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产后子痫前期表现为短暂性脑缺血发作:一例高危患者多学科管理的病例报告

Postpartum Preeclampsia Manifesting as a Transient Ischemic Attack: A Case Report on the Multidisciplinary Management of a High-Risk Patient.

作者信息

Ngardig Ngaba Neguemadji, Quidet Xegfred Lou T, Bhatti Ali Hanif, Nabeta Henry, Akanyijuka Abel, Mehta Adrija, Khaja Misbahuddin

机构信息

Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, USA.

Medicine, American University of Antigua, Coolidge, ATG.

出版信息

Cureus. 2025 Feb 28;17(2):e79833. doi: 10.7759/cureus.79833. eCollection 2025 Feb.

DOI:10.7759/cureus.79833
PMID:40166525
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11955561/
Abstract

Transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by focal brain ischemia, typically lasting less than one hour without acute infarction. Preeclampsia, a multisystem hypertensive disorder occurring in pregnancy, significantly heightens the risk of stroke, particularly during the postpartum period. This case report details a 34-year-old Sub-Saharan African woman, gravida 4 para 4, who experienced a TIA characterized by right-sided weakness and slurred speech 13 days after delivering a baby by cesarean section. Upon presentation to the emergency department with symptoms suggesting a minor stroke, clinical examination revealed hypertension and neurological deficits. Imaging studies clarified the absence of acute intracranial pathology but indicated hypoperfusion in the right frontal white matter and significant chronic sinusitis. The patient's elevated blood pressure and clinical conditions were consistent with postpartum preeclampsia. Management included dual antiplatelet therapy and antihypertensives alongside seizure prophylaxis. The patient's neurological symptoms resolved within 24 hours, and she was discharged on supportive medications, with follow-up arrangements established for various specialties. This case emphasizes the need for careful monitoring of postpartum women for signs of preeclampsia and cerebrovascular events, particularly in high-risk populations. It highlights the interaction between these conditions and the importance of collaborative multidisciplinary care. Further research is warranted to explore the link between chronic sinusitis and postpartum preeclampsia.

摘要

短暂性脑缺血发作(TIA)是由局灶性脑缺血引起的短暂性神经功能障碍发作,通常持续不到一小时且无急性梗死。子痫前期是一种发生在孕期的多系统高血压疾病,会显著增加中风风险,尤其是在产后期间。本病例报告详细介绍了一名34岁的撒哈拉以南非洲妇女,孕4产4,剖宫产分娩一名婴儿13天后经历了一次TIA,其特征为右侧肢体无力和言语含糊。因出现提示轻度中风的症状前往急诊科就诊时,临床检查发现高血压和神经功能缺损。影像学检查明确无急性颅内病变,但显示右侧额叶白质灌注不足及显著的慢性鼻窦炎。患者血压升高及临床情况符合产后子痫前期。治疗措施包括双重抗血小板治疗、使用降压药以及预防癫痫发作。患者的神经症状在24小时内缓解,出院时带支持性药物,并安排了各专科的随访。本病例强调了对产后妇女进行子痫前期和脑血管事件迹象仔细监测的必要性,尤其是在高危人群中。它突出了这些病症之间的相互作用以及多学科协作护理的重要性。有必要进一步研究以探索慢性鼻窦炎与产后子痫前期之间的联系。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c367/11955561/93e44ea67563/cureus-0017-00000079833-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c367/11955561/8c08b5befb4a/cureus-0017-00000079833-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c367/11955561/9489c1664a75/cureus-0017-00000079833-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c367/11955561/93e44ea67563/cureus-0017-00000079833-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c367/11955561/8c08b5befb4a/cureus-0017-00000079833-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c367/11955561/9489c1664a75/cureus-0017-00000079833-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c367/11955561/93e44ea67563/cureus-0017-00000079833-i03.jpg

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本文引用的文献

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The use of dual antiplatelet therapy for ischemic cerebrovascular events.双联抗血小板治疗用于缺血性脑血管事件。
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Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy.
产后子痫前期或子痫:在妊娠高血压疾病中确定其位置和管理。
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Clinical Course, Associated Factors, and Blood Pressure Profile of Delayed-Onset Postpartum Preeclampsia.迟发性产后子痫的临床病程、相关因素和血压特征。
Obstet Gynecol. 2019 Nov;134(5):995-1001. doi: 10.1097/AOG.0000000000003508.
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Preeclampsia postpartum: Impairment of cerebral autoregulation and reversible cerebral hyperperfusion.子痫产后:脑自动调节功能障碍和可逆性大脑过度灌注。
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ACOG Committee Opinion No. 767: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.美国妇产科医师学会委员会意见第 767 号:妊娠期和产后急性发作严重高血压的紧急治疗。
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