The young woman with postpartum "thunderclap" headache
The young woman with postpartum "thunderclap" headache
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DOI：
10.1111/j.1526-4610.2005.05012.x
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发表时间：
2005-01-01
期刊：
影响因子：
5
通讯作者：
Evans, R
中科院分区：
文献类型：
--
作者：
Gladstone, JP;Dodick, DW;Evans, R
一名19岁的女性在没有并发症的情况下完成了她的第一次怀孕。产后第四天，她坐在家里时突然出现严重而持续的头痛。在6小时后进行评估时，她的头痛持续存在，被描述为重度（“我一生中最严重的”）、弥漫性、非偏侧性、非搏动性，不受体位变化的影响。她否认相关的颈部僵硬。她的既往病史是自11岁起发作性偏头痛伴和不伴视觉先兆。在她怀孕期间，她只经历过偶尔和相对轻微的头痛。生命体征稳定。血压为130/78，心率为每分钟76次，无发热。她的一般和神经系统检查正常。她的颈部柔软，没有视神经乳头水肿的迹象。头痛发作后6小时进行了非对比脑CT，结果正常。进行腰椎穿刺，结果显示开放压升高（320 mm/H2O）;获得的CSF呈铁锈色，实验室分析显示250 000 RBC/mm 3、255 WBC/mm 3（80%多聚体，20%单核细胞）、葡萄糖77 mg/dL和蛋白质185 mg/dL。脑部MRI显示提示上级矢状窦内急性血栓形成的结果，MRV显示窦的远端三分之二不可见。
A 19-year-old female completed her first ever pregnancy without complication. On the fourth postpartum day, she abruptly developed a severe and unremitting headache while sitting at home. At the time of her evaluation 6 hours later, her headache persisted and was described as severe (“the worst of my life”), diffuse, nonlateralized, nonpulsatile, and not affected by positional change. She denied associated neck stiffness. Her past medical history was notable for episodic migraine with and without visual aura since age 11. During her pregnancy, she had experienced only occasional and relatively mild headaches. Vital signs were stable. Blood pressure was 130/78, heart rate was 76 beats per minute, and she was afebrile. Her general and neurologic examinations were normal. Her neck was supple and there was no evidence of papilledema.Noncontrast brain CT was performed 6 hours following headache onset and was normal. Lumbar puncture was performed and demonstrated an elevated opening pressure (320 mm/H2O); the CSF obtained was rust colored, and laboratory analyses demonstrated 250 000 RBC/mm3, 255 WBC/mm3 (80% polys, 20% mononuclear cells), glucose 77 mg/dL, and protein 185 mg/dL. Brain MRI demonstrated findings suggestive of acute thrombosis within the superior sagittal sinus, and on MRV the distal two-thirds of the sinus was not visualized.