Background

Cerebral cavernous malformation (CCM) in third ventricular area may become symptomatic relatively rarely, secondary to hemorrhage and growth or rupture into the ventricle, causing obstructive hydrocephalus, during third trimester of pregnancy.

Case description

A 34⁺⁴ weeks pregnant (G4P1A2) lady was admitted to one of our satellite hospitals with one-week history of severe headache, blurred vision, nausea, vomiting, and right-sided facial numbness. At presentation, she had sudden decreased level of consciousness with Glasgow Coma Scale (GCS) equal to 4, and bilateral fixed pupils. A brain computed tomography (CT) showed enlargement of both lateral ventricles with 2.5 cm sized round hemorrhagic lesion at the right posterior thalamic region. After medical stabilization and placement of an external ventricular drain (EVD), the patient was referred for neurosurgical intervention. Magnetic resonance imaging (MRI) revealed a cavernous hemangioma adjacent to the right posterior wall of the third ventricle. After cesarean section and anterior interhemispheric trans-callosal approach, the mass was removed totally. However, on third postoperative day, she experienced mild hypoxia and dyspnea with fever. Chest CT-scan of the patient showed bilateral consolidation. Thereafter, COVID-19 was confirmed subsequently with positive nasopharyngeal swab testing for RT-PCR. The patient was treated as COVID-19 infection and symptoms improved on day 10 of the treatment and completely recovered.

Conclusions

COVID-19 may promote ICH from CCM leading to obstructive hydrocephalous in our patient.

中文翻译：

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孕妇感染 COVID-19 后第三脑室海绵状血管畸形的急性表现：病例报告

背景

第三脑室区域的脑海绵状血管畸形 (CCM) 可能会相对罕见地出现症状，继发于妊娠晚期的出血和生长或脑室破裂，导致阻塞性脑积水。

案例描述

一名怀孕 34 ^{+ 4}周 (G4P1A2) 的女士因严重头痛、视力模糊、恶心、呕吐和右侧面部麻木一周而被收入我们的卫星医院。就诊时，她的意识水平突然下降，格拉斯哥昏迷量表 (GCS) 等于 4，双侧瞳孔固定。脑部计算机断层扫描 (CT) 显示双侧脑室扩大 2.5 右后丘脑区 cm 大小的圆形出血性病灶。在药物稳定并放置脑室外引流管 (EVD) 后，患者被转诊接受神经外科干预。磁共振成像 (MRI) 显示毗邻第三脑室右后壁的海绵状血管瘤。剖宫产和前纵裂经胼胝体入路后，肿块被完全切除。然而，在术后第三天，她出现轻度缺氧和呼吸困难并伴有发热。患者的胸部 CT 扫描显示双侧实变。此后，随后通过 RT-PCR 鼻咽拭子检测呈阳性确认了 COVID-19。该患者被视为 COVID-19 感染，治疗第 10 天症状改善并完全康复。

结论

COVID-19 可能促进 CCM 的 ICH，导致我们患者出现阻塞性脑积水。