产后特发性颅内高压:病例报告和处理策略。

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Annals of Medicine and Surgery Pub Date : 2024-09-18 eCollection Date: 2024-11-01 DOI:10.1097/MS9.0000000000002575
Abdiwahid Ahmed Ibrahim, Mohamed Sheikh Hassan, Abdirisak Abdikarin Ahmed, Nor Osman Sidow, Mohamed Farah Osman Hidig, Mohamed Salad Kadiye, Bakar Ali Adam
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摘要

导言产后头痛又称假性脑瘤,是指产后 6 周内出现的头痛和肩颈疼痛。产褥期头痛的常见原因包括先兆子痫、蛛网膜下腔出血、脑静脉血栓、脑膜炎、脑肿瘤、脑血管疾病和后可逆性脑病综合征。假性脑瘤是导致产后剧烈头痛并伴有或不伴有视神经乳头水肿的一种极为罕见的病因:本文作者介绍了一名 32 岁的产后女性患者,她因剧烈头痛和视力障碍就诊 10 天。神经系统检查未发现任何局灶性或偏侧性缺损。然而,眼底检查显示双侧乳头水肿严重。对比增强脑部磁共振成像未发现占位性肿块病变。磁共振成像排除了静脉闭塞。腰椎穿刺显示开口压力高达 75 cmH2O,细胞计数、蛋白质和葡萄糖水平正常。患者被诊断为特发性颅内高压。使用地佐米和托吡酯治疗 8 周后,患者的临床症状有所改善,乳头水肿消退:临床讨论:IIH 在产后女性中非常罕见。据我们所知,医学文献中很少有关于产后 IIH 的报道。尽管罕见,但产后头痛并伴有视力障碍的患者应进行眼底镜检查。该患者得到了及时的诊断和治疗,临床症状明显改善,视力也得到了挽救:正如本病例所描述的,特发性颅内高压可导致产后期间伴有或不伴有视力障碍的严重头痛(尽管在这一时期非常罕见),因此应在鉴别诊断中予以考虑。
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Idiopathic intracranial hypertension following childbirth: a case report and management strategies.

Introduction: A postpartum headache, also known as pseudotumor cerebri, is defined as a headache and shoulder or neck pain that occur in the first 6 weeks following childbirth. Common causes of headaches during puerperium include pre-eclampsia, subarachnoid hemorrhage, cerebral venous thrombosis, meningitis, brain tumors, cerebrovascular diseases, and posterior reversible encephalopathy syndrome. Pseudotumor cerebri is an extremely rare cause of postpartum severe headache with visual disturbance with or without papilledema.

Case presentation: Here, the authors present a 32-year-old postpartum female patient who presented with a severe headache and visual disturbance for 10 days. Neurological examination did not show any focal or lateralizing deficit. However, a fundus examination showed severe bilateral papilledema. A contrast-enhanced brain MRI did not reveal a space-occupying mass lesion. MRV excluded venous occlusion. A lumbar puncture demonstrated a high opening pressure of 75 cmH2O with a normal cell count and protein and glucose levels. The patient was diagnosed with idiopathic intracranial hypertension. After 8 weeks of treatment with diazomid and topiramate, the patient improved clinically, and her papilledema regressed.

Clinical discussion: The occurrence of IIH is very rare among postpartum females. To our knowledge, very few cases of postpartum IIH have been reported in the medical literature. Although rare, patients with postpartum headache with visual disturbances should have a fundoscopic examination. The patient was diagnosed and managed in time, which led to significant clinical improvement and salvage of her vision.

Conclusion: As described in this case, idiopathic intracranial hypertension can cause severe headaches with and without visual disturbance during the postpartum period (despite being rare in this period), so it should be considered in the differential diagnosis.

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Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
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5.90%
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