A rare case of post-partum cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis is a rare neurologic emergency during pregnancy. Life threatening complications can be prevented if it is detected and treated well in time. A 24 years P2L3A2 lady, who had undergone elective caesarean delivery developed sudden onset severe episodic parieto-occipital headache and bilateral diminution of vision on 4th post-partum day. She had no known risk factors for thrombosis. There was no history suggestive of sepsis or pre-eclampsia. On clinical examination her blood pressure was found to be very high (164-180/104-110 mm Hg). There was no sensory or motor deficit. Relevant haematological and biochemical investigations were within normal limits. Urinary protein was negative. With a provisional diagnosis of imminent eclampsia, she was put on antihypertensive and Magnesium Sulphate. However, in view of persistence of the symptoms even after 24 hours, contrast-enhanced computed tomography (CECT) was done, which revealed venous infarction in occipital cortex and subcortical white matter. Magnetic resonance (MR) venography confirmed thrombus in left transverse and sigmoid sinuses. Thus, definitive treatment in the form of heparin in therapeutic doses was started. Antihypertensive was continued and prophylactic anticonvulsant was added in view of presence of the infarction. Patient responded well. Vision improved, and headache resolved completely. The patient was discharged on antihypertensive, anticonvulsant and vitamin K antagonist (Warfarin sodium) with an advice of regular follow-up. Cerebral venous thrombosis (CVT) is an uncommon entity and a high index of suspicion is needed to diagnose it at an earlier stage for timely initiation of treatment and prevention of complications. Prognosis in pregnant cases is better than that during a non-pregnant state.

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Cerebral Venous Sinus Thrombosis: An Uncommon Presentation of Headache Mimicking Subarachnoid Hemorrhage

Journal of Medicine ◽

10.3329/jom.v10i2.2826 ◽

1970 ◽

Vol 10 (2) ◽

pp. 115-118

Author(s):

Naima Sultana ◽

Monzurul H Chowdhury ◽

Md Shahriar Mahbub ◽

Md Billal Alam

Keyword(s):

Subarachnoid Hemorrhage ◽

Oral Contraceptives ◽

Sinus Thrombosis ◽

Serum Levels ◽

Cerebral Venous Sinus Thrombosis ◽

Sudden Onset ◽

Interesting Case ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Uncommon Presentation

Cerebral venous sinus thrombosis is a rare disorder accounting for less than 1% of all strokes. It is more common in children and young adults. Here we report a rare and interesting case of cerebral venous l sinus thrombosis mimicking subarachnoid hemorrhage. A 40 years old women, presented with sudden onset of headache, vomiting and unconsciousness associated with convulsions. She had a history of taking oral contraceptives for the last 12 years. Clinical examinations showed ill-looking women with Glasgow Coma Scale of 12 along with neck rigidity and bilateral papilloedema. Although initially we suspected her as a case of subarachnoid hemorrhage, subsequent investigations with MRI and MRV showed to be a case of superior sagittal and transverse sinus thrombosis. Treatment with anticoagulation recovered her from headache and papilloedema. Serum levels of thrombophilic factors were within the normal physiological limits. Thus we concluded that although cerebral venous thrombosis is 100 times less than the cerebral arterial disease, a women presented with sudden onset of headache and vomiting with long term use of oral contraceptives, cerebral thrombosis should be considered as a differential. Key words: Cerebral venous sinus thrombosis , Sagittal sinus thrombosis, Subarachnoid hemorrhage , Magnetic resonance venography. doi: 10.3329/jom.v10i2.2826 J MEDICINE 2009; 10 : 115-118

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Etiological associations of Cerebral Venous Sinus Thrombosis (CVT) among Sudanese patients in Khartoum state Neurological Centers, Sudan, 2020

10.21203/rs.3.rs-530219/v1 ◽

2021 ◽

Author(s):

Mohamed Malekaldar ◽

Abbasher Hussien ◽

Khabab Abbasher Hussien Mohamed Ahmed ◽

Yassin Abdalla

Keyword(s):

Oral Contraceptive ◽

Sinus Thrombosis ◽

Post Partum ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Oral Contraceptive Pills ◽

Venous Sinus Thrombosis ◽

Contraceptive Pills ◽

Work Up ◽

Treatable Condition

Abstract Background As cerebral venous sinus thrombosis is common in our country and it carries a high risk of morbidity and mortality if it is not detected and treated early. The common aetiological associations of CVST are post-partum, pregnancy and oral contraceptive pills. Objectives To study the etiological association of CVST among Sudanese patients in Khartoum state in neurological centers. Methodology This is a descriptive prospective hospital based study was conducted on CVST patients in four neurological centers in Khartoum state in the period from March to October 2020. Results Sixty patients were studied for etiological association of CVST using standardized questionnaire including medical history, clinical examination, investigation and treatment. The most common etiological association were pregnancy in 15(25%) OCP in 11(18.3) and being in the post-partum period in 23(38.3%). Recommendation Cerebral venous sinus thrombosis is a treatable condition and has good outcome. Early detection of patients and performing suitable work up including thrombophilia and connective tissue disease screening is essential. Conclusion Post-partum, pregnancy and oral contraceptive pills were the most common etiological associations of cerebral venous sinus thrombosis compared with other populations.

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Cerebral Venous Sinus Thrombosis in Early Pregnancy : A Case Report

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v18i1.42139 ◽

2019 ◽

Vol 18 (1) ◽

pp. 54-56

Author(s):

Salma Akhter

Keyword(s):

Sinus Thrombosis ◽

Post Partum ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Low Molecular Weight ◽

Contributing Factors ◽

Venous Sinus Thrombosis ◽

Mother And Child ◽

Uncommon Condition ◽

Neuro Imaging

Cerebral Venous Sinus Thrombosis (CVST) in pregnancy is an uncommon condition and affects about 5 women per million. Actual etiology is difficult to confirm, a hypercoagulable state along with protein Sand C deficiency, hyperhomocystinaemia are the contributing factors. MRV like neuro imaging is the main stay of diagnosis. Treatment with Low molecular weight heparin throughout the pregnancy and post partum period can save the life of both mother and child. Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 54-56

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Report of clinical case: Catatonic symptoms as a result of cerebral venous sinus thrombosis

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.627 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s500-s500

Author(s):

P. Ortega Orihuela ◽

A.L. Pérez Morenilla ◽

C. Hernández González

Keyword(s):

Clinical Case ◽

Psychiatric Symptoms ◽

Sinus Thrombosis ◽

Vital Signs ◽

Cerebral Venous Sinus Thrombosis ◽

Sudden Onset ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Sagittal Sinus ◽

Competing Interest

Clinical caseWe present the case of an 18-year-old woman attending the emergency room due to behavioral disorders that appeared 24 hours ago. The clinic was of restlessness, uninhibited behavior, stereotyped movements, global insomnia, semimutism and negativism. Initially she was diagnosed with catatonia, and was admitted to the Mental Health Hospitalization Unit. There were no previous psychopathological antecedents, although relatives reported that she had several stressors. During admission, she had a partial response to benzodiazepine treatment, and a loss of strength in the left upper limb was evidenced, and venous sinus thrombosis was diagnosed. With the anticoagulant treatment, the psychiatric symptomatology presented was markedly improved.Medical examinationNormal vital signs, afebrile. Absence of focal neurological signs. Stereotyped movements, oral-buccal dyskinesia. Negativism, disinhibition and oppositional behaviour. Supplementary tests with results within the normal range. Cranial MRI: Upper, transverse and sigmoid right sagittal sinus thrombosis.ConclusionsNumerous cases of thrombosis have been documented as a result of a catatonic state, mainly due to the immobilization and the risk involved. However, in this case, sudden onset of psychiatric symptoms, absence of psychiatric antecedents, and excellent response to anticoagulant therapy, leads us to conclude that catatonic symptoms could be considered as a consequence of cerebral edema caused by thrombosis. The presentation of catatonia as the sole cause of a somatic disorder is not common, but would be stimulated by certain factors, such as excessive stress and personality disorders, documented as vulnerability factors for such symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Relationship between cerebral venous sinus thrombosis and intracranial arteritis during pregnancy and post partum

Journal of Investigative Medicine ◽

10.1136/jim-2020-001757 ◽

2021 ◽

pp. jim-2020-001757

Author(s):

Xiurong Li ◽

Jianan Dong ◽

Yaping Sun ◽

Qing Li ◽

Li Shi

Keyword(s):

Sinus Thrombosis ◽

Post Partum ◽

White Cell Count ◽

Fluid Pressure ◽

Clinical Manifestations ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Disturbance Of Consciousness ◽

Imaging Results

Our study was conducted to explore the relationship between cerebral venous sinus thrombosis (CVST) and intracranial arteritis during the time of pregnancy as well as puerperium. The current retrospective case study involved a total of 153 patients with pregnancy-related CVST. CVST was diagnosed mainly based on clinical manifestations and imaging results. Detailed information on demographics, risk factors (excluding intracranial arteritis), and pregnancy outcomes was systematically recorded. The average age of patients diagnosed with CVST was 28.67±3.54 years old. Among these patients, there were 62 cases of puerperal CVST and 91 cases of pregnancy-related CVST. The clinical manifestations of patients with CVST included headache in 55 cases (35.95%), symptomatic seizures in 26 cases (16.99%), symptomatic limb weakness in 22 cases (14.38%), symptomatic nausea/vomiting in 18 cases (11.76%), symptomatic disturbance of consciousness in 15 cases (9.80%), symptomatic blurred vision in 10 cases (6.54%), and symptomatic fever in 7 cases (4.58%). A proportion of patients reported higher abnormal cerebrospinal fluid pressure (98.28%), white cell count (79.31%), total cholesterol (71.55%) and low-density lipoprotein (62.93%) (p<0.01). The proportion of intracranial arteritis lesions and CVST lesions was high, including 51 cases (43.97%) on the left side and 31 cases (26.72%) on the right side. Bilateral CVST lesions occurred in 13 cases (11.20%) of unilateral intracranial arteritis lesions, and bilateral intracranial arteritis lesions occurred in 16 cases (13.79%) of unilateral CVST lesions. In summary, CVST indicates a potential positive link to intracranial arteritis at the time of pregnancy and puerperium.

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