Reversible cerebral vasoconstriction syndrome during caesarean section

Article Article scientifique Rapport de cas Reversible cerebral vasoconstriction syndrome during caesarean section eng 2019-12-05 2019-12-05 author Safran Szilard Laszlo Service d'anesthésiologie et de réanimation du CHVR, Hopital du Valais, Sion, Switzerland.,Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland. 974089 author Balmer Christian Service d'anesthésiologie et de réanimation du CHVR, Hopital du Valais, Sion, Switzerland. author Savoldelli Georges Louis 0000-0002-8968-6920 Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland Georges.savoldelli@hcuge.ch.,Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 41344 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) e230606 10.1136/bcr-2019-230606 31811105 1757-790X PMC6904171 https://casereports.bmj.com/content/12/12/e230606.long We describe the case of a 25-year-old parturient who presented sudden onset and short-lived severe headache caused by reversible cerebral vasoconstriction syndrome (RCVS) during an emergency caesarean section. The syndrome was triggered by phenylephrine administered intravenously to correct arterial hypotension following spinal anaesthesia. RCVS is a clinical and radiological syndrome attributed to transient disturbance in the control of cerebral arterial tone resulting in vasospasms. The syndrome can be precipitated by several triggers, including vasoactive drugs, often used during spinal anaesthesia, illicit drugs, pregnancy and postpartum state. Diagnosis and management can be challenging during pregnancy, peripartum or post partum, since many medications commonly used during these periods must be avoided to prevent triggering RCVS. The aim of this report is to raise the awareness, particularly for anaesthesiologists and obstetricians, of this rare and potentially serious syndrome. We discuss diagnosis, triggers, pathogenesis, clinical course and complications, as well as coordinated multidisciplinary management plans. Anaesthesia Headache (including migraines) Neurology (drugs and medicines) Obstetrics, gynaecology and fertility Adult Anesthesia, Spinal / adverse effects Cerebrovascular Disorders / chemically induced Cerebrovascular Disorders / complications Cerebrovascular Disorders / diagnosis Cerebrovascular Disorders / diagnostic imaging Cesarean Section Diagnosis, Differential Female Headache / etiology Humans Hypertension / chemically induced Hypertension / complications Hypertension / diagnosis Hypertension / diagnostic imaging Intraoperative Complications / chemically induced Intraoperative Complications / diagnosis Phenylephrine / administration & dosage Phenylephrine / adverse effects Precipitating Factors Pregnancy Vasoconstrictor Agents / administration & dosage Vasoconstrictor Agents / adverse effects Vasospasm, Intracranial / chemically induced Vasospasm, Intracranial / complications Vasospasm, Intracranial / diagnosis Vasospasm, Intracranial / diagnostic imaging Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 538 Groupe Savoldelli Georges (simulation) 878 BMJ case reports 12 12 23c0c22c-4a47-4a10-a14e-430da8475126 Article (Published version) Public Article_scientifique_from_europePmc.pdf 316096 application/pdf 8e6b4d0f4d5777ac35e313b6ac7309df29aa61cc8fa99ada00b153e918d9eb9c openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Reversible cerebral vasoconstriction syndrome during caesarean section	BMJ case reports			2019	59	95

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Safran, Szilard Laszlo