Key result
Fludrocortisone improves postural hypotension and neurological symptoms in a pregnant patient with moyamoya vasculopathy.
Why the study?
Does fludrocortisone improve blood pressure and symptoms in a pregnant woman with Moyamoya disease and postural hypotension?
Case Report (n=1)
Does fludrocortisone improve blood pressure and symptoms in a pregnant woman with Moyamoya disease and postural hypotension?
This is the first report demonstrating the successful use of fludrocortisone to maintain blood pressure and resolve neurological symptoms in a pregnant patient with Moyamoya disease.
May support fludrocortisone for postural hypotension in pregnant Moyamoya; hypothesis-generating case requiring prospective validation.
Moyamoya disease is a rare cerebrovascular occlusive disorder characterized by stenosis in the circle of Willis with the development of a compensatory circulation. It has been associated with significant morbidity in pregnancy including intracranial haemorrhage, ischaemic stroke and epilepsy. We present the case of a 26-year-old woman with a previous diagnosis of moyamoya vasculopathy with bilateral superficial temporal to middle cerebral artery bypass grafting. During the second trimester, she developed significant neurological symptoms related to postural hypotension in the presence of a stenosis of the right-sided graft. The hypotension was treated with fludrocortisone therapy with improvement in blood pressure and symptoms. Moyamoya vasculopathy poses unique challenges to obstetric care. This is the first report of use of fludrocortisone for maintenance of blood pressure during pregnancy in this condition.
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Barrett et al. (2011) conducted a case report in Moyamoya disease in pregnancy with postural hypotension (n=1). Fludrocortisone was evaluated on Improvement in blood pressure and symptoms. Fludrocortisone therapy successfully improved blood pressure and neurological symptoms related to postural hypotension in a pregnant woman with moyamoya vasculopathy.
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