Central venous thrombosis misdiagnosed as eclampsia in an emergency department

Abstract

Central venous sinus thrombosis can present in the emergency department with a diverse range of symptoms and signs, including a non-neurological scenario, and it thus poses a diagnostic challenge. It is amenable to treatment, so a patient history and awareness of the condition prompts early diagnosis and instigation of treatment which may reduce morbidity and mortality.

Deep cerebral vein thrombosis misdiagnosed as tumour

“…If the adjacent diencephalon or brainstem are affected or compressed, patients may become comatose or even die from cerebral herniation if untreated 2. In the case described by Savage and Harrison,1 an isolated postpartum epileptic seizure and muzzy headache were the leading symptoms. In our cases, one patient had a slight speech problem and the other had relatively isolated focal signs (aphasia, hemiparesis).…”

“…We read with interest the article by Savage and Harrison on deep cerebral venous thrombosis (DCVT) misdiagnosed as eclampsia in an emergency department 1. Cerebral venous thrombosis is estimated to occur in 3–4 persons per 1 million of the population per year.…”

Krampfanfall und Koma bei Schwangeren und Wöchnerinnen

“…Diese schwerste Komplikation einer meist nicht ausreichend therapierten Präeklampsie tritt gewöhnlich unvorhergesehen und ohne Vorwarnung bei oft sonst asymptomatischen Schwangeren auf, ist aber nur in etwa 50% mit schwerer Hypertonie assoziiert und selbst bei fehlender Hypertonie oder Proteinurie möglich (14-34% der Fälle; [6,15] [24]. Erfahrungen bei Schwangeren zeigen, dass die Abgrenzung zur Eklampsie schwierig ist [25]. Hier ist eine suffiziente zerebrale MR-Bildgebung mit modernen "Schlaganfallsequenzen" hilfreich.…”

Postpartum emergencies

“…In a case report by Savage and Harrison there was a reminder to consider eclampsia in women presenting with neurological symptoms during the puerperium 1. The authors also highlight the importance of including central venous thrombosis in the differential diagnosis of suspected late-onset eclampsia.…”

“…Although at this stage a diagnosis of eclampsia is tempting, an urgent CT scan is indicated to exclude the possibility of central venous thrombosis or haemorrhage 1 2. A CT scan of the head and venography demonstrated superior sagittal sinus thrombosis and a small amount of subarachnoid haemorrhage.…”