de Paula Viviane Ribeiro, Rocha Laura Penna, Tiveron Giovanni Carlos, de Oliveira Guimarães Camila Souza, Dos Reis Marlene Antônia, Tavares Beatriz Barco, Corrêa Rosana Rosa Miranda
Discipline of General Pathology, Department of Biological Sciences, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
J Med Case Rep. 2011 Aug 25;5:415. doi: 10.1186/1752-1947-5-415.
Hypertensive syndromes in pregnancy are one of the leading causes of obstetric admissions into intensive care units. They are related to changes in the central nervous system caused by a decrease in cerebral perfusion pressure, indicated by an increase in intracranial pressure. These changes in pressure usually result from acute injuries or a decrease in the mean arterial pressure due to iatrogenic action or shock. However, other vascular disorders may contribute to similar occurrences.
A 15-year-old girl was admitted to our hospital complaining of severe headaches since the eighth month of pregnancy, and presented with an arterial blood pressure of 180/120 mmHg. The diagnostic hypothesis was pre-eclampsia. Our patient's blood pressure levels remained elevated, and she was submitted to a cesarean section. After the procedure, she was referred to our infirmary, presenting with a blank distant look and with no interaction with the environment, dyslalia, and labial and upper and lower right limb paresis. She was confused and unable to speak, but responded to painful stimuli as she conveyed abdominal pain at superficial and deep palpation. The hypothesis of post-partum psychosis was suggested. She was then transferred to our intensive care unit, maintaining an impassive attitude in bed but reacting to external stimuli. Results of a computed tomography scan revealed ischemic infarction of the territory of her left middle cerebral artery. A selective cerebral arteriography showed bilateral occlusion of her internal carotid artery in the intracranial position, prebifurcation and angiodysplasia in the cervical segments of her internal carotid artery. Sixteen days after hospital admission, our patient died.
This data shows the need for careful monitoring of hypertensive syndromes in pregnancy cases, especially in cases with a history of chronic hypertension or with vascular alterations, It also highlights the need for constant supervision of blood pressure levels during the use of anti-hypertensive medications.
妊娠高血压综合征是产科重症监护病房收治患者的主要原因之一。它们与脑灌注压降低引起的中枢神经系统变化有关，颅内压升高表明了这一点。这些压力变化通常是由急性损伤或医源性作用或休克导致的平均动脉压降低引起的。然而，其他血管疾病也可能导致类似情况。
一名15岁女孩因自怀孕第八个月起出现严重头痛入院，动脉血压为180/120 mmHg。诊断假设为子痫前期。我们患者的血压水平持续升高，随后接受了剖宫产手术。术后，她被转诊至我们的医务室，表现出茫然的神情，与周围环境无互动，构音障碍，唇部及右上肢和下肢轻瘫。她神志不清，无法说话，但对疼痛刺激有反应，如在浅触诊和深触诊时表示腹痛。有人提出产后精神病的假设。随后她被转入我们的重症监护病房，躺在床上表情冷漠，但对外界刺激有反应。计算机断层扫描结果显示其左侧大脑中动脉供血区缺血性梗死。选择性脑动脉造影显示其颅内段颈内动脉双侧闭塞，颈段颈内动脉分叉前及血管发育异常。入院16天后，我们的患者死亡。
这些数据表明，对于妊娠高血压综合征病例，尤其是有慢性高血压病史或血管改变的病例，需要仔细监测，这也凸显了在使用抗高血压药物期间持续监测血压水平的必要性。
