J Neurol Surg A Cent Eur Neurosurg 2012; 73 - P040
DOI: 10.1055/s-0032-1316242

Management of Neurotrauma in Pregnancy: A Multidisciplinary Approach

G. Neville 1, C. Kaliaperumal 1, L. Kenny 2, G. Kaar 1
  • 1Cork University Hospital, Cork, Ireland
  • 2Cork University Maternity Hospital, Cork, Ireland

Introduction: It is uncommon to encounter traumatic brain injury (TBI) warranting neurosurgical intervention in the pregnant population. There prevails paucity in the evidence available on best management of this condition. We describe a case of TBI in a woman of 13 weeks’ gestation and the management for which a multidisciplinary approach was adopted.

Case Description: A 27-year-old woman presented with multiple traumas following a road traffic accident. Glasgow Coma Scale was 6/15 on admission. Computed tomography (CT) of brain revealed extensive hemorrhagic contusions, diffuse brain swelling, and multiple skull and facial fractures. Decompressive craniectomy was performed to control her intracranial pressure during her initial management in the intensive care unit. A viable intrauterine pregnancy was confirmed and progressed over the following months as maternal stabilization and rehabilitation continued.

Results: At 35+3 weeks of pregnancy, a 2770 g boy was delivered via emergency caesarean section after spontaneous onset of labor. The infant had no detectable abnormalities and is clinically well. Post-TBI, at 8 months, the patient continues to make gradual improvements with ongoing rehabilitative efforts; but is left with severe cognitive impairment. Disability Rating Scale is currently 21/29 indicating extremely severe disability.

Discussion: A multidisciplinary approach, involving clinical and para clinical specialties, was adopted in the overall care of our patient. Challenging maternal behaviors in the setting of TBI needed neuropsychiatry input as a part of the management paradigm. The constant need for risk-benefit analysis in the context of ongoing viable pregnancy added further complexity to an already challenging situation.

Conclusion: An aggressive multidisciplinary approach to treatment is recommended in the setting of TBI in pregnancy to optimize both fetal and maternal outcomes. We recommend that these patients be managed in a tertiary care center.