#2021 Vitality Conference ##益阳市中心医院 #
Recently, Ms. Chen, who was more than 4 months pregnant, had repeated headaches and went to the obstetrics and gynecology department of the local hospital.
Shortly after being admitted to the hospital, Ms. Chen's condition suddenly worsened, she lost consciousness, and then her heartbeat and breathing stopped, and her family was frightened.
After the doctor's active rescue, Ms. Chen's breathing and heartbeat recovered, but she was still unconscious, and the cause of the disease was unknown, and her condition was very critical.
【CT examination at the onset of illness】
The local hospital immediately launched the Yiyang critically ill maternal treatment system, under the coordination of the medical department of Yiyang Central Hospital, after the joint diagnosis of neurosurgery, neurology, gynecology, obstetrics and other specialties, and improved the CT examination, it was known that Ms. Chen was a cerebellar hemorrhage, and the amount of bleeding was large, the surrounding important tissue structures were under pressure, the situation was very critical, and the condition could worsen at any time and lead to death.
In addition, the cause of intracerebral hemorrhage is still unknown, adding more uncertainties to the determination of the next treatment plan.
After emergency communication with the family, the Medical Department of Yiyang Central Hospital took the lead, and the members of the expert group of emergency, laboratory, radiology, neurological and neurovascular disease responded at the first time, cooperated closely, and quickly started the green channel for maternal treatment.
Ms. Chen was immediately transferred to the Central Hospital for further treatment.
【Patient DSA Examination】
Li Kai, deputy chief physician of the Cerebrovascular Disease Professional Group of Neurosurgery, improved the whole cerebral angiography for Ms. Chen in the shortest possible time, and clarified the root cause of the patient's cerebellar hemorrhage - cerebellar vascular malformations combined with aneurysm, which is an extremely dangerous and seriously life-threatening disease, and is a complex "bomb" hidden in the patient's skull, which may explode again at any time.
【Preoperative discussion】
For pregnant women with cerebellar arteriovenous malformations with aneurysms and rupture and bleeding, especially those who have just undergone cardiopulmonary resuscitation, the difficulty and risk of treatment can be imagined!
It was also a great challenge for the neurosurgery team.
With the strong support of the Medical Department and the full understanding and trust of the patient's family, the medical team has fully discussed and formulated a meticulous treatment plan and adverse risk plan.
Under the personal coordination and command of Director Su Qiucai and Director Xiong Ming, an operating team consisting of Chief Physician Sun Xuezhi, Deputy Chief Physician Li Zheng and Attending Physician Huang Tao was formed to perform emergency craniotomy for Ms. Chen on the day of admission.
The next day after the operation, Ms. Chen gradually regained consciousness and was able to communicate with the medical staff simply, and the hanging hearts of the doctors and their families were slightly relaxed.
【CT for postoperative review】
After the operation, Ms. Chen recovered well after the meticulous treatment and care of the neurosurgery cerebrovascular disease team and the intensive care team, as well as the follow-up related rehabilitation treatment.
【Postoperative Group Photo of Ms. Chen and the Medical Staff of the Department】
Intracerebral hemorrhage in pregnant women is rare and, once present, has a very high mortality rate.
According to relevant literature, the risk of cerebral hemorrhage during pregnancy and puerperium is 0.6/100,000, which is a rare incidence, but the mortality rate is as high as 40% to 83%.
For pregnancy-related nonhypertensive intracerebral hemorrhage, that is, those pregnant women with no history of hypertension, about 76% of the causes are intracranial arteriovenous malformations and aneurysms, which further increases the difficulty of treatment.
Intracranial arteriovenous malformations are congenital dysplasias, which are pathological cerebrovascular masses formed by one or more abnormally developed blood supply arteries and drainage veins, which can grow with the development of the human body, some less than 1cm, and some up to 10cm, sometimes with aneurysms.
Clinical manifestations are often bleeding, epilepsy, etc., CT, MRI and DSA can assist in diagnosis, surgical resection is still the best treatment plan, in addition to interventional embolism and gamma knife therapy.
Yiyang Central Hospital Neurosurgery Cerebrovascular Sub-specialty (Neurosurgery Ward I) has developed rapidly in recent years, nerve intervention and micro-clipping go hand in hand, constantly challenging high-tech and high-difficulty surgery, the level of diagnosis and treatment has reached the advanced level in the province, and the average annual completion of cerebral aneurysms and cerebrovascular malformations is about 120, more than 200 cerebral angiography, and the surgical effect is mostly satisfactory.
In the past, a large part of these difficult and risky surgeries required travel to changsha, Beijing, Shanghai and other major cities, which greatly increased the burden of patients and their families.
Nowadays, the continuous development of the technical strength of the neurosurgical team can basically meet the medical needs of the people in Yiyang and surrounding districts and counties, and make a contribution to solving the problem of the difficulty of the people to see a doctor.
(Editing Rainbow.) Some of the image sources of the network, invasion and deletion)
Hunan Medical Chat Special Author: Huang Tao, Yiyang Central Hospital Pay attention to @Hunan Medical Chat for more health science information!