Published: 2019-11-26

Successful management of a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy

Aditi P. Kaundinya, Meena N. Satia, V. R. Badhwar


Large population-based studies on stroke report that intracerebral haemorrhage is rare in young women however it is a grave and disturbing complication of pregnancy. Preeclampsia is usually clinically silent, but may cause symptoms of neurological dysfunction such as headache, visual disturbances and impairment of consciousness. Eclampsia is in the occurrence of seizures in the context of preeclampsia and is often, but not always, preceded by the above neurological symptoms. Most published data support the view that preeclampsia and eclampsia are important causative factors for pregnancy related ICH. Sparse data is available with respect to the management of such cases. Identification of near miss cases is an important step in reducing mortality. Herein we report a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy.


Craniotomy, Eclampsia, Intracranial haemorrhage, Near miss, Preeclampsia

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Tate J, Bushnell C. Pregnancy and stroke risk in women. Women’s Health (London, England). 2011;7(3):363-74.

Liang ZW, Lin L, Gao WL, Feng LM. A clinical characteristic analysis of pregnancy-associated intracranial haemorrhage in China. Scie Reports. 2015;5:9509.

Yoshimatsu J, Ikeda T, Katsuragi S, Minematsu K, Toyoda K, Nagatsuka K, et al. Factors contributing to mortality and morbidity in pregnancy‐associated intracerebral hemorrhage in Japan. J Obstet Gynaecol Res. 2014;40(5):1267-73.

James AH, Bushnell CD, Jamison MG, Myers ER. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol. 2005;106(3):509-16.

World Health Organization. World Health Statistics 2011. Fact sheets. Geneva: WHO, 2009 and 2014. Available at: publications/world_health_statistics?EN_WHS2011_Ful l.pdf.

Kitnner SJ, Stern BJ, Feeser BR, Hebel R, Nagey DA, Bliccholz DW, et al. Pregnancy and the risk of stroke. N Engl J Med. 1996;335(11):768-74.

Wittin AC, Friedman SA, Egermanter, Frangien AY, Sibai BM. Cardiovascular disorders complications in pregnancy beyond eclampsia. Am J Obstet Gynaecol. 1997:1139-45.

Liang CC, Chang SD, Lai SL, Hsieh CC, Chueh HY, Lee TH. Stroke complicating pregnancy and the puerperium. Eur J Neurol. 2006;13:1256-60.

Sharshar T, Lamy C, Mas JL. Incidence and causes of strokes associated with pregnancy and puerperium. A study in public hospitals of Ile de France. Stroke in Pregnancy Study Group. Stroke. 1995;26:930-6.

Bateman BT, Schumacher HC, Bushnell CD, Pile-Spellman J, Simpson LL, Sacco RL, et al. Intracerebral haemorrhage in pregnancy: Frequency, risk factors and outcome. Nuerol. 2006;67:424-9.

Kurth T, Kase CS, Berger K, Gaziano JM, Cook NR, Buring JE. Smoking and risk of haemorrhagic stroke in women. Stroke. 2003;4:2792-5.

Klatsky AL, Friedman GD, Sidney S, Kipp H, Kubo A, Armstrong MA. Risk of haemorrhagic stroke in Asian American ethnic groups. Nueroepidemiol. 2005;25:26-31.

Hameed AB, Shrivastava VK, Blair L, Wing DA. Intracranial haemorrhage in pregnancy AJP Rep. 2012;2(1):47-50.

Mendelow AD, Gregson BA, Fernandes HM. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial haematomas in the International Surgical Trial in Intracerebral Haemorrhage: a randomised trial. Lancet. 2005;365:387-97.

Dias MS, Sekhar LN. Intracranial haemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Nuerosurg. 1990;27:855-65.

Connolly Jr ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711-37.

Geller SE, Rosenberg D, Cox S, Brown M, Simonson L, Kilpatrick S. A scoring system identified near-miss maternal morbidity during pregnancy. J Clin Epidemiol. 2004;57:716-2.