Pontine infarction in a patient with HELLP syndrome: сase report with a review

INTRODUCTION. The prevalence of HELLP syndrome ranges from 0.5% to 0.9%. The mortality rate during its development reaches 24%. One of the reasons for the unfavorable outcome of this complication is acute cerebrovascular accident, but the true frequency of this complication in HELLP syndrome is currently not specified. An even rarer complication is ischemic brainstem stroke. Progressive endothelial dysfunction leading to generalized microthrombosis and coagulopathy may be the cause of neurological complications in HELLP syndrome and requires a rapid differential diagnosis with other thrombotic microangiopathies (TMA). In case of negative dynamics after delivery, early initiation of plasma exchange or plasma filtration helps stabilize the condition and allows one to safely exclude other variants of TMA.
CASE PRESENTATION. The purpose of the publication is to present a clinical case of the development of brainstem stroke in a patient with an atypical course of HELLP syndrome without clinical and laboratory signs of liver failure, to summarize existing data on the frequency of strokes during pregnancy, risk factors, etiology, as well as diagnostic and treatment strategies.
CONCLUSION. TMA with the development of HELLP syndrome can be the cause of ischemic stroke; it requires an urgent differential diagnosis with hemorrhagic stroke, thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremic syndrome (aHUS), an interdisciplinary approach to diagnosis and treatment, as well as early inclusion in complex therapy therapeutic apheresis.

引言。HELLP 综合征的患病率介于 0.5% 至 0.9% 之间。在其发展过程中的死亡率高达 24%。导致这种并发症不良预后的原因之一为急性脑血管意外，但目前尚未明确该并发症在 HELLP 综合征中的确切发生率。缺血性脑干卒中是一种更为罕见的并发症。进展性内皮功能障碍，导致弥漫性微血栓形成和凝血病，可能是 HELLP 综合征中神经系统并发症的原因，并需要迅速与其他血栓性微血管病（TMA）进行鉴别诊断。在分娩后出现负面动态的情况下，早期启动血浆置换或血浆滤过有助于稳定病情，并确保安全排除其他 TMA 变体。
病例报告。本出版物的目的是呈现一位 HELLP 综合征病程不典型、无肝衰竭临床和实验室表现的患者的脑干卒中病例，总结关于妊娠期间卒中频率、风险因素、病因，以及诊断和治疗策略的现有数据。
结论。TMA 的发生可能是 HELLP 综合征导致缺血性卒中的原因；它需要与出血性卒中、血栓性血小板减少性紫癜（TTP）、非典型溶血性尿毒症综合征（aHUS）进行紧急鉴别诊断，并采用跨学科的诊断和治疗途径，以及早期纳入复杂治疗方案中的血液净化疗法。