Recurrent embolic stroke associated with adenomyosis: A single case report and literature review
Recurrent embolic stroke associated with adenomyosis: A single case report and literature review
复制标题
DOI：
10.1007/s10072-023-06701-3
复制
发表时间：
2023-02
影响因子：
3.3
通讯作者：
Yuto Morishima;Yuji Ueno;A. Satake;Toko Fukao;M. Tsuchiya;T. Hata;Tatsuyuki Ogawa;Naoki Oishi;Sho Nakajima;Shuji Hirata;K. Shindo;Y. Takiyama
中科院分区：
文献类型：
--
作者：
Yuto Morishima;Yuji Ueno;A. Satake;Toko Fukao;M. Tsuchiya;T. Hata;Tatsuyuki Ogawa;Naoki Oishi;Sho Nakajima;Shuji Hirata;K. Shindo;Y. Takiyama
子宫腺肌症是一种良性疾病，子宫内膜腺体和间质存在于子宫肌层内。已经有几个病例报告与子宫腺肌病脑梗死，但其临床特点，最佳治疗，预后没有系统review.MethodsA例脑梗死子宫腺肌病的报道，和一个全面系统的文献检索使用PubMed databasewered.ResultsA 42岁的女人，以前诊断为子宫腺肌病，在月经期间开发多个脑梗死。她的CA 125水平为293 U/mL，开始接受依度沙班30 mg治疗。出院后7天，她出现了随后的月经期，然后发生了复发性卒中。她的CA 125水平在再入院时为743 U/mL。进行子宫切除术，患者没有进一步的中风复发。一项系统性综述确定了19例与子宫腺肌病相关的脑梗死病例，包括本病例。患者的临床特征包括年轻（44.7 ± 6.2岁），月经期间发生卒中（85%），累及≥ 3个血管区域的多发性梗死（39%），以及高水平的CA 125和D-二聚体（分别为810.6 ± 888.4 U/mL和10.3 ± 18.6 μg/mL）。14例患者接受了抗血栓治疗，但5例（36%）患者发生了复发性卒中。子宫切除术的5例和4例患者的初始和复发stoke，分别有没有进一步复发after. Conclusion脑梗死相关子宫腺肌病有其特殊的临床特点。抗血栓治疗是不够的，子宫切除术应特别考虑在复发性中风的情况下。
IntroductionUterine adenomyosis is a benign disorder in which endometrial glands and stroma are present within the myometrium. There have been several case reports of cerebral infarction associated with adenomyosis, but their clinical characteristics, optimal treatment, and prognosis have not been systematically reviewed.MethodsA case of cerebral infarction with adenomyosis is reported, and a comprehensive systematic literature search using the PubMed database was conducted.ResultsA 42-year-old woman, previously diagnosed with adenomyosis, developed multiple cerebral infarctions during menstruation. Her CA125 level was 293 U/mL, and treatment with edoxaban 30 mg was started. Seven days after hospital discharge, she had her subsequent menstrual period and then developed a recurrent stroke. Her CA125 level was 743 U/mL on readmission. A hysterectomy was performed, and the patient has had no further stroke recurrence. A systematic review identified 19 cases with cerebral infarction associated with adenomyosis, including the present case. The patients’ clinical characteristics included young age (44.7 ± 6.2 years), stroke development during menstruation (85%), multiple infarctions affecting ≥ 3 vessel territories (39%), and high levels of CA125 and D-dimer (810.6 ± 888.4 U/mL, and 10.3 ± 18.6 μg/mL, respectively). Antithrombotic therapy was given to 14 patients, but recurrent stroke occurred in 5 (36%) patients. Hysterectomy was conducted in 5 and 4 patients with initial and recurrent stokes, respectively, and there were no further recurrences thereafter.ConclusionCerebral infarction associated with adenomyosis has specific clinical characteristics. Antithrombotic therapy was insufficient, and hysterectomy should particularly be considered in cases of recurrent stroke.