Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, Guangdong, China.
The Intensive Care Unit, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, PR China.
BMC Infect Dis. 2024 Oct 14;24(1):1155. doi: 10.1186/s12879-024-10054-3.
Cerebral venous sinus thrombosis (CVST), a serious cerebrovascular and neurological emergency, is common in pregnant individuals and accounts for approximately 0.5-1.0% of all cerebrovascular diseases. However, CVST with cryptococcal meningoencephalitis in immunocompetent pregnant patients is rare.
A 30-year-old woman who was 33 weeks pregnant presented with recurrent dizziness, headache, and vomiting as the main clinical manifestations, all of which were initially nonspecific. After assessment of the cerebrospinal fluid, skull computerized tomography, magnetic resonance imaging, and other laboratory and imaging examinations, the patient was diagnosed with secondary pregnancy-related CVST with cryptococcal meningoencephalitis. Despite receiving potent anticoagulant and antifungal treatment, the patient's condition deteriorated, and the patient's family opted to cease treatment.
We present a rare case of CVST with cryptococcal meningoencephalitis in an immunocompetent pregnant patient. The difficulty of diagnosing and treating secondary pregnancy-related CVST caused by cryptococcal meningoencephalitis, as well as the great challenges faced at present are highlighted. One crucial lesson from the present case is that when clinical and imaging signs are unusual for CVST during pregnancy, it is essential to account for the possibility of other central nervous system (CNS) diseases, such as CNS infections with Cryptococcus, which may cause CVST.
脑静脉窦血栓形成（CVST）是一种严重的脑血管和神经系统急症，在孕妇中较为常见，约占所有脑血管疾病的 0.5-1.0%。然而，免疫功能正常的孕妇合并隐球菌性脑膜脑炎的 CVST 较为罕见。
一名 30 岁的女性，妊娠 33 周，以反复头晕、头痛和呕吐为主要临床表现，均为非特异性。在评估脑脊液、头颅计算机断层扫描、磁共振成像和其他实验室及影像学检查后，该患者被诊断为继发于妊娠相关的 CVST 合并隐球菌性脑膜脑炎。尽管接受了强有力的抗凝和抗真菌治疗，患者的病情仍恶化，患者家属选择停止治疗。
我们报告了一例免疫功能正常的孕妇合并隐球菌性脑膜脑炎的 CVST 罕见病例。该病例强调了诊断和治疗继发于隐球菌性脑膜脑炎的妊娠相关 CVST 的困难，以及目前面临的巨大挑战。该病例的一个重要教训是，当妊娠期间 CVST 的临床和影像学表现不典型时，必须考虑到其他中枢神经系统（CNS）疾病的可能性，如 CNS 感染隐球菌，这可能导致 CVST。
