A rare case of post-partum cerebral venous sinus thrombosis

Abstract

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.