LAUSR

A 31-year-old pregnant primipara with a normal course of pregnancy presented with a history of familial cavernous malformations, with a Krev interaction trapped protein 1 mutation identified. The woman reported a moderate headache since she had been diagnosed. In a recent cerebro-spinal magnetic resonance imaging (MRI), several cerebral cavernous malformations were noted in the frontal and parietal lobes of the right hemisphere [Figure 1]. No lesions were detected in the spinal cord. Spontaneous delivery occurred after 40 weeks of amenorrhoea. The introduction of a lumbar epidural catheter during labour allowed an appropriate control of pain using programmed intermittent epidural bolus (10 ml per hour and 5 ml bolus upon request with a refractory period of 12 min) with 1% ropivacaine and 0.2 μg/ml sufentanil.[2] Blood pressure was monitored during the entire procedure, with the objective of keeping it in a normal range. Because of foetal rhythm disturbances, obstetricians used a vacuum-assisted delivery. The baby presented normal breathing efforts, heart rate, reflexes and skin colour at 5 min of life. No complications appeared during hospitalisation. Cavernous malformation appears mostly in a sporadic form but can be inherited. Single lesions characterise the sporadic form, whereas multiple cavernous malformations may indicate an inherited form. Lesions are composed of dilated capillaries organised in multilobulated caverns with a large range in size.[1] Their natural evolution can be thrombosis and regression as well as growth and more symptomatic forms. The symptoms are linked to their localisation.