{"id":133,"title":"Spontaneous spinal cerebrospinal fluid leak in very early pregnancy following frozen embryo transfer: A case report","title_zh":"冻融胚胎移植后极早期妊娠发生自发性脊髓脑脊液漏：一例病例报告","url":"https://pubmed.ncbi.nlm.nih.gov/42964301","doi":"10.1016/j.crwh.2026.e00868","pmid":"42964301","journal":"Case Rep Womens Health","kind":"paper","lang":"en","published_at":"2026-10-21T00:00:00+00:00","fetched_at":"2026-11-08T03:43:53+00:00","authors":["Salam Y","El Moussa H","Obeid M","Chehade Z","Shaar S","Nasr A","Ghazeeri G"],"primary_topic":"art-clinical","topics":[{"slug":"art-clinical","score":4.0,"hits":["frozen embryo transfer"]},{"slug":"early-pregnancy","score":4.0,"hits":["early pregnancy"]}],"topic_score":4.0,"preference_score":5.0,"preference_labels":["可转化到 ART 实验室的发现"],"llm_score":60.0,"final_score":65.0,"score_dims":{"novelty":55,"rigor":30,"impact":45,"relevance":75,"translation":50},"recommend_reason":"罕见但具临床警示价值的病例报告，提醒ART后极早期妊娠出现直立性头痛时需警惕自发性脊髓脑脊液漏，且脑MRI正常不能排除；但证据级别低，对实验室转化有限。","keywords":["自发性颅内低压","脊髓脑脊液漏","冻融胚胎移植","早期妊娠","直立性头痛","硬膜外血贴"],"selected":1,"story_id":353,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"报告一例33岁G2P1女性，冻融胚胎移植后孕4周4天出现严重直立性双枕部头痛，伴恶心、呕吐和颈痛，无外伤或脊柱操作史。脑MRI未见异常，全脊柱MRI显示颈至腰段广泛脑脊液信号聚集，提示脊髓脑脊液漏。三次硬膜外血贴后症状部分且渐进改善，余予补液、咖啡因、镇痛及活动限制等保守治疗，最终完全缓解；妊娠足月无复发。提示新发直立性头痛孕妇应考虑自发性颅内低压，脑MRI正常不能排除，临床高度怀疑时需行脊柱MRI。","summary":"Spontaneous intracranial hypotension, typically resulting from spontaneous leakage of spinal cerebrospinal fluid (CSF), is an uncommon and underrecognized condition, particularly during pregnancy. Diagnosis can be challenging when cranial imaging is normal, and presentations in very early pregnancy are sparsely reported. This report describes the case of a 33-year-old woman (gravida 2, para 1) who presented at 4 weeks and 4 days of gestation following frozen embryo transfer with a severe orthostatic bi-occipital headache associated with nausea, vomiting and neck pain. There was no preceding trauma or recent spinal instrumentation. Magnetic resonance imaging (MRI) of the brain was unremarkable; however, whole-spine MRI revealed an extensive longitudinal CSF-signal collection extending from the cervical to the lumbar spine, compatible with spinal CSF leakage. Three epidural blood patches produced partial but progressive symptomatic improvement. Residual symptoms were managed conservatively with hydration, caffeine, analgesia, and relative activity restriction, with eventual complete clinical resolution. The remainder of the pregnancy progressed to term without recurrence, and the patient underwent a repeat cesarean delivery under general anesthesia in accordance with maternal preference. Spontaneous intracranial hypotension should be considered in pregnant patients presenting with new-onset orthostatic headache. Normal brain MRI does not exclude the diagnosis, and spinal MRI may demonstrate evidence of CSF leakage when clinical suspicion remains high. This case highlights that spontaneous spinal CSF leakage may present in very early pregnancy, following a medicated frozen embryo transfer, an infrequently reported clinical scenario. Management should be individualized and multidisciplinary, given the limited pregnancy-specific evidence and variable response to epidural blood patching.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}