González PJA, González AJC, Vázquez BY, Reyes TR, Fabián RM

Language: Spanish
References: 11
Page:
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ABSTRACT

The cerebrovascular disease during pregnancy is uncommon. The objective of present paper is to describe the clinical features of a patient with embolisms of the right humeral artery and of the brainstem at expulsion period of a spontaneous labor without emboligen focus causing this cerebrovascular accident. This is the case of a pregnant woman aged 29 with 40,2 weeks of gestational age who during the expulsion period of a spontaneous labor had a intensive pain in the right superior limb with changes of coloration and temperature as well as functional impotence, impossibility to bilateral palpebral opening, vomiting without nauseas, dysarthria and difficulty with the ocular movements. In physical screening it was noted a slight basal mesosystolic souffle II/IV in pulmonary souffle, cyanosis, coldness and lack or humeral and radial pulse in the right superior limb, cerebellum dysarthria, bilateral vertical nystagmus, right faciobrachial monoparesis 1-2. Neuroimaging showed the presence of a recent cerebelum ischemic infarction and at level of left cerebral peduncle. The right humeral artery is explored using a Fogarty's catheter, removing a 6 cm thrombus. Was admitted in intensive care unit under treatment with 1,5 mg/kg/day for 5 days Fraxiparin followed by 0,5 mg/kg warfarin as a dose of impregnation remaining with 5 mg/day as maintenance dose and with a favorable evolution improving progressively the neurologic symptomatology being discharged at 15 days starting the functional rehabilitation program.

REFERENCES

1. Bejot Y, Benatru I, Rovauda U, Fromont A, Besancenot JP. Epidemiolgy of stroke in Europe: Geographic and environmental differences. J Neurol Sci. 2007;262(1-2):86.

2. Buergo Zuaznabar MA. Guías de práctica clínica. Enfermedad Cerebrovascular. La Habana: Editorial Ciencias Médicas. 2009;(IX):1.

3. Karnad D, Guntupalli K. Neurologic desorden in pregnancy. Crit Care Med. 2007;33:Supp 10:362.

4. James A, Bushnell C, Jamison M. Incidence and risk factors for stroke in pregnancy and the puerperium. Rev Obstet Gynecol. 2006;106:299.

5. Sáez M, David E, Fuentes Paulo. Neurología y embarazo. Rev Chil Neuro-psiquiatria (online). 2010;48(4):279.

6. 6.Gómez Bravo T, Briones JC. Medicina Critica en Obstetricia .Impacto de un programa educativo. Rev Asoc Mex Med Crit y Ter Int. 2009;23:101.

7. Gómez BTE, Briones JC, Morales EJC, Rodríguez RM. Mortalidad Materna en el estado de México. Rev Asoc Mex Med Crit y Ter Int. 2010;34:199.

8. Dilip R. Neurological disorder in pregnancy. Crit Care Med. 2005;33:362.

9. Almagro Vázquez Delfina. La hemostasia en el embarazo. Rev Cubana Hematol Inmunol Hemoter. 2000;16(2):90-8.

10. Davie C, O Brien P. Stroke and pregnancy. JNNP. 2008;79:240.

11. González- Blanco I, A Bravo P, Quesada G, Rodríguez-Bújez A, Taracón I. Infarto cerebeloso en el primer trimestre del embarazo. Rev Clin Invest Gin Obst. 2009;30(5):167.