产后椎动脉动脉瘤所致蛛网膜下腔出血的延迟诊断:1例最初误诊为硬膜穿刺后头痛。

IF 0.7 Q4 CLINICAL NEUROLOGY
Nirmalya Ray, Mithun Shekar, Ritwick Mondal, Shramana Deb, Jayanta Roy, Julián Benito-León
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引用次数: 0

摘要

背景:由动脉瘤破裂引起的产后蛛网膜下腔出血是一种罕见但可能危及生命的并发症,它可以模拟良性产后头痛,特别是在神经轴向麻醉后。病例报告:我们描述了一位40岁的女性,她在脊柱麻醉下剖宫产手术后出现严重的头痛,主要位于枕部和后颈部区域。最初推测为硬脑膜穿刺后头痛,术后第5天病情恶化,出现昏迷和癫痫发作。颅脑电脑断层显示弥漫性蛛网膜下腔及脑室出血。血管影像学显示右侧椎动脉(V4段)夹层动脉瘤,小脑后下动脉起源于动脉瘤穹窿。她接受了血管内盘绕术并牺牲了母血管。她恢复良好,出院时仅出现轻度小脑性共济失调。在3年的随访中,她的神经系统完好。讨论:本病例强调了考虑动脉瘤性蛛网膜下腔出血的重要性,产后患者不典型或加重的头痛后,轴向麻醉。早期的神经成像和及时的干预可以导致良好的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Delayed Diagnosis of Postpartum Subarachnoid Hemorrhage Caused by Vertebral Artery Aneurysm: A Case Initially Misdiagnosed as Post-Dural Puncture Headache.

Background: Postpartum subarachnoid hemorrhage caused by aneurysm rupture is a rare but potentially life-threatening complication that can mimic a benign postpartum headache, especially after neuraxial anesthesia.

Case report: We describe a 40-year-old woman who developed a severe headache, predominantly located in the occipital and posterior neck region, following cesarean section under spinal anesthesia. Initially presumed to be post-dural puncture headache, her condition deteriorated by postoperative day 5, with coma and seizures. Cranial computed tomography revealed diffuse subarachnoid and intraventricular hemorrhage. Vascular imaging showed a dissecting aneurysm of the right vertebral artery (V4 segment), with the posterior inferior cerebellar artery arising from the aneurysm dome. She underwent endovascular coiling with parent vessel sacrifice. Her recovery was favorable, with only mild cerebellar ataxia at discharge. At the 3-year follow-up, she was neurologically intact.

Discussion: This case underscores the importance of considering aneurysmal subarachnoid hemorrhage in postpartum patients with atypical or worsening headache following neuraxial anesthesia. Early neuroimaging and timely intervention can lead to excellent outcomes.

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来源期刊
Neurohospitalist
Neurohospitalist CLINICAL NEUROLOGY-
CiteScore
1.60
自引率
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发文量
108
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