Afonso Catarina, Bicheiro Luís, Lopes Marta
General Practice/Family Medicine, USF Planície, Évora, PRT.
General Practice/Family Medicine, USF Portas do Arade, Portimão, PRT.
Cureus. 2024 Feb 26;16(2):e54972. doi: 10.7759/cureus.54972. eCollection 2024 Feb.
A breastfeeding 29-year-old woman who gave birth to her first child three months ago presented at the family doctor's appointment with a diverse array of symptoms, including vertigo, blurred vision, right lower limb weakness, and abdominal allodynia. She has a history of obesity and anxiety. The patient had a pre-pregnancy history of several visits to the family doctor. She takes folic acid, vitamin B12, iodine, and omega-3 supplements. The diverse symptomatology, the patient's insistence on seeking medical care, and the history of anxiety pose significant hurdles in arriving at a timely diagnosis. Magnetic resonance imaging showed signs compatible with primary demyelinating lesions of the central nervous system, which elicited a referral to neurology. The clinical and imagiological findings were suggestive of multiple sclerosis (MS), for which a conservative approach was taken. MS is a chronic inflammatory autoimmune disease with a mean age of onset of 20-30 years, more common in females. Stressful life events, viral infections, vaccination, physical trauma, previous anesthesia, excessive physical activity, and puerperium have all been described as trigger factors. This case underscores the importance of vigilance in postpartum healthcare and the importance of conducting a comprehensive diagnostic assessment. Early diagnosis has a positive impact on the prognosis of the disease.
一名三个月前产下第一个孩子的29岁哺乳期女性在家庭医生预约就诊时出现了一系列症状,包括眩晕、视力模糊、右下肢无力和腹部痛觉过敏。她有肥胖和焦虑病史。该患者在怀孕前曾多次就诊于家庭医生。她服用叶酸、维生素B12、碘和ω-3补充剂。多样的症状表现、患者坚持寻求医疗护理以及焦虑病史给及时诊断带来了重大障碍。磁共振成像显示出与中枢神经系统原发性脱髓鞘病变相符的迹象,这促使患者被转诊至神经科。临床和影像学检查结果提示为多发性硬化症(MS),对此采取了保守治疗方法。MS是一种慢性炎症性自身免疫性疾病,平均发病年龄为20 - 30岁,在女性中更为常见。生活应激事件、病毒感染、疫苗接种、身体创伤、既往麻醉、过度体力活动和产褥期均被描述为触发因素。该病例强调了产后医疗保健中保持警惕的重要性以及进行全面诊断评估的重要性。早期诊断对疾病的预后有积极影响。