Trombosis venosa cerebral secundaria a estado protrombótico transitorio del embarazo y puerperio. Un reporte de caso
Cerebral venous thrombosis secondary to transient prothrombotic state of pregnancy and puerperium. A case report
Resumen
La trombosis venosa cerebral es una causa frecuente de evento vascular cerebral en la paciente embarazada o en etapa de puerperio debido al estado protrombótico transitorio generado por los diferentes cambios fisiológicos suscitados durante estas dos etapas. En México, cerca del 50% de los casos se encuentran durante embarazo o puerperio. El diagnóstico se puede realizar y confirmar con imagen por resonancia magnética o con estudios invasivos como la angiografía cerebral. La instauración de un régimen de tratamiento involucra la anticoagulación por un periodo de hasta seis meses y, por lo general, se tiene una buena respuesta y evolución favorable. Se presenta el caso de una paciente en puerperio inmediato que debuta con evento vascular cerebral asociado a trombosis venosa cerebral, quien al descartar otras etiologías relacionadas, se determinó ser secundario al estado procoagulante transitorio del embarazo y puerperio. Cursó con evolución favorable durante su hospitalización con anticoagulación con heparina de bajo peso molecular y egresa con anticoagulación vía oral sin secuelas neurológicas residuales durante su seguimiento por 6 meses. Se resalta la importancia de identificar factores de riesgo que predispongan al desarrollo de patología vascular cerebral durante la atención de la mujer gestante y en periodo posparto, que si bien de baja frecuencia, debe ser siempre una entidad clínica a considerar para no retrasar el diagnóstico y otorgar tratamiento oportuno de forma temprana para evitar el riesgo de secuelas neurológicas residuales y/o mortalidad materna.
Palabras clave: trombosis venosa cerebral, embarazo, puerperio, medicina interna, neurología, ginecología y obstetricia.
ABSTRACT:
Cerebral venous thrombosis is a frequent cause of cerebral vascular event in pregnant or postpartum patients due to the transient prothrombotic state generated by the different physiological changes produced during these two stages. In Mexico, about 50% of cases are found during pregnancy or puerperium. The diagnosis can be made and confirmed with magnetic resonance imaging or with invasive studies such as cerebral angiography. The establishment of a treatment regimen involves anticoagulation for a period of up to six months and, generally, there is a good response and favorable evolution. We present the case of a patient in the immediate postpartum period who debuted with a cerebral vascular event associated with cerebral venous thrombosis. She had a favorable course of illness during her hospitalization with low molecular weight heparin anticoagulation, and she was discharged with oral anticoagulation without residual neurological sequelae during her 6-month follow-up. The importance of identifying risk factors that predispose to the development of cerebral vascular pathology during the care of pregnant women and in the postpartum period is emphasized. Although it is rare, it should always be considered as a clinical entity to avoid delaying diagnosis and to provide early and timely treatment to prevent the risk of residual neurological sequelae and/or maternal mortality.
DOI:
Palabras clave
Referencias
Aguiar de Sousa, D., Canhão, P., Crassard, I., Coutinho, J., Arauz, A., Conforto, A., Béjot, Y., Giroud, M., Ferro, J. M. & ISCVT-2-PREGNANCY Investigators (2017). Safety of Pregnancy After Cerebral Venous Thrombosis: Results of the ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis)-2 PREGNANCY Study. Stroke, 48(11), 3130–3133. https://doi.org/10.1161/STROKEAHA.117.018829
Bajko, Z., Motataianu, A., Stoian, A., Barcutean, L., Andone, S., Maier, S., Drăghici, I. A. & Balasa, R. (2021). Postpartum cerebral venous thrombosis: A single-center experience. Brain Sciences, 11(3), 327. https://doi.org/10.3390/brainsci11030327
Camargo, E. & Singhal, A. (2021). Stroke in Pregnancy: A Multidisciplinary Approach. Obstetrics and gynecology clinics of North America, 48(1), 75–96. https://doi.org/10.1016/j.ogc.2020.11.004
Coutinho, J., Zuurbier, S., Aramideh, M. & Stam, J. (2012). The incidence of cerebral venous thrombosis: A cross-sectional study. Stroke, 43(12), 3375–3377. http://dx.doi.org/10.1161/STROKEAHA.112.671453
Ferro, J., Bousser, M., Canhão, P., Coutinho, J., Crassard, I., Dentali, F., di Minno, M., Maino, A., Martinelli, I., Masuhr, F., Aguiar de Sousa, D., Stam, J. & European Stroke Organization (2017). European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. European journal of neurology, 24(10), 1203–1213. https://doi.org/10.1111/ene.13381
Ferro, J. M., Canhão, P., Stam, J., Bousser, M., Barinagarrementeria, F. & ISCVT Investigators. (2004). Prognosis of cerebral vein and dural sinus thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke, 35(3), 664–670. http://dx.doi.org/10.1161/01.STR.0000117571.76197.26
Hung, S., Lee, M., Lin, H., Chen, L., Chuang, C., Chew, C., Yu, B., Yang, H., Hsu, F. & Chiou, W. (2022). Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time. Stroke, 53(2), 338–344. https://doi.org/10.1161/STROKEAHA.121.034109
James, A., Bushnell, C., Jamison, M. & Myers, E. (2005). Incidence and risk factors for stroke in pregnancy and the puerperium. Obstetrics and gynecology, 106(3), 509–516. https://doi.org/10.1097/01.AOG.0000172428.78411.b0
Kamel, H., Navi, B., Sriram, N., Hovsepian, D., Devereux, R. & Elkind, M. (2014). Risk of a thrombotic event after the 6-week postpartum period. The New England journal of medicine, 370(14), 1307–1315. https://doi.org/10.1056/NEJMoa1311485
Karjalainen, L., Tikkanen, M., Rantanen, K., Aarnio, K., Korhonen, A., Saaros, A., Laivuori, H., Gissler, M. & Ijäs, P. (2021). Stroke in Pregnancy and Puerperium: Validated Incidence Trends With Risk Factor Analysis in Finland 1987-2016. Neurology, 96(21), e2564–e2575. https://doi.org/10.1212/WNL.0000000000011990
Ruiz-Sandoval, J., Chiquete, E., Bañuelos-Becerra, L., Torres-Anguiano, C., González-Padilla, C., Arauz, A., León-Jiménez, C., Murillo-Bonilla, L., Villarreal-Careaga, J., Barinagarrementería, F., Cantú-Brito, C. & RENAMEVASC investigators (2012). Cerebral venous thrombosis in a Mexican multicenter registry of acute cerebrovascular disease: the RENAMEVASC study. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association, 21(5), 395–400. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.01.001
Saposnik, G., Barinagarrementeria, F., Brown, R., Jr, Bushnell, C., Cucchiara, B., Cushman, M., deVeber, G., Ferro, J., Tsai, F. & American Heart Association Stroke Council and the Council on Epidemiology and Prevention (2011). Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(4), 1158–1192. https://doi.org/10.1161/STR.0b013e31820a8364
Swartz, R., Cayley, M., Foley, N., Ladhani, N., Leffert, L., Bushnell, C., McClure, J. & Lindsay, M. (2017). The incidence of pregnancy-related stroke: A systematic review and meta-analysis. International journal of stroke: official journal of the International Stroke Society, 12(7), 687–697. https://doi.org/10.1177/1747493017723271
Wabnitz, A. & Bushnell, C. (2015). Migraine, cardiovascular disease, and stroke during pregnancy: systematic review of the literature. Cephalalgia: an international journal of headache, 35(2), 132–139. https://doi.org/10.1177/0333102414554113
Zhou, B., Huang, S., Huang, C. & Liu, S. (2022). Cerebral venous sinus thrombosis in pregnancy: A case report. World journal of clinical cases, 10(1), 309–315. https://doi.org/10.12998/wjcc.v10.i1.309
Enlaces refback
- No hay ningún enlace refback.
Depósito Legal Electrónico: ME2016000090
ISSN Electrónico: 2610-797X
DOI: https://doi.org/10.53766/GICOS
![]() ![]() ![]() ![]() ![]() ![]() ![]() |
Se encuentra actualmente registrada y aceptada en las siguientes base de datos, directorios e índices: | |||
![]() | ![]() | ![]() | |
![]() | ![]() | ![]() | ![]() |
![]() | ![]() | ![]() | ![]() |
![]() | ![]() | ![]() | ![]() |
![]() | ![]() | ![]() | ![]() |
![]() | ![]() | ![]() | ![]() |
![]() | ![]() |
Todos los documentos publicados en esta revista se distribuyen bajo una
Licencia Creative Commons Atribución -No Comercial- Compartir Igual 4.0 Internacional.
Por lo que el envío, procesamiento y publicación de artículos en la revista es totalmente gratuito.