Department of Neurology, Klinikum Bremen-Mitte, St.-Jürgen-Strasse 1, 28177, Bremen, Germany.
Neurocrit Care. 2011 Aug;15(1):166-9. doi: 10.1007/s12028-010-9389-3.
During late pregnancy and the puerperium cerebral venous and sinus thrombosis (CVST) is a rare but important cause of stroke. Despite adequate anticoagulation some patients deteriorate, which may warrant the use of more aggressive treatment modalities.
A 29-year-old pregnant woman (29th week of pregnancy) presented with diffuse headaches and a progressive left hemiparesis. MRI revealed a CVST involving the superior sagittal sinus, the left lateral sinus, and the rectal sinus. Furthermore, it showed a space occupying brain edema and a congestional bleeding within the frontal and parietal lobes on the right side. Despite immediate intravenous anticoagulation and treatment with mannitol the patient developed a progressive loss of consciousness and unilateral third nerve palsy as a result of a beginning transtentorial herniation. Due to the severe course of the CVST an urgent decompressive craniectomy and shortly thereafter a cesarean section were performed. The patient made an excellent recovery.
While previous reports have demonstrated the feasibility of decompressive hemicraniectomy in selected patients with CVST and beginning herniation due to space occupying brain edema, venous infarction and congestional bleeding with mass effect, our rare case supports the notion that this procedure can also be life-saving in pregnant women.
在妊娠晚期和产褥期，脑静脉和窦血栓形成（CVST）是一种罕见但重要的中风原因。尽管进行了充分的抗凝治疗，一些患者的病情仍会恶化，这可能需要采用更积极的治疗方法。
一名 29 岁的孕妇（妊娠 29 周）出现弥漫性头痛和进行性左侧偏瘫。MRI 显示 CVST 累及上矢状窦、左侧横窦和直肠窦。此外，还显示右侧额叶和顶叶的占位性脑水肿和充血性出血。尽管立即进行了静脉内抗凝治疗和甘露醇治疗，但由于开始出现颅腔通过性脑疝，患者意识逐渐丧失并出现单侧动眼神经麻痹。由于 CVST 病情严重，紧急进行了减压性颅骨切除术，随后不久进行了剖宫产术。患者恢复良好。
尽管之前的报告已经证明了在由于占位性脑水肿、静脉梗死和充血性出血伴有占位效应而导致的 CVST 和开始脑疝的情况下，选择行减压性半颅骨切除术在一些患者中是可行的，但我们的罕见病例支持这样一种观点，即在孕妇中，这种手术也可以救命。
