A 40-year-old pregnant woman with a family history of aneurysmal subarachnoid haemorrhage (aSAH) underwent magnetic resonance angiography (MRA). The MRA revealed two aneurysms (both measuring 4.0 mm) originating from both sides of the internal carotid artery in this patient, confirming the high prevalence rate of aneurysm with reported incidence of 25% among women with a family history of aSAH. Literature review suggested that advanced maternal age and family history of aSAH are risk factors for aSAH. Annual risk of aSAH is 0.95% for general Japanese patients with multiple small (<5 mm) unruptured aneurysms. Our analyses of published data suggested that the risk of aSAH was higher in the perinatal period compared to pregnancy remote from term. The patient elected to undergo prophylactic caesarean section.
Ryutaro Yamada, Rina Akaishi, Mamoru Morikawa, Takahiro Yamada*, Takashi Kojima, Hisanori Minakami*