Binhas M, Zakine C, Khelil N, Mekacher L, Wafo E, Lebonhomme J J, Iung B
Service d'anesthésie, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France.
Service de cardiologie, Grand hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4, rue de la Gondoire, 77600 Jossigny, France.
Ann Cardiol Angeiol (Paris). 2019 Apr;68(2):129-131. doi: 10.1016/j.ancard.2018.10.010. Epub 2019 Jan 25.
Stroke occurring during pregnancy is linked to high mortality. Stroke may be directly related to pregnancy (e.g. eclampsia, cerebral venous thrombosis), but all the other causes of stroke are possible. Brain magnetic resonance imaging that is not contraindicated during pregnancy remains the reference in this context. We report the case of a woman with severe headache associated with visual disturbances, without hypertension or proteinuria at 32 weeks of pregnancy. MRI revealed multiple recent cerebral vascular accidents. An echocardiogram detected a papillary fibroelastoma of 5mm. Maternal fetal experts determined it safe to continue the pregnancy. Childbirth at 39 weeks was normal uneventful for the newborn and mother. In the postpartum, despite the theoretical operative indication to resect the small residual papillary fibroelastoma, the patient was followed expectantly because of the stable neuro-cardiologic state. A fibroelastoma can be revealed by a stroke during pregnancy. In the postpartum period, an expectant attitude can be reasonably chosen in case of small size of the fibroelastoma.
妊娠期发生的中风与高死亡率相关。中风可能与妊娠直接相关(如子痫、脑静脉血栓形成),但其他所有中风病因也都有可能。在这种情况下,孕期无禁忌的脑磁共振成像仍是参考检查。我们报告一例在妊娠32周时出现严重头痛并伴有视觉障碍的女性病例,该患者无高血压或蛋白尿。磁共振成像显示近期发生了多处脑血管意外。超声心动图检测到一个5毫米的乳头肌纤维弹性瘤。母婴专家确定继续妊娠是安全的。39周时分娩,对新生儿和母亲来说均正常且顺利。产后,尽管理论上有手术切除小的残余乳头肌纤维弹性瘤的指征,但由于神经心脏状态稳定,对患者进行了观察等待。纤维弹性瘤可在妊娠期因中风而被发现。在产后,如果纤维弹性瘤体积较小,可以合理选择观察等待的态度。