Maternal cerebral venous thrombosis, uncommon but serious disorder, pathologic predictors and contribution of prothrombotic abnormalities

Klai, Sarra; Fekih-Mrissa, Najiba; Mrissa, Ridha; Rachdi, R; Gritli, Nasredine

doi:10.1097/mbc.0b013e32835bace4

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…In our cohort of obstetric CVT, despite the fact that anemia was not validated in the final model as the highest association variable for bad functional outcome and death, it remained as an important associated factor, which should be explored in terms of not the presence of hemoglobin decrease, but also hematologic intrinsic effects in hemostasis and thrombi formation, which was not explored in our study. Protein C/S deficiency and hyperhomocysteinemia were other frequently identified risk factors present in one-fifth of our tested patients, a finding contrasting VENOST study [30], but similar to a report by Klai et al [31].…”

Section: Discussionsupporting

confidence: 89%

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Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

et al. 2022

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Introduction: Cerebral venous thrombosis (CVT) associated with pregnancy and puerperium has long been recognized, with poor information in terms of functional outcomes. Our objective was to analyze risk factors, clinical, imaging, and laboratory variables to predict functional outcome and death in this population. Methods: CVT registries from three referral centers from Pakistan, Turkey, and Mexico, recruiting prospective cases, were combined for CVT associated with pregnancy or puerperium. Datasets and variables were standardized. Demographic characteristics, presentation, risk factors, and functional outcomes in pregnancy/puerperium-related CVT were analyzed. Binary logistic regression was used to assess predictors of outcome. The main outcome was modified Rankin score >2 at 30 days and mortality at 30 days. Results: Five hundred fifty-three cases (median age 28 years [IQR 23–34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified. Predictors of poor outcome (mRS >2) were encephalopathy (OR 12.8, p < 0.001), cases from Mexican origin (OR 3.1, p = 0.004), fever/puerperal infection (OR 2.7, p = 0.02), and anemia (OR 2.2, p = 0.01). Cases from Mexican origin (OR 12.0, p = 0.003) and Encephalopathy (OR 7.7, p < 0.001), presented with the highest mortality association in the final adjusted model. Discussion/Conclusion: In CVT associated with pregnancy and puerperium, encephalopathy, fever/puerperal infection, and anemia are associated with bad functional outcomes, meanwhile encephalopathy and cases from Mexican origin with higher mortality in the acute (30-days) of CVT onset. Anemia and infection are potential reversible predictors of poor outcome that clinicians should be aware of in order to prevent poor outcomes in these patients.

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Section: Discussionsupporting

confidence: 89%

“…years [IQR [23][24][25][26][27][28][29][30][31][32][33][34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified.…”

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confidence: 99%

Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

et al. 2022

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“…Of the 32 potentially eligible articles, 18 articles were excluded (reasons presented in Chart 1) and 14 remained for final analysis. Two had overlapping data, leaving a total of 12 eligible studies [4,[11][12][13][14][15][16][17][18][19][20][21]. No studies were added from manual search of the reference lists.…”

Section: Resultsmentioning

confidence: 99%

Thrombophilia and venous thromboembolism in pregnancy: a meta-analysis of genetic risk

Ziakas

Poulou

Pavlou

et al. 2015

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Most pregnancy related stroke occurs in peripartum and puerperium [3]. Cerebral venous thrombosis is a rare complication during pregnancy or the puerperium [4]. The cerebrovascular system may be primarily involved in young adults suffering from anticoagulants deficiency [5].…”

Section: Discussionmentioning

confidence: 99%

Stroke in pregnancy: A rare case of protein C and protein S deficiency

Kumari¹,

Biswas²,

Misra³

2014

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Stroke in pregnancy is a rare occurrence, its reported incidence being 11-26 deliveries per 100,000. Ischemic strokes are slightly more common than hemorrhages. Subarachnoid hemorrhage, embolism and cerebral venous thrombosis can also occur, albeit with a lesser incidence. Peak incidence of stroke is in the peripartum and postpartum period. Mortality rate of pregnancy associated stroke is 10.13%. Therefore, rapid recognition and management of these patients are imperative to ensure successful outcome. We report a rare case of stroke during pregnancy which has the protein C and protein S deficiency as its precipitating cause. Case Report: We report a case of a 24-year-old female, with previous cesarean section in her third trimester, suddenly developed weakness of left side of the body and deviation of face to the right. There was no history of head trauma, fever, unconsciousness or seizure. She did not have any skin rash, arthritis or signs of deep vein thrombosis. There was no history of prior fetal loss. Protein C and protein S levels were low. Conclusion: We report a rare case of stroke during pregnancy which has the protein C and protein S deficiency as its precipitating cause. Stroke is a recognized complication of pregnancy, is uncommon but feared. Stroke in young adults aged 15-35 years is more common in women with poorer outcome in terms of disability and dependence. Most pregnancy related stroke occurs in peripartum and puerperium.

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Maternal cerebral venous thrombosis, uncommon but serious disorder, pathologic predictors and contribution of prothrombotic abnormalities

Cited by 7 publications

References 19 publications

Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

Thrombophilia and venous thromboembolism in pregnancy: a meta-analysis of genetic risk

Stroke in pregnancy: A rare case of protein C and protein S deficiency

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