Clinical Features and Prognosis of Cerebral Venous Sinus Thrombosis during Pregnancy and Puerperium

Abstract

Background: Cerebral venous sinus thrombosis (CVST) is a rare and serious complication during pregnancy and puerperium with a variety of clinical features. Little is known about the prognostic factors of CVST during the acute phase, subsequent pregnancy outcomes, and the risk of recurrence of CVST. The purpose of the study is to investigate the clinical features and prognosis of pregnancy-related CVST in China. Methods: We retrospectively analyzed the clinical data of 41 patients diagnosed with CVST during pregnancy or puerperium from January 2007 through March 2018 in Shengjing Hospital. Poor outcome was defined as modified Rankin Scale (mRS) ³3 at discharge. Independent prognostic factors for CVST outcome were identified via multivariate logistic regression analysis. Long-term outpatient interview was followed to know the next pregnancies outcome and CVST relapse rate. Results: CVST occurred about 2.4 times (29 vs. 12) during puerperium than in pregnancy. Headache (90%) was found the most common clinical feature, followed by focal neurologic deficits (61%), seizure (59%), visual disorder (37%) and impaired consciousness (29%). The multivariate analysis revealed D-dimer levels >1134 µg/L (OR=18.67, 95% CI:1.79-194.84) and impaired consciousness (OR=33.85, 95% CI: 3.14-365.45) were independent prognostic factors of a poor outcome during acute phase. Twenty-eight (68%) patients underwent a long-term interview. Only three women had multiple pregnancies (six pregnancies, two in each women), but no birth occurred from these. One patient had a relapse of CVST three years later, which had no relationship with pregnancy or puerperium. Conclusions: CVST occurred mostly during puerperium. D-dimer levels >1134µg/L and impaired consciousness could predict poor outcomes of pregnancy-related CVST. The subsequent pregnancy rate and CVST relapse rate was low in this Chinese population.