Postpartum Cerebral Venous Thrombosis

McCaulley, Jill A.; Pates, Jason A.

doi:10.1097/aog.0b013e318212fca2

Cited by 18 publications

(11 citation statements)

References 5 publications

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“…As per McCaulley et al the mortality rate is less than 10%. 10 The recurrence rate in subsequent pregnancy as per Mehraein et al is 1%-2%. 11 This underlies the importance of regular follow up of these cases and judicious preconception counselling prior to planning for next pregnancy.…”

Section: Discussionmentioning

confidence: 91%

A rare case of post-partum cerebral venous sinus thrombosis

Singh

Vardhan

2018

Int J Reprod Contracept Obstet Gynecol

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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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Section: Discussionmentioning

confidence: 91%

A rare case of post-partum cerebral venous sinus thrombosis

Singh

Vardhan

2018

Int J Reprod Contracept Obstet Gynecol

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“…45 Cerebral venous sinus thrombosis is extremely rare in developed countries with incidence ranging from 1:10000 to 1:25000. 45,46 However, CVST is more common in pregnancy than the general population due to the hypercoagulable pregnancy state and damage to the venous sinuses during labor due to changes in intracranial pressure. 45,46 Choriocarcinoma Choriocarcinoma is a rare malignant neoplasm that arises in placental trophoblastic tissue and tends to metastasize to the brain; it is typically diagnosed within a year of pregnancy with persistently elevated beta human chorionic gonadotropin not due to retained placental tissue.…”

Section: Cerebral Venous Sinus Thrombosismentioning

confidence: 99%

“…45,46 However, CVST is more common in pregnancy than the general population due to the hypercoagulable pregnancy state and damage to the venous sinuses during labor due to changes in intracranial pressure. 45,46 Choriocarcinoma Choriocarcinoma is a rare malignant neoplasm that arises in placental trophoblastic tissue and tends to metastasize to the brain; it is typically diagnosed within a year of pregnancy with persistently elevated beta human chorionic gonadotropin not due to retained placental tissue. 8,47 Ischemic strokes caused by metastasis of choriocarcinoma typically arise from direct injury to the cerebral vasculature or trophoblastic embolism.…”

Section: Cerebral Venous Sinus Thrombosismentioning

confidence: 99%

Pregnancy-Related Stroke: A Review

Doiron

Ramseyer²,

Phelps³

et al. 2022

Obstetrical &Amp; Gynecological Survey

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ImportanceThe maternal risk of strokes in the United States is approximately 30/100,000 pregnancies, and strokes are the eighth leading cause of maternal death. Because of the relationship between stroke and significant neurological disability/maternal death, obstetrical health care providers must be able to identify, evaluate, diagnosis, and treat these women.Evidence AcquisitionPubMed was searched using the search terms “stroke” OR “cerebrovascular accident” OR “intracranial hemorrhage” AND “pregnancy complications” OR “risk factors” OR “management” OR “outcome.” The search was limited to the English language and was restricted to articles from 2000 to 2020.ResultsThere were 319 abstracts identified, and 90 of the articles were ultimately used as the basis of this review. Presenting stroke signs and symptoms include headache, composite neurologic defects, seizures, and/or visual changes. Diagnosis is typically made with computed tomography scan using abdominal shielding or magnetic resonance imaging without contrast. Management options for an ischemic stroke include reperfusion therapy with intravenous recombinant tissue plasminogen activator catheter-based thrombolysis and/or mechanical thrombectomy. Hemorrhagic strokes are treated similarly to strokes outside of pregnancy, and that treatment is based on the severity and location of the hemorrhage.Conclusions and RelevanceEarly recognition and management are integral in decreasing the morbidity and mortality associated with a stroke in pregnancy.Relevance StatementThis study was an evidence-based review of stroke in pregnancy and how to diagnose and mange a pregnancy complicated by a stroke.Target AudienceObstetricians and gynecologist, family physiciansLearning ObjectivesAfter completing this learning activity, the participant should be better able to identify the pregnancy-related risk factors for a stroke; explain the presenting signs and symptoms of a stroke in pregnancy; describe the imaging modalities available to diagnose a stroke; and outline treatment options for an ischemic stroke and a hemorrhagic stroke.

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“…Furthermore, the risk of CVT is also thought to be increased in those patients with sinusitis, thrombophilias, dehydration, head trauma, and pregnancy [6]. Pregnancy and postpartum status is conceivably one of the most common risk factors and misdiagnosis of CVT as an eclamptic seizure can be frequent [7,8].…”

Section: Introductionmentioning

confidence: 99%

CVT in the Peripartum Period: A Diagnostic Dilemma

Allbright

McLeod

Mauney

2020

Case Reports in Obstetrics and Gynecology

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Women in the peripartum period can develop headache with a variety of etiologies that require a multidisciplinary approach if unresponsive to treatment (Stella et al. 2007). Neuroimaging needs to be undertaken even occasionally in the absence of focal neurologic signs to rule out life-threatening causes of headache. We present the case of a 23-year-old woman who presented postpartum with severe frontal headache without other neurologic symptoms. Treatment was initiated for tension type, then subsequently postdural puncture headache (PDPH), and finally preeclampsia. When CT venogram was obtained ten days later, the diagnosis of cerebral venous thrombosis (CVT) was made. She was started on anticoagulation and achieved complete recovery.

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Postpartum Cerebral Venous Thrombosis

Abstract: Cerebral venous thrombosis and eclampsia may manifest in a similar manner. Physicians can optimize the care of patients presenting with seizures by considering etiologies rarer than eclampsia and pursuing tests that may distinguish them.

Cited by 18 publications

References 5 publications

A rare case of post-partum cerebral venous sinus thrombosis

A rare case of post-partum cerebral venous sinus thrombosis

Pregnancy-Related Stroke: A Review

CVT in the Peripartum Period: A Diagnostic Dilemma

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