CVT in the Peripartum Period: A Diagnostic Dilemma

Allbright, Leah; McLeod, Francine; Mauney, Donald

doi:10.1155/2020/7656232

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…Pregnancy and postpartum period are associated with complex physiological changes and adaptation mechanisms, which can lead to altered homeostasis and a high risk of complications [ 1 ]. The main causes for increased CVT risk during the postpartum period are the hypercoagulability related to pregnancy, cesarean delivery, infections, blood loss during delivery and dehydration, fluctuations of intracranial pressure during labor, hypertensive complications of pregnancy, and even loss of cerebrospinal fluid after dural puncture [ 12 , 13 ]. The prothrombotic state during pregnancy results from a shift in the equilibrium between the fibrinolytic and hemostatic system to prevent severe hemorrhage during labor.…”

Section: Introductionmentioning

confidence: 99%

Postpartum Cerebral Venous Thrombosis—A Single-Center Experience

et al. 2021

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Background: Cerebral venous thrombosis (CVT) is a rare variant of stroke in the general population, but an important subtype among pregnancy- and puerperium-related cases. Studies describing its risk factors and clinical characteristics are limited. The aim of our study is to disclose these aspects and compare with cases unrelated to pregnancy and puerperium. Materials and Methods: We performed a retrospective analysis including 88 consecutive cases from a tertiary neurology clinic with a diagnosis of CVT. Ten of the 88 cases (11.3%) appeared during the postpartum period. Results: The mean age of the puerperal CVT cases was 26.5 years. The main pregnancy-related risk factors besides puerperium were cesarean delivery (5/10), preeclampsia (2/10), and stillbirth (1/10). General risk factors for thrombosis, i.e., infection, smoking, and primary hypercoagulability, were identified in 50% of cases. Onset was in the first 3 weeks after delivery, with a mean value of 9.6 ± 5.6 days. Headache was present in 90% of postpartum CVT cases and in 76.1% of non-postpartum female cases. Seizures were more frequent in the postpartum group (60% vs. 34.8%). Onset was acute (<48 h) in 50% of postpartum cases and in 30.4% of the non-postpartum female group. The Rankin score at discharge was significantly lower in the postpartum group (0.22 vs. 0.7, p=0.02), suggesting a more favorable short-term outcome. Conclusions: The early postpartum period represents an important risk for the development of CVT. Cesarean delivery and preeclampsia, besides general risk factors such as infection, smoking, and primary thrombophilia, contribute to enhanced risk. Puerperium-related CVT presents a more favorable outcome compared with CVT with other etiologies.

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Section: Introductionmentioning

confidence: 99%

Postpartum Cerebral Venous Thrombosis—A Single-Center Experience

et al. 2021

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“…Furthermore, CVT represents 2 to 57% of pregnancy-related strokes [15], and the majority of cases appear in the postpartum period [16] with the main causes of increased risk during the postpartum period. pregnancy-related hypercoagulability, cesarean delivery, infections, blood loss during delivery and dehydration, fluctuations in intracranial pressure during labor, hypertensive complications of pregnancy, and even loss of cerebrospinal fluid after dural puncture [17]. Acute treatment of stroke is associated with the risk of bleeding, and current recommendations for the treatment of acute stroke do not apply to women in the puerperium; therefore, recommendations for acute treatment with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) are necessary.…”

Section: Discussionmentioning

confidence: 99%

Postpartum Stroke: Epidemiological, Clinical, Etiological and Progressive Aspects of Nine (9) Cases in the Neurology Department of CHU Ignace Dean from Conakry

2023

Int J Cerebrovasc Dis Stroke

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Introduction: Postpartum is the period following childbirth and during which the maternal body undergoes many physiological changes, sometimes exposing the mother to the risk of stroke. The aim of our work was to evaluate the clinical, etiological and progressive aspect of postpartum strokes. Material and Methods: This was a retrospective study of the descriptive type lasting 2 years from January 2020 to December 31, 2022, focusing on stroke. Postpartum in the neurology department of Ignace Deen University Hospital. The variables used were epidemiological, clinical, etiological and evolutionary. Results: Of 14 women admitted for stroke associated with pregnancy, 9 cases occurred in postpartum 64.3%. The average age was22 ± 10.9 years with a mean time to admission of postpartum vascular event was 13.5±5.2 days. In this study we noted chronic hypertension in 55.6% of cases. The reasons for consultation were dominated by motor deficit (100%); seizures (61.9%) and headaches (66.7%). The stroke type was dominated by cerebral infarction in 33.3% and cerebral venous thrombosis in 44.4%. Conclusion: Postpartum stroke, although rare, is potentially serious and often associated with significant maternal morbidity and mortality. However, a positive impact on risk factors could significantly reduce the mortality rate.

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“…Other factors that enhance thrombotic risk are added to the above modifications, such as cesarean delivery, anemia secondary to blood loss, dehydration, intracranial pressure fluctuations during labor, pre-eclampsia and eclampsia, and the dural puncture during spinal analgesia [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. The loss of cerebrospinal fluid after dural puncture may lead to decreased intracranial pressure, compensatory venous and arterial dilation, decreased venous flow, endothelial damage, and activation of the coagulation system [ 26 ]. Silvis et al demonstrated that women after delivery present an increased risk of CVT, but not during pregnancy [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Risk Factor Profile and Clinical Characteristics in 89 Consecutive Cases of Cerebral Venous Thrombosis

Bajkó

Moţăţăianu

Stoian

et al. 2021

JCM

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Gender has been shown to be an important variable in cerebral venous thrombosis (CVT) risk and significantly influences its clinical manifestations and outcome. The aim of our study was to investigate the gender-specific risk factor profile and clinical picture of this rare cerebrovascular disorder. Materials and methods: We retrospectively reviewed the medical records of 89 consecutive cases of CVT at a tertiary neurology clinic in Târgu Mures, Romania, between June 2009 and January 2021 to analyze the gender-related differences in etiology, clinical presentation, and outcome. Results: Women comprised 62.5% of the cohort. Females were significantly younger than males (37.3 years versus 48.8 years, respectively, p = 0.001), and the main risk factors were hormone related in 37.9% of the cases, followed by primary thrombophilia (34.4%), smoking (25.8%), obesity (17.2%), infections (17.2%), mechanical factors (17.2%), cancer (8.6%), systemic autoimmune disorders (8.6%), and hematological disorders (8.6%). In male patients, the main risk factors were smoking (41.9%), primary thrombophilia (29%), infections (22.6%), heavy alcohol consumption (16.1%), and venous thromboembolism in the medical history (12.9%). Frequency of headache was higher in females than in males (75.9% versus 67.7%), whereas frequency of coma (6.5% in males versus 1.7% in females) and dizziness (19.4% in males versus 10.3% in females) was higher in males. CVT onset was acute in 41.4% of females and 38.7% of males. The Rankin score at discharge was significantly lower in females compared with males (0.6 versus 1.6), reflecting a more favorable short-term outcome. Mortality was 6.4% in males and 1.7% in females. Conclusions: CVT is a multifactorial disorder that has a broad spectrum of risk factors with important gender-related differences in clinical manifestation and prognosis. Female patients, especially those with hormone-related risk factors, have a more favorable outcome than male patients.

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CVT in the Peripartum Period: A Diagnostic Dilemma

Cited by 3 publications

References 25 publications

Postpartum Cerebral Venous Thrombosis—A Single-Center Experience

Postpartum Cerebral Venous Thrombosis—A Single-Center Experience

Postpartum Stroke: Epidemiological, Clinical, Etiological and Progressive Aspects of Nine (9) Cases in the Neurology Department of CHU Ignace Dean from Conakry

Gender Differences in Risk Factor Profile and Clinical Characteristics in 89 Consecutive Cases of Cerebral Venous Thrombosis

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