Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Int J Neurosci. 2021 Jan;131(1):65-69. doi: 10.1080/00207454.2020.1733555. Epub 2020 Mar 2.
A number of hormonal, physiologic, immunologic, and hemodynamic changes can cause a series of central nervous system-related problems in pregnant and postpartum women. Posterior reversible encephalopathy syndrome (PRES) is commonly seen in these conditions. However, PRES during pregnancy and the postpartum period are not always due to pregnancy. We describe a patient who presented with headache followed by an epileptic seizure after cesarean section and whose computed tomography (CT) showed bilateral low-density lesions in the frontal lobe. To explore the pathogenesis, we further examined the patient with brain magnetic resonance imaging (MRI) and lumbar puncture. Brain MRI revealed vasogenic edema in the frontal lobe and temporal-occipital regions of both hemispheres. MRI of the brain with contrast showed diffuse enhancement of the supratentorial dura mater and decreased of bilateral lateral ventricles. There was no abnormality in brain magnetic resonance angiography and magnetic resonance venography. Bloody cerebrospinal fluid flowed very slowly during lumbar puncture. These findings suggest that, although rare, intracranial hypotension in postpartum patients may be a cause of PRES.
许多激素、生理、免疫和血液动力学变化会导致妊娠和产后妇女出现一系列与中枢神经系统相关的问题。后部可逆性脑病综合征（PRES）在这些情况下很常见。然而，妊娠和产后期间的 PRES 并不总是由妊娠引起的。我们描述了一位患者，她在剖宫产术后出现头痛，随后出现癫痫发作，其计算机断层扫描（CT）显示额叶双侧低密度病变。为了探讨发病机制，我们进一步对患者进行了脑部磁共振成像（MRI）和腰椎穿刺检查。脑部 MRI 显示额叶和颞枕叶半球的血管源性水肿。脑部 MRI 增强扫描显示颅顶硬脑膜弥漫性增强，双侧侧脑室减小。脑磁共振血管造影和磁共振静脉造影无异常。腰椎穿刺时血性脑脊液流动非常缓慢。这些发现表明，尽管罕见，但产后患者的颅内低血压可能是 PRES 的原因之一。
