Epidural anaesthesia for caesarean section in a patient with a cerebral artery aneurysm.

A case is described of a 30-year-old insulin-dependent diabetic woman who presented at 25 weeks gestation with frontal headache. Contrast tomography revealed an aneurysm of the middle cerebral artery with no evidence of subarachnoid bleeding. Although elective caesarean section at term was planned, it was performed at gestational week 38 due to the onset of vaginal bleeding and premature labour. In contrast to previous reports, the cerebral aneurysm was not managed surgically at the same time as the delivery, but was treated conservatively. An epidural anaesthetic was performed successfully and postoperative analgesia maintained with a continuous infusion of local anaesthetic in the epidural space. Literature is reviewed and advantages of regional versus general anaesthesia are discussed.