Anaesthesia for Caesarean section in a patient with recent subarachnoid haemorrhage and severe pre-eclampsia

Subarachnoid haemorrhage is a leading 'indirect' cause of maternal death in the UK. We describe the case of a 43-year-old woman who presented with hea dache, photophobia and neck stiffness of sudden onset at 32 weeks' gestatio n. Cerebral computed tomography demonstrated subarachnoid blood in the cist erns around the midbrain, and oral nimodipine was started to prevent vasosp asm. Preparations were made for endovascular coil embolisation in the event of identification of a posterior circulation aneurysm. However, angiograph y under general anaesthesia failed to reveal any vascular abnormality. On e mergence from anaesthesia, headache persisted, and over the next 24 h sever e pre-eclampsia developed. Magnesium sulphate was started, and urgent Caesa rian section performed under general anaesthesia without incident. The rati onale for the neuroradiological, obstetric and anaesthetic management is di scussed.