妊娠期神经系统急症

Neurological Emergencies During Pregnancy.

机构信息

Department of Neurology, University of New Mexico, MSC10 5620, 1 University of New Mexico, Albuquerque, NM 87131, USA. Electronic address: https://twitter.com/SportsDoc2009.

Neurosciences Critical Care Fellowship, Department of Neurology, University of New Mexico; MSC10 5620, 1 University of New Mexico, Albuquerque, NM 87131, USA.

出版信息

Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008.

DOI:10.1016/j.ncl.2021.02.008

PMID:33896537

Abstract

This article serves as a comprehensive review of neurologic emergencies in pregnancy. Common initial presentations of neuroemergencies are reviewed with a clinical algorithm. Neurovascular disorders in pregnancy are reviewed, including acute ischemic strokes with data on tPA and thrombectomy; cerebral venous sinus thrombosis diagnosis and management; posterior reversible encephalopathy syndrome management; reversible cerebral vasoconstriction syndrome; and intracerebral hemorrhage. Attention is paid to management of cerebral edema and safety of osmotic therapies. A review of seizures in pregnancy is provided, including new-onset causes and decreased seizure thresholds. For status epilepticus, a low teratogenicity risk medication protocol in pregnancy is provided.

摘要

这篇文章全面回顾了妊娠相关的神经急症。本文首先介绍了神经急症的常见初始表现，并提供了临床决策算法。接着讨论了妊娠相关的神经血管疾病，包括急性缺血性卒中（tPA 和取栓治疗）、脑静脉窦血栓形成的诊断和治疗、可逆性后部脑病综合征的处理、可逆性脑血管收缩综合征和脑出血。文中还介绍了脑水肿的管理和渗透性治疗的安全性。此外，本文还对妊娠相关癫痫发作进行了综述，包括新发病因和癫痫发作阈值降低。对于癫痫持续状态，文中提供了一种妊娠低致畸风险的药物治疗方案。