摘要：

目的: 报道1例以产褥期精神行为异常发病的重症脑静脉血栓形成病例，总结其临床表现及影像学变化，以提高临床医师对此类疾病的认识。方法与结果: 女性患者，34岁，分娩后1个月以精神行为异常发病，被家属误以为“产后抑郁”，外院诊断为“精神障碍原因待查”，经抗精神病药物治疗后精神行为异常仍进一步加重，直至出现右侧肢体力弱后，结合影像学检查，最终明确诊断为重症脑静脉血栓形成，经补液、抗凝、降低纤维蛋白原、激素抗炎症、抗精神病药物等治疗后，精神行为异常和右侧肢体力弱症状缓解，预后良好。结论: 以精神行为异常发病的脑静脉血栓形成较为罕见，其临床表现与多种精神疾病存在重叠，尤其对于产褥期出现精神行为异常的患者，常误诊为“产后抑郁”，故此类患者出现抗精神病药物治疗效果欠佳时，应警惕脑静脉血栓形成的可能，尽早完善多模态影像学检查，以免误诊、误治。

关键词: 静脉血栓形成, 脑静脉, 磁共振成像, 产后期, 精神障碍

Abstract:

Objective: To report a case of severe cerebral venous thrombosis (CVT) with an initial presentation of puerperium psychiatric and behavioral abnormalities, and to summarize and analyze its clinical manifestations and imaging changes, to enhance clinicians' awareness of this condition. Methods and Results: A 34 - year - old female patient developed psychiatric and behavioral abnormalities one month postpartum. She was initially presumed by her family to have "postpartum depression", and subsequently diagnosed at an external hospital as "psychiatric disorder of undetermined etiology". Following treatment with antipsychotic medications, the patient's psychiatric and behavioral abnormalities progressively aggravated. Upon the patient's development of right - sided limb weakness, a definitive diagnosis of severe CVT was ultimately established, corroborated by imaging findings. After a therapeutic regimen comprising fluid repletion, anticoagulation, reduction of fibrinogen level, corticosteroid anti - inflammatory therapy, and antipsychotic medications, the patient's psychiatric and behavioral abnormalities and right - sided limb weakness ameliorated, with a good prognosis. Conclusions: CVT manifesting with psychiatric and behavioral abnormalities is relatively uncommon. Its clinical presentation overlaps with that of various psychiatric disorders. Particularly in puerperium patients exhibiting psychiatric and behavioral abnormalities, a misdiagnosis of "postpartum depression" is frequent. Consequently, when such patients demonstrate an inadequate response to antipsychotic medications, the potential for CVT should be vigilantly considered, and comprehensive multimodal imaging should be pursued promptly to prevent misdiagnosis and inappropriate treatment.

Key words: Venous thrombosis, Cerebral veins, Magnetic resonance imaging, Postpartum period, Mental disorders