal outcomes were favorable.

Early recognition and an individualized, multidisciplinary approach are essential to improving outcomes for both mother and fetus. This case highlights that, in selected scenarios, prompt delivery combined with conservative neurocritical management can lead to successful results and contribute to the limited body of literature guiding care in such complex situations.