Case report: postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache

Abstract

Background: Cerebral venous thrombosis can be a fatal complication of the postpartum period. Pregnancy is known to be a risk factor for thromboembolism in itself. Case presentation: A normal spontaneous vaginal delivery was planned for a 20-year-old primigravida patient with patient-controlled epidural analgesia. Next morning, the patient complained of an occipital headache. An epidural blood patch was performed for diagnostic and therapeutic purpose with 10 ml of autologous blood. That night, she had an episode of seizures. Endotracheal intubation was done to secure the airway. She was transferred to an intensive care unit. Brain CT angiography and MRI showed superior sagittal sinus thrombosis with acute infarct and mild subarachnoid haemorrhage. For cerebral venous thrombosis treatment, heparin was injected and for intracranial pressure control, a hypertonic solution was injected. Despite this medical treatment, intracranial pressure continued to rise. The next day, her mental state changed to stupor. Emergency decompressive craniectomy was performed. Her mental state improved rapidly after surgery. A week later, she was transferred to a general ward. Her health recovered and she was discharged. Conclusions: We experienced postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache. We hope that this case report would be helpful in situation which a postpartum young woman complains severe headache in spite of management for headache including autologous epidural blood patch.

Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report

“…This case report presents a case of ADP that occurred during cesarean section, which developed into PDPH and subsequently to CVST. Similar cases have been documented in previously [ 7 , 8 ]. CVST is a rare and fatal complications of the postpartum period, hence, early diagnosis and proper differential diagnosis are crucial.…”

“…Moreover, dural puncture is also linked to the occurrence of CVST. A dural puncture can lead to decreased CSF pressure, potentially causing displacement that impacts cerebral blood vessels and sinuses, thereby causing venous wall deformation or subsequent thrombus formation [ 7 ]. CVST symptoms includes headache, focal neurological impairment, seizures, dural arteriovenous fistula, papilledema, intracranial hemorrhage, blurred vision, mental change, diplopia, disturbance of consciousness, and coma [ 10 ].…”

Postpartum Cerebral Venous Sinus Thrombosis: A Case Report

“…The rate from 0.018% to 0.2% had been reported for developing venous thrombosis during pregnancy and puerperium. 4 The prevalence of CVT has long been likely to be about 0.3-0.5/ 100,000 per year, nevertheless latest studies have been declared a greater level of around 1-1.5/100,000 per year. 5,6 While the rise in incidence has been reflected to simply greater awareness of this condition, developments and CVT has known risk factors and causes, which are pregnancy, postpartum, venous thromboembolism, contraceptives medications, estrogen therapies, thrombophilia and hypercoagulability which is part from local infections and inflammatory conditions although CVST is three times more common in women of reproductive age than in men, probably due to the use of oral contraceptives, postpartum condition and pregnancy.…”

Spontaneous Outflow Venous Thrombosis of an Unruptured Arteriovenous Malformation in the Setting of COVID-19 Infection

“…In the absence of bleeding or venous stenosis, spontaneous thrombosis may occur in the presence of a hypercoagulable state. Although rare, cases have reported spontaneous venous thrombosis post-partum and in the setting of widespread cerebral venous thrombosis in a patient with an inherited Factor V Leiden mutation [23][24][25]. In addition, heritable thrombophilia has been identified as a risk factor for cerebral venous (but not arterial) thrombosis [26].…”