An Early Pregnant Chinese Woman with Cerebral Venous Sinus Thrombosis Succeeding in Induction of Labor in the Second Trimester.
Zhang Xue Fang,Zhang Zhen Yu,Li Nan
Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih
Cerebral venous sinus thrombosis (CVST) is a rare condition in early pregnancy. A 22-year-old Chinese woman at 10 weeks of pregnancy requested induced abortion and was diagnosed as CVST for a severe headache accompanying with nausea and vomiting. The patient was treated successfully with anticoagulation, followed by amniocentesis, and finally succeeded in induction of labor safely. The diagnosis, treatment and prognosis for this rare condition are discussed in this paper.
10.24920/31806
[Clinical characteristics and outcomes of cerebral venous sinus thrombosis during pregnancy and puerperium].
Zhou Qi,Wang Feng-ying,Zhang Peng,Long Xiao-yu,Sun Xiao-yan,Liu Tong
Zhonghua fu chan ke za zhi
OBJECTIVE:To explore the clinical features and outcomes of patients with cerebral venous sinus thrombosis (CVT) during pregnancy and puerperium. METHODS:A retrospective study was performed in 24 cases of pregnant women with CVT among 15 625 deliveries in Xuanwu Hospital from January 2002 to October 2009, including 7 cases happened during pregnancy and 17 during puerperium. The etiology, clinical presentations, imaging examination results, other relevant examinations, and pregnant outcomes of these patients were analyzed. RESULTS:(1) Incidence and etiology: the incidence of CVT during pregnancy and puerperium was 0.15% (24/15 652) and 29% (7/24) of the patients fell ill during pregnancy and 71% (17/24) during puerperium. Five were complicated with severe preeclampsia, while another 5 complicated with hyperemesis. One woman was complicated with anemia. CVT was identified after spontaneous delivery in 9 cases and 8 after cesarean section. (2) CLINICAL PRESENTATIONS: Among the 24 CVT cases, 22 (92%) suffered from headache, 16 (67%) reported nausea and vomiting, 15(63%) experienced hyperspasmia and 6 (25%) complained of blurred vision. On admission, 8 (33%) patients were unconscious, 3 (13%) with hemiplegia, and 8 (33%) were febrile. (3) Imaging and laboratory examinations: twelve patients underwent digital subtraction arteriography (DSA) and were diagnosed. Fifteen women showed superior sagittal sinus thrombosis in MRI and magnetic resonance intravenous angiograph (MRV). Examination of the fundus found papilledema in 4 cases. Normal cerebral sinus fluid and laboratory routine tests were reported in 13 cases, but 6 cases of hyperlipidemia, 7 cases of abnormal activated partial thromboplastin time (APTT), 5 cases of abnormal international normalized ratio (INR), 3 cases elevated platelet count, 4 cases of positive D-dipolymer, 1 cases of low hemoglobulin level (<10 g/L), 4 cases with abnormal hematocrit, and 10 cases of elevated fibrinogen (>4 g/L) were identified. (4) Management and pregnancy outcomes: among the 7 cases happened during pregnancy, 2 were complicated with severe preeclampsia and delivered through cesarean section immediately and discharged after proper management including depressurization, spasmolysis, dehydration and anticoagulant therapy. Five of the 7 cases presented with CVT during early pregnancy, among which 1 was discharged after dilation and curettage followed by anticoagulant therapy, 2 received endovascular thrombolysis after which one was discharged and the other one left with right hemiparesis and 2 patients died. Among the 17 patients presented with CVT during puerperium, 10 received anticoagulant therapy after which 4 were fully recovered, 5 left with functional disturbance (3 with hemiplegia, 1 with incomplete motor aphasia and hemiparesis and 1 with blurred vision) and one died. Among the rest 7 cases who underwent endovascular thrombolysis, 3 were fully recovered, 3 left with functional impairment (1 with blind and headache and 2 with hemiplegia), and one died. Altogether, there were 14 patients underwent systemic anticoagulant therapy after which 7 were fully recovered, 5 left with dysfunction and 2 died. Among the 10 cases received endovascular thrombolysis, 4 were fully recovered, 4 remained some dysfunction and 2 died. CONCLUSIONS:CVT, mostly presented as superior sagittal sinus thrombosis, are more common in puerperium than during pregnancy and DSA is the golden standard for the diagnosis of CVT. Anticoagulant therapy and endovascular thrombolysis are effective in the treatment of CVT, but may left the patients with functional disturbance or even death. Prompt diagnosis and treatment ensure a better outcome for pregnant women complicated with CVT.
[Postpartum cerebral sinus thrombosis leading to death of a young woman].
Melkas Susanna,Harno Hanna,Pälvimäki Elina,Siironen Jari
Duodecim; laaketieteellinen aikakauskirja
Of all cerebral sinus thromboses, 5 to 20% occur in connection with pregnancy or childbirth, or during the puerperium. The risk is highest during the first month following delivery. Approximately half of the women developing sinus thrombosis possess several concomitant risk factors predisposing to venous thrombosis, and about a fifth of them have a trombophilic disorder. We describe a postpartum cerebral sinus thrombosis leading with the associated complications to the patient's death. The patient was afterwards shown to possess the most common factor predisposing to venous thrombosis, the factor V Leiden mutation.
[Thrombosis risk during pregnancy after history of cerebral venous thrombosis].
Pourrat O,Neau J-P,Pouget-Abadie J-F,Pierre F
La Revue de medecine interne
INTRODUCTION:Few data have been published about the prognosis of a pregnancy following an episode of venous cerebral thrombosis (CVT), and far less about preventive strategy. METHODS:This is a retrospective study of a case series of 11 pregnancies in six women who had previously presented a CVT. RESULTS:The first pregnancies after CVT occurred on average 58 months later. Prevention with aspirin or heparin was administered in ten cases during pregnancy, and in all the cases with heparin in postpartum. No recurrence of CVT was observed. A minor pulmonary embolism was diagnosed in postpartum in one case. CONCLUSION:Prognosis of a pregnancy after a CVT seems to be favourable if a sufficient delay after CVT is respected. Although no results of controlled trials are available, prophylaxis with heparin is probably reasonable as benefit seems higher than risks and is strongly advised during the postpartum period.
10.1016/j.revmed.2013.08.002
Cerebral sinus thrombosis with intracerebral hemorrhage in pregnancy: a case report.
Lin Hung-Shih,Lin Jui-Feng,Chang Cheng-Kuei,Tsai Cheng-Chia,Chen Shiu-Jau
Acta neurologica Taiwanica
A 29-year-old woman who was pregnant for 12 weeks presented with headache for one week and drowsiness for two days. Computed tomography of the brain revealed multifocal hematomas with mass effect. Decompressive craniectomy was done to relieve the increased intracranial pressure. Magnetic resonance angiography and cerebral angiography were subsequently performed, both demonstrating thrombosis of the left transverse sinus. Treatment of sinus thrombosis generally includes correction of increased intracranial pressure and administration of anticoagulants, such as heparin. However, in this case heparin was contraindicated for the presence of intracranial bleeding, a clinical dilemma that requires careful considerations to balance treatment risks and benefits.
Pregnancy after cerebral venous thrombosis.
Abbattista Maria,Capecchi Marco,Martinelli Ida
Thrombosis research
Pregnancy outcome in women with previous cerebral vein thrombosis (CVT) on antithrombotic prophylaxis with low-molecular weight heparin (LMWH) is largely unknown. Aims of this study were to evaluate the risk of recurrent VTE, bleeding and pregnancy outcome in a cohort of pregnant women on LMWH after a first episode of CVT. To estimate the efficacy of LMWH in the prevention of obstetrical complications we compared pregnancies before (without LMWH) with pregnancies after (with LMWH) CVT in 25 women. Two recurrent thrombosis (3.2%, 95% CI 0.9-10.9%) and no bleeding episodes were observed in 63 pregnant women on LMWH. The risk of miscarriage was 13.5% (95% CI 6.1-24.8%) and that of late obstetrical complications 19.2% (95% CI 10.2-31.6%), independently of previous history of obstetrical complications and carriership of thrombophilia abnormalities. A double prevalence of terminations was observed in patients with thrombophilia than in those without. In conclusion, women with previous CVT on LMWH prophylaxis during pregnancy have a low risk of recurrent thrombosis and bleeding, but an increased risk of obstetrical complications.
10.1016/S0049-3848(19)30360-3
Cerebral venous sinus thrombosis in pregnancy and puerperium.
Gazioglu Sibel,Dinc Gulseren
Acta neurologica Belgica
Cerebral venous sinus thrombosis (CVST) is more common in women than in men, possibly due to gender-specific risk factors in young adults. The purpose of this study was to investigate whether the clinical and radiological findings, other risk factors, and clinical course of CVST associated with pregnancy and puerperium differ from those of other CVST cases. We retrospectively reviewed patients diagnosed with CVST in our hospital between September 2007 and December 2019. The risk factors, clinical and radiological characteristics, and follow-up data for female patients with CVST were compared between cases associated with pregnancy and puerperium with those of other cases. A total of 50 female patients with CVST were included in the study. Twenty-four (48%) cases occurred during pregnancy and puerperium. The mean age of the pregnant or puerperal patients was lower than that of the other patients (p = 0.007). There was no significant difference between the groups in terms of clinical and neuroradiological findings or presence of any additional risk factors including hereditary thrombophilia. There was also no difference in terms of in-hospital mortality rates and modified Rankin Scale (mRS) scores at 6 months between the groups. The clinical presentation of CVST and the frequencies of the presence of other risk factors including genetic thrombophilia in pregnant and puerperal patients were similar to those of non-pregnant female patients. Screening for additional risk factors, especially genetic thrombophilia, should therefore not be neglected in CVST occurring during pregnancy and puerperium.
10.1007/s13760-020-01459-3
Cerebral venous sinus thrombosis in pregnancy and puerperium: A comprehensive review.
Brain circulation
Cerebral venous sinus thrombosis (CVST) is a distinct neurological emergency caused by occlusion, either partial or complete, of the dural venous sinus and/or the cerebral veins. It occurs more frequently in women during pregnancy and puerperium as compared to the general population. The clinical diagnosis is difficult in some cases due to its variable clinical presentation with numerous causes and risk factors. The diagnosis can be made at an early stage if clinical suspicion is high with the help of advanced neuroimaging techniques that were developed recently. Early therapeutic intervention using anticoagulants allows for preventing complications and improving outcomes. In this article, we review the topic of CVST in pregnancy and the postpartum period with an emphasis on its epidemiology, pathophysiology, clinical presentation, and treatment. We also elaborate on several practical points that are important to the treating team. This review will help obstetricians, neurologists, and emergency physicians diagnose affected pregnant women as early as possible to provide prompt treatment and avoid adverse outcomes.
10.4103/bc.bc_50_22