Intracerebral Hemorrhage with Cerebral Arteriovenous Malformation Rupture During Pregnancy

摘要

The incidence of arteriovenous malformation (AVM) is approximately 1 per 100,000 population per year in unselected populations, and the point prevalence in adults is approximately 18 per 100,000 population per year. AVM accounts for between 1% and 2% of all strokes and 3% of strokes in young adults. In addition, of all primary intracerebral hemorrhages, they are responsible for 4% overall but for as high as one-third in young adults [1].The natural history and prevalence of intracranial AVMs during pregnancy are largely unknown, because some AVMs remain asymptomatic. An AVM is a congenital tangle of abnormal arteries and veins, with interposed cavernous vascular channels that are neither arteries nor veins. The malformations can be asymptomatic and discovered incidentally, or can be accompanied by headache, seizures or focal signs. Brain AVMs usually present between the ages of 10 and 40 years. The clinical presentation typically falls into one of three categories: intracranial hemorrhage (41-79%); seizure (11-33%); and headache and focal neurologic deficit. Most of the available data suggest that the risk of hemorrhage from a brain AVM is not increased during pregnancy [2]. Pregnancy does not appear to increase the likelihood of hemorrhage from an AVM. Many women with known AVMs have been advised not to become pregnant because of concern about hemorrhaging. Hypertension and albuminuria were present at some time during the pregnancy in 34% of patients with documentation, which sometimes made it difficult to differentiate angiomatous or aneurysmal intracerebral hemorrhage from that associated with eclampsia [3].