妊娠及产褥期出血性脑卒中的临床及影像学特点

目的 探讨妊娠及产褥期出血性脑卒中(HSPP)的临床及影像学特点.方法 对中国医科大学附属盛京医院2004年6月至2008年7月7例HSPP的发病时间、发病诱因、临床表现、影像学特点、治疗及预后进行回顾性分析.结果 HSPP在妊娠早期无发病,妊娠中期发病3例,妊娠晚期发病2例,产褥期发病2例.病因为脑血管动静脉畸形(AVM)破裂的4例患者的发病时间为妊娠中期3例、产褥期1例.2例患者在妊娠前已经确诊有脑血管AVM,1例患者妊娠期有子痫.头部影像学检查提示基底节区出血2例,脑叶出血4例,蛛网膜下腔出血(SAH)1例;病因为脑血管AVM破裂4例.7例患者采用手术治疗2例、血管内介入治疗2例、保守治疗3例.经治疗最终1例痊愈,4例症状明显好转,1例症状有所改善,1例死亡.结论 HSPP发病时间集中在妊娠中、晚期及产褥期;病因为脑血管AVM破裂的患者的发病时间以妊娠中期为主.头部影像学检查能明确病变性质及病因.

Clinical and imaging features of hemorrhagic stroke during pregnancy and puerperium

Objective To investigate the clinical and imaging features of hemorrhagic stroke during pregnancy and puerperium (HSPP).Methods A retrospective analysis was conducted about timing, precipitating factors, clinical manifestations, imaging characteristics, treatment and outcome of 7 HSPP patients.Results None of 7 HSPP occurred in the first trimester, 3 in the second trimester, 2 in the third trimester and 2 in the puerperium. Three of 4 patients whose etiology was due to ruptured arteriovenous malformations (AVM) occurred in the second trimester, including one case in the puerperium. Two patients had been diagnosed as cerebral vascular AVM before pregnancy. One patient had eclampsia during pregnancy. The initial symptoms and signs of 7 patients: 4 cases with headache, nausea and vomiting, 4 cases with extremity paralysis, 3 cases with disorders of consciousness, 4 cases with aphasia, 2 cases with central face and tongue paralysis and 1 case with extremity numbness. Cerebral imaging investigations showed 2 cases with basilar ganglia hemorrhage, 4 cases with lobar hemorrhage and 1 case with subarachnoid hemorrhage (SAH). There were 4 cases whose etiology was because of ruptured AVM. Two of 7 patients were treated with operation, 2 with endovascular intervention and 3 with conservative treatment. The prognosis included full recovery (1/7), marked improvement (4/7), slight improvement (1/7) and death (1/7).Conclusion The onset time of HSPP concentrated in the second, third trimester and the puerperium;Onset time of the patients because of ruptured AVM concentrated in the second trimester. Cerebral imaging examination could elucidate the nature of lesion and the etiology of disease.