懷孕期之腦部靜脈栓塞併腦部動脈梗塞：病例報告

Cerebral Venous Thrombosis with Cerebral Arterial Infarction during Pregnancy: A Case Report

黃士益(Shih-I Huang) ； 陳天文(Tien-Wen Chen) ； 黃茂雄(Mao-Hsiung Huang)

《台灣復健醫學雜誌》 39卷4期 (2011/12) Pp. 259-263

https://doi.org/10.6315/2011.39(4)09

摘要

腦部靜脈栓塞（cerebral venous thrombosis）對懷孕的婦女而言，是造成腦出血或腦梗塞相當重要的因素之一，初期症狀有時只有頭痛，因此在進展成腦中風之前，正確的診斷並不容易。本病例報告為30歲女性，除了之前懷孕時曾有甲狀腺亢進的病史，並無其他特殊病史。她在懷孕32週時突然發生左側無力的情形，當時的腦部核磁共振顯示在右側中大腦動脈區域有梗塞，且在左側乙狀竇（sigmoid sinus）亦發現栓塞，當時左側肢體布朗斯狀的分級（Brunnstrom stage）為第二級（Ⅱ），有輕微構音困難的狀況，除此之外，並無意識喪失或大小便失禁等其他神經學症狀。在病理上，靜脈或靜脈竇的栓塞會造成腦實質的病灶或功能異常，此外，靜脈竇的栓塞亦會降低腦脊髓液的吸收，進而升高顱內壓，而臨床上除了頭痛最常見之外，有時也會發生癲癇的狀況。治療的方面，若是發生中風處理方式跟一般患者相同，若是尚未發展成中風，可以給予抗凝血劑等相關藥物治療。此外，不管是中風或未中風，都要檢查看看是否有其他凝血相關的疾病，以期加以適當的控制。

關鍵字

懷孕（pregnancy） ； 腦部靜脈栓塞（cerebral venous thrombosis）

並列摘要

Cerebral venous thrombosis (CVT) usually occurs in young adult or middle aged adult women. Although not of high incidence, it is an important cause of brain hemorrhage or infarction in pregnant women. According to previous studies, the most common symptom is headache. However, because of only headache mostly, correct diagnosis is a challenge before progression to stroke. The patient was a 30-year-old female. Except for hyperthyroidism history during last pregnancy, she did not have any special associated past history. She suffered sudden onset of left side weakness; when her term was 32 weeks. Brain magnetic resonance imaging showed right middle cerebral artery territory infarction and left sigmoid sinus thrombosis. At that time, Brunnstrom stage was II and mild dysarthria was also noted. No loss of consciousness, incontinence, or other neurologic sign was noted. Basically, venous or sinus thrombosis will cause brain lesion or functional abnormality. Sinus thrombosis also decreases absorption of cerebrospinal fluid and increases intracranial pressure. Headache is the most frequently occurring symptom and sometimes seizure occurs. If a cerebral vascular accident occurs, management is the same as for other stroke patients. If cerebral vascular accident does not occur, management considered may include: anticoagulant, endovascular thrombolysis, or therapeutic lumbar puncture if increased intracranial pressure is noted. Besides, other survey for associated diseases may need arrange for appropriate control.

並列關鍵字

Pregnancy ； cerebral venous thrombosis