Yamakawa Shiori, Kisimoto Kaori, Wada Kuniyasu, Hashimoto Yoichiro, Ueda Mitsuharu
Department of Neurology, Kumamoto City Hospital.
Department of Obstetrics and Gynecology, Kumamoto City Hospital.
Rinsho Shinkeigaku. 2021 Oct 28;61(10):681-686. doi: 10.5692/clinicalneurol.cn-001627. Epub 2021 Sep 25.
A 35-year-old pregnant woman with mild migraine experienced thunderclap headache at 37 weeks of gestation. Her cerebral MRA showed arterial segmental narrowing of right middle cerebral artery and bilateral posterior cerebral artery. When admitted, she had no sign of eclampsia/preeclampsia. After 4 days, she had premature rupture of the membrane and gave birth by caesarean section. Caesarean section immediately resolved the headache. The postpartum course of the patient and her baby was uneventfull. One month after her onset, her cerebral MRA showed improvement in arterial segmental narrowing of cerebral artery. We diagnosed reversible cerebral vasoconstriction syndrome (RCVS) assoiated with pregnancy. Pregnancy-related RCVS develops primarily during the puerperal period, but our case was a rare case that developed just before delivery and was successful with aggressive intervention. When antepartum RCVS develops, early cesarean section with epidural anesthesia in parallel with active treatment for headache may lead to good outcomes for both mother and child.
一名35岁患有轻度偏头痛的孕妇在妊娠37周时出现霹雳样头痛。她的脑部磁共振血管造影（MRA）显示右侧大脑中动脉和双侧大脑后动脉节段性狭窄。入院时，她没有子痫/先兆子痫的迹象。4天后，她胎膜早破并剖宫产分娩。剖宫产术后头痛立即缓解。患者及其婴儿的产后过程顺利。发病1个月后，她的脑部MRA显示脑动脉节段性狭窄有所改善。我们诊断为与妊娠相关的可逆性脑血管收缩综合征（RCVS）。妊娠相关的RCVS主要在产褥期发生，但我们的病例是罕见的在分娩前发生的情况，通过积极干预获得了成功。当产前发生RCVS时，早期硬膜外麻醉下剖宫产并同时积极治疗头痛可能对母婴均产生良好结局。
