Cerebral Venous and Arterial Thrombosis in Pregnancy and Puerperium: A Study of 135 Patients

Background: Cerebral venous thrombosis (CVT) is an uncommon and sometimes critical disease, especially in untreated patients. CVT is an elusive diagnosis because of its nonspecific presentation and its numerous predisposing causes. Accurate diagnosis is difficult but important because effective therapies, including anticoagulants and intrasinus thrombolysis are available. Patients with cerebral venous thrombosis often make dramatic recoveries after anticoagulation. For this reason, accurate diagnosis is important and critical. The aim was to study the extent of venous sinus involvement and associated cerebral parenchymal changes on magnetic resonance venogram (MRV); to study the pattern of diffusion weighted images and ADC (apparent diffusion coefficient) mapping in patients with cerebral venous thrombosis; to study the role of susceptibility weighted images in patients with cerebral venous thrombosis. Methods: Study was conducted on 34 patients diagnosed to have cerebral venous thrombosis on imaging. Results: Imaging analyses of 34 patients (19 females, 15 males, and age range 19-75 years) were done. Thrombus on MRV was seen as loss of high flow signal from the sinus in cases of complete occlusion of the sinus and frayed or patchy flow signal in the cases of non-occlusive thrombus. 16 patients with hemorrhagic infarct showed heterogeneous signal intensity on DWI (diffusion weighted imaging) and blooming on SWI (suseptibility weighted imaging) sequence. 13 patients with non-hemorrhagic infarct showed multifocal high signal intensities in DWI with variable ADC values and no blooming on SWI. 5 patients with intracerebral hematoma showed areas of heterogeneous signals on DWI with blooming on SWI, corresponding ADC values were variable. Conclusions: MRV, diffusion and susceptibility weighted imaging can be used to evaluate the extent of thrombus, discriminate between different types of edema, detect intracerebral hematoma, hemorrhagic and non-hemorrhagic infarcts, and deliver time-saving information for early diagnosis of CVT.

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“…8,9 Mehta SR et al found seizures in 26.6%. In our study 26.4% of patients had convulsion of which generalized tonic clonic type was commonest.…”

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confidence: 98%

Role of magnetic resonance venogram, diffusion and susceptibility weighted imaging in diagnosis of cerebral venous thrombosis

2016

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“…2 Srinivasan suggested that puerperal CVT is seen more frequent in India compared to western countries. 3 The reason for this high incidence is not clear. There have been many studies from India on postpartum CVT.…”

Section: Introductionmentioning

confidence: 99%

“…Srinivasan in his study stated that puerperal CVT was 10-12 times more frequent in India and the predisposing factors like anaemia, increased coagulability of blood, slowing of the blood stream and dehydration aggravated by the local custom of withholding fluid intake in puerperium contributed to the high incidence of CVT. 3 Alexander et al in their study stated that in patients with pregnancy associated CVT, prothrombotic markers can be multiple and are associated with increased odds of mortality. 4 In addition to these pathophysiologic processes and factors, several other risk factors have also been noted by various investigators.…”

Section: Introductionmentioning

confidence: 99%

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Clinical profile of postpartum cerebral venous thrombosis

Rajoor

Seema

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Pregnancy and puerperium are most prevalent prothrombotic states leading to cerebral venous thrombosis (CVT). Pregnancy induces several changes in coagulation system, which persists at least during early puerperium, rendering it a prothrombotic state. The objective of the study was to study the clinical profile of postpartum CVT.Methods: A total of 32 consecutive patients admitted in medicine and obstetrics and gynecology ward between April 2012 and March 2015 with radiologically confirmed diagnosis of CVT were included in the study. Detailed history, clinical examination, and laboratory investigations were carried out in all the cases.Results: Out of 32 patients of CVT studied, the age of patients varied from 18 to 40 years. Maximum incidence was seen in 21-30 age group comprising 74% of the cases, with mean age being 25.5 years. Two-third of the patients belongs to the low socio-economic class. The majority of them had subacute presentation with the headache in 93.75%, followed by altered sensorium (90.6%) and convulsions (75%) being the most common presenting symptoms. Radiologically the most common finding noted was hemorrhagic infarction (85.3%), followed by non-hemorrhagic infarction (15.7%).Conclusions: Pregnancy and puerperium are most prevalent prothrombotic states leading to CVT.

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“…3,4 In occidental countries, CVT is an unusual complication of pregnancy with an incidence of 1:10,000 to 1:20,000 deliveries, mainly observed during the postpartum period, and represents the main cause of puerperium stroke.…”

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Case report: Cerebral vein thrombosis after subarachnoid analgesia for labour

Kapessidou

Vokaer

Laureys

et al. 2006

Can J Anesth/J Can Anesth

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Purpose:We report a case of sagittal sinus thrombosis occurring after spinal analgesia for labour to highlight the difficulty of such diagnosis in the presence of postpartum atypical headache following regional anesthesia/analgesia. Clinical features:A previously healthy 21-yr-old, primiparous, preeclamptic parturient was admitted to the hospital at 37 weeks gestation for uterine contractions. Before pregnancy she was taking no medication other than oral contraceptives and was a non-smoker. Spinal analgesia was established on the first attempt at 8 cm of cervical dilation, in the setting of rapid progression of labour. Following an uneventful delivery, on the third day postpartum, the patient experienced gradual onset of an atypical headache with unclear postural character, followed by focal neurological signs five days later. Emergency neuroimaging revealed direct evidence of thrombosis in the posterior sagittal venous sinus. Anticoagulation was initiated with iv heparin (500 UI·kg ). The patient's headache decreased progressively and full motor recovery was noted by day 14 postpartum. After 24 days, the patient was discharged without any neurological disability. Common inherited thrombophilic dispositions were absent, with the exception of a decrease in protein S level. Conclusion:Central venous thrombosis, while rare, is a recognized cause of puerperium stroke. The present case highlights the importance of considering the diagnosis in the presence of postpartum atypical headache following spinal anesthesia/analgesia. Early intervention with systemic heparinization is critical when the diagnosis is confirmed. Objectif

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Cerebral Venous and Arterial Thrombosis in Pregnancy and Puerperium: A Study of 135 Patients

Cited by 140 publications

References 12 publications

Role of magnetic resonance venogram, diffusion and susceptibility weighted imaging in diagnosis of cerebral venous thrombosis

Role of magnetic resonance venogram, diffusion and susceptibility weighted imaging in diagnosis of cerebral venous thrombosis

Clinical profile of postpartum cerebral venous thrombosis

Case report: Cerebral vein thrombosis after subarachnoid analgesia for labour

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