1887
Volume 2024, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare and life-threatening condition that may be encountered during pregnancy and puerperium. The diagnosis of CVST is a challenge because of its varied presentation.

Case Report: A 28-year-old woman presented with headache, projectile vomiting, and generalized tonic–clonic seizures 10 days after delivery by cesarean section. She had an uneventful antenatal period of 38 weeks of gestation. High clinical suspicion and the availability of magnetic resonance venography helped in making a diagnosis of CVST. She was successfully managed with a low-molecular-weight heparin (LMWH) and anti-epileptic therapy with no residual complications.

Discussion: Pregnancy induces several prothrombotic changes in the coagulation system that predispose to CVST. These changes persist for six to eight weeks after birth. Infection and cesarean section are the additional risk factors for CVST during puerperium. The symptoms of CVST depend on the sinuses and veins involved, raised intracranial pressure, and the extent of brain parenchymal injury.

Conclusion: Greater awareness of the disease and the availability of imaging modalities have contributed to the early diagnosis and favorable outcomes in these cases. LMWH is the main stay of treatment in this disease.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2024.13
2024-03-11
2024-07-25
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2024/1/qmj.2024.13.html?itemId=/content/journals/10.5339/qmj.2024.13&mimeType=html&fmt=ahah

References

  1. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007; 6:(2):162–70. doi: 10.1016/S1474-4422(07)70029-7
    [Google Scholar]
  2. Ferro JM. Causes, predictors of death, and antithrombotic treatment in cerebral venous thrombosis. Clin Adv Hematol Oncol. 2006; 4:(10):732–3. PMID: 17099629
    [Google Scholar]
  3. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004 Mar; 35:(3):664–70. doi: 10.1161/01.STR.0000117571.76197.26
    [Google Scholar]
  4. Hassan MA, Omar AA, Mohamed IA. Postpartum cerebral venous sinus thrombosis: a case report. Vasc Health Risk Manag. 2023 Jan 30; 19:63–7. doi: 10.2147/VHRM.S390098
    [Google Scholar]
  5. Oh MK, Ryu JH, Jeon WJ, Lee CW, Cho SY. Case report: postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache. BMC Anesthesiol. 2020 Apr 7; 20:(1):80. doi: 10.1186/s12871-020-00992-1
    [Google Scholar]
  6. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005; 352:(17):1791–8. doi: 10.1056/NEJMra042354
    [Google Scholar]
  7. Pabinger I, Grafenhofer H, Kyrle PA, Quehenberger P, Mannhalter C, Lechner K, et al. Temporary increase in the risk for recurrence during pregnancy in women with a history of venous thromboembolism. Blood. 2002; 100:(3):1060–2. doi: 10.1182/blood-2002-01-0149
    [Google Scholar]
  8. Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke. 2000; 31:(6):1274–82. doi: 10.1161/01.str.31.6.1274
    [Google Scholar]
  9. Appenzeller S, Zeller CB, Annichino-Bizzachi JM, Costallat LT, Deus-Silva L, Voetsch B, et al. Cerebral venous thrombosis: influence of risk factors and imaging findings on prognosis. Clin Neurol Neurosurg. 2005; 107:(5):371–8. doi: 10.1016/j.clineuro.2004.10.004
    [Google Scholar]
  10. Garetier M, Rousset J, Pearson E, Tissot V, Gentric JC, Nowak E, et al. Value of spontaneous hyperdensity of cerebral venous thrombosis on helical CT. Acta Radiol. 2014 Dec; 55:(10):1245–52. doi: 10.1177/0284185113513977
    [Google Scholar]
  11. Saposnik G, Barinagarrementeria F, Brown RD Jr, , Bushnell CD, Cucchiara B, Cushman M, et al. American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Apr; 42:(4):1158–92. doi: 10.1161/STR.0b013e31820a8364
    [Google Scholar]
  12. Zhang S, Hu Y, Li Z, Huang D, Zhang M, Wang C, et al.. Endovascular treatment for hemorrhagic cerebral venous sinus thrombosis: experience with 9 cases for 3 years. Am J Transl Res. 2018 Jun 15; 10:(6):1611–19. PMID: 30018704
    [Google Scholar]
  13. Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Cerebral venous thrombosis: a practical guide. Pract Neurol. 2020 Oct; 20:(5):356–67. doi: 10.1136/practneurol-2019-002415
    [Google Scholar]
  14. Aaron S, Alexander M, Moorthy RK, Mani S, Mathew V, Patil AK, et al. Decompressive craniectomy in cerebral venous thrombosis: a single centre experience. J Neurol Neurosurg Psychiatry. 2013 Sep; 84:(9):995–1000. doi: 10.1136/jnnp-2012-303356
    [Google Scholar]
  15. Coutinho JM, Stam J. How to treat cerebral venous and sinus thrombosis. J Thromb Haemost. 2010; 8:(5):877–83. doi: 10.1111/j.1538-7836.2010.03799.x
    [Google Scholar]
  16. Aguiar de Sousa D, Canhão P, Ferro JM. Safety of pregnancy after cerebral venous thrombosis: a systematic review. Stroke. 2016 Mar; 47:(3):713–18. doi: 10.1161/STROKEAHA.115.011955
    [Google Scholar]
/content/journals/10.5339/qmj.2024.13
Loading
/content/journals/10.5339/qmj.2024.13
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): PregnancyPuerperium and Thrombosis
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error