急性前循环大面积脑梗死合并甲状腺危象一例  

Acute large hemispheric infarction combined with thyroid storm: a case report

作　　者：范琳琳[1] 于彦彩 张静雯 田飞[1] 张艳[1] 宿英英[1] Fan Linlin;Yu Yancai;Zhang Jingwen;Tian Fei;Zhang Yan;Su Yingying(Neurology Department,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]山东省沂水县人民医院神经内科,276400

出　　处：《中国脑血管病杂志》2022年第4期274-277,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：甲状腺功能亢进是缺血性卒中的少见危险因素,其可能导致心房颤动和血管狭窄、闭塞、畸形及血液高凝状态等,从而导致脑梗死的发生。在某些诱因下,甲状腺功能亢进患者可能发生罕见且致死性的甲状腺危象,使病情更加复杂、凶险。作者报道1例40岁急性脑梗死女性患者,既往甲状腺功能亢进病史8年,血管评估显示左侧颈内动脉闭塞,血栓弹力图提示高凝状态,经急诊血管内治疗后头部CT显示左侧半球大面积脑梗死、脑组织肿胀、侧脑室受压,部分对比剂外渗、少量渗血,病因诊断为甲状腺功能亢进相关卒中。同时,患者合并甲状腺功能亢进未规范化治疗,且存在多种诱因,病程中突发高热、窦性心动过速、意识障碍加重,确诊甲状腺危象。经过低温脑保护、渗透治疗、抗凝、抗感染、营养支持、甲状腺危象综合治疗等措施后病情明显好转。目前,关于甲状腺功能亢进相关缺血性卒中合并甲状腺危象的报道较少,作者报道该例危重患者,并对甲状腺危象的早期识别和治疗进行探讨。Hyperthyroidism is a rare risk factor of ischemic stroke, which may lead to atrial fibrillation or vascular stenosis, occlusion, malformation or hypercoagulation, and subsequent cerebral infarction. Under certain triggers, patients with hyperthyroidism may develop a rare and fatal thyroid storm, making the condition more complex and dangerous. The authors reported a 40-year old female patient with hyperthyroidism for 8 years and acute cerebral infarction. Vascular assessment showed left internal carotid artery occlusion, and thrombelastogram indicated hypercoagulability. After endovascular treatment, head CT showed large left-hemispheric infarction, cerebral tissue swelling, lateral ventricle compression, contrast extravasation and a small amount of hemorrhage. The etiology was diagnosed as hyperthyroidism-related stroke. At the same time, the patient was complicated with hyperthyroidism without standardized treatment, and there were a variety of triggers. In the course of the disease, sudden high fever, sinus tachycardia, and increased disturbance of consciousness emerged and were diagnosed as thyroid storm. After hypothermia treatment, osmotic therapy, anticoagulation, anti-infection, nutritional support, thyroid storm comprehensive treatment and other measures, the condition improved significantly. Currently, there is few reports on hyperthyroidism-related ischemic stroke complicated with thyroid storm. The authors reported this critically ill patient and discussed the early identification and treatment of thyroid storm.

关 键 词：脑梗死 甲状腺功能亢进 甲状腺危象 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R581[医药卫生—临床医学]