SPONTANEOUS NON-ANEURYSMAL SUBARACHNOID HEMORRHAGE IN PREGNANCY: A CASE REPORT

A 41-year-old primigravida woman transferred from an outside hospital to our Lithuanian University of Health Sciences Hospital with acute-onset severe occipital hea­dache, accompanied by nuchal rigidity, nausea, and vomi­ting at 35+5 weeks’ gestation. The patient was Hunt and Hess grade I or II with a GCS of 13 and was intubated under sedation and transferred to the NICU. Computed tomography revealed the presence of hemorrhage in the suprasellar, interpeduncular, left cerebellopontine angle, anterior segments of Sylvian cisterns and IV ventricle. Suspicion of a 1.5 mm saccular aneurysm in the distal part of the C7 segment of the left ACI on CTA was ruled out by DSA without evidence of vascular malformations or other structural sources of bleeding. The caesarean section was performed based on the predominant indi­cations observed in the ultrasound assessment. Post-sur­gery extubated, fully conscious, no focal or generalized neurological deficits, predominantly painful and menin­geal syndromes. The transcranial Doppler assessment of mean flow velocity (MFV) in the MCA indicated the presence of bilateral mild vasospasm (MFV of 120-149 cm/s), with no clinical symptoms expressed during the initial fourteen-day period in the NICU. A second dia­gnostic cerebral angiography, performed thirteen days later, did not reveal any cerebrovascular abnormalities. The choice of diagnostic approach should be tailored on a case-by-case basis, and it is not reasonable to delay or defer necessary emergency maternal diagnosis because of pregnancy in the presence of a suspicious and nega­tive CTA, independently of the extent of hemorrhage.