1. AbstractPreeclampsia is a condition that affects nearly 8% of pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered. A spontaneous subdural hematoma associated with preeclampsia is extremely rare. The author is reporting in this article the case of a 32-year-old woman with 34 weeks of gestation, who sought treatment for high blood pressure, headache, and proteinuria. Nearly 6 weeks after a cesarean delivery of a stillborn baby, the patient developed headache and palsy of the left VIth cranial nerve. Magnetic resonance imaging revealed a left hemispherical subdural hematoma, with midline deviation.
2. Introductionreeclampsia is a multisystem disorder that complicates 3-8% of pregnancies and constitutes a major source of morbidity and mortality worldwide [4]. Intracranial hemorrhage is a rare complication during pregnancy, but potentially fatal. The main causes are ruptured aneurysm, arteriovenous malformations (MAV) and pregnancy-induced hypertension. Subdural hemorrhage associated with pregnancy has been reported in post trauma or as a complication of epidural anesthesia during labor. A spontaneous subdural hematoma associated with preeclampsia is considered as a rare condition, it has been reported in some cases in the literature
3. Case ReportA 32-year-old gravida 3 para 2 patient with a history of cesarean delivery of a stillborn baby for preeclampsia six weeks ago was referred to our department. She has had headache and visual diorders since the fourth week postpartum. On admission the patient was fully awake with a Glasgow Coma Scale at 15. Eye examination revealed a diplopia, a left ptosis and a left esotropia which means a palsy of the VIth cranial nerve. The cardiopulmonary examination was unremarkable. Laboratory studies included hemoglobin of 10.4g/l, platelet count 290000/mm3, serum glutamic oxaloacetic transaminanse (SGOT): 30.4 IU/L, glutamic puryvate transaminase (SGPT): 28.2IU/L, urea: 0.08g/l, créatinine: 9.46mg/l, total bilirubin: 0.7mg/dl. The brain CT Scan showed an 11.6mm left fronto-temporo- parietal chronic subdural hematoma with rebleeding marks, a 4.1mm midline deviation to the right and a subfalcine herniation (Figure 1 and 2). In our case the patient had a normal count of platelet and did not receive magnesium sulfate before.
4. DiscussionIntracranial hemorrhage is a rare complication occurring in 0.01- 0.05% in pregnancies [2]. Subdural hematoma is a common condition, complicating around 1% of head trauma. Most cases occur after trauma, coagulopathy, dural metastases, meningiomas and aneurysms, and are extremely rare in the context of pregnancy and postpartum. Some cases subdural hematoma resulting from a head injury during pregnancy has been reported [1].
5. ConclusionSubdural hematomas during pregnancy are rare, they should be considered in the differential diagnosis of headache in pregnancy and puerperium, especially when there is a focal neurological sign and/or thrombotic microangiopathy. Possibly involving maternal and fetal prognosis, they must be detected early and treated effectively.
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Atroune L. Non-Traumatic Postpartum Subdural Hematoma: A Case Report of Probable Complication of Preeclampsia. Annals of Clinical and Medical Case Reports 2023