Gómez-Martí M, Boschín V, Puchades F, Cerdán A, Cunquero A, Sanz F, Tamarit J J
Consorcio Hospital General Universitario de Valencia, Valencia, España.
Rev Neurol. 2022 Aug 16;75(4):97-100. doi: 10.33588/rn.7504.2021373.
Infection by coronavirus type 2, which is the cause of severe acute respiratory syndrome (SARS-CoV-2), gives rise to thromboembolic complications, including acute cerebrovascular disease. Due to the hypercoagulable state that accompanies pregnancy, the thrombotic risk in these patients may be particularly significant.
We report the case of a 41-year-old woman, 34+1 weeks pregnant, diagnosed with bilateral interstitial pneumonia, caused by coronavirus disease 2019 (COVID-19). The patient presented with severe respiratory failure, and so the decision was made to perform an emergency caesarean section and she was transferred to the intensive care unit. During her stay in hospital, the patient suffered a sudden episode of decreased level of consciousness, and magnetic resonance angiography revealed thrombosis in the left vertebral artery and in the basilar artery, with the presence of acute ischaemic infarction in both cerebellar hemispheres and bilateral involvement of the brainstem.
Severe SARS-CoV-2 disease results in a prothrombotic state that correlates with the prognosis of the disease. The last trimester of pregnancy and the puerperium are known prothrombotic risk factors. Recommendations for anticoagulation management in pregnant patients with COVID-19 are based on limited evidence. This is the first case to be published in Spain involving cerebral arterial thrombosis in a pregnant patient with SARS-CoV-2 infection.
2型冠状病毒感染是严重急性呼吸综合征（SARS-CoV-2）的病因，可引发血栓栓塞并发症，包括急性脑血管疾病。由于妊娠会伴随高凝状态，这些患者的血栓形成风险可能尤为显著。
我们报告一例41岁、孕34 + 1周的女性病例，其被诊断为新型冠状病毒肺炎（COVID-19）所致的双侧间质性肺炎。患者出现严重呼吸衰竭，因此决定进行紧急剖宫产，并将其转入重症监护病房。在住院期间，患者突然出现意识水平下降，磁共振血管造影显示左椎动脉和基底动脉血栓形成，双侧小脑半球存在急性缺血性梗死，脑干双侧受累。
严重的SARS-CoV-2疾病会导致血栓前状态，这与疾病的预后相关。妊娠晚期和产褥期是已知的血栓形成危险因素。关于COVID-19孕妇抗凝管理的建议基于有限的证据。这是西班牙发表的首例SARS-CoV-2感染孕妇发生脑动脉血栓形成的病例。
