Postpartum fatal cerebral vein thrombosis: A case report and review

Kontogiorgi, Marina; Kalodimou, Vasiliki E; Kollias, Spyros; Exarchos, Demetrios; Nanas, Serafim; Ghiatas, Abraham A.; Routsi, Christina

doi:10.4236/ojcd.2012.21001

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…This case report presents a case of ADP that occurred during cesarean section, which developed into PDPH and subsequently to CVST. Similar cases have been documented in previously [ 7 , 8 ]. CVST is a rare and fatal complications of the postpartum period, hence, early diagnosis and proper differential diagnosis are crucial.…”

Section: Discussionsupporting

confidence: 91%

Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report

Wang,

Zhou,

Sheng

et al. 2024

BMC Anesthesiol

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Background Parturients are prone to postdural puncture headache (PDPH) after epidural puncture. Cerebral venous sinus thrombosis (CVST) is a fatal complication of PDPH. The main symptom of both is headache, however, the mechanism is not similar. For persistent PDPH, early differential diagnosis from CVST is essential. Optic nerve sheath diameter (ONSD) measurements can be used to identify changes in intracranial pressure as an auxiliary tool to distinguish the cause of headache. Case presentation The dura of a 32-year-old woman undergoing cesarean section was accidentally penetrated while administering epidural anesthesia, and the patient developed PDPH the subsequent day. The patient refused epidural blood patch (EBP) treatment and was discharged after conservative treatment. Fourteen days post-discharge, she was readmitted for a seizure. Magnetic resonance imaging (MRI) and Magnetic resonance angiography (MRA) indicated low cranial pressure syndrome and superior sagittal sinus thrombosis with acute infarction. The next morning, the EBP was performed with 15 ml autologous blood. Subsequently, the headache symptoms decreased during the day and worsened at night. ONSD measurement suggested dilation of the optic nerve sheath, and subsequently, the patient showed intracranial hypertension with papilledema. After dehydration and anticoagulant treatment, the patient’s symptoms were relieved and she was discharged from the hospital 49 days later. Conclusions Headache is the main symptom of PDPH and cerebral venous thrombosis, which are difficult to distinguish. ONSD measurement may help to estimate the intracranial pressure, and early measurement may be helpful for women with PDPH to avoid serious complications, such as CVST.

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Section: Discussionsupporting

confidence: 91%

Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report

Wang,

Zhou,

Sheng

et al. 2024

BMC Anesthesiol

View full text Add to dashboard Cite

show abstract

“…Cerebral venous thrombosis can be a fatal complication of the postpartum period. The incidence of venous thrombosis during pregnancy or in the puerperium has been reported to vary from 0.018 to 0.2% depending on the study [1][2][3]. Because 13.4% of CVT patients are known to be at an increased risk of an unfavourable outcome [4], it is important to diagnose and treat the condition correctly.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral venous thrombosis (CVT) can be a fatal complication of the postpartum period [1]. Pregnancy is known to be a risk factor for thromboembolism in itself.…”

Section: Introductionmentioning

confidence: 99%

Case report: postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache

Ryu

Jeon

et al. 2020

BMC Anesthesiol

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Background: Cerebral venous thrombosis can be a fatal complication of the postpartum period. Pregnancy is known to be a risk factor for thromboembolism in itself. Case presentation: A normal spontaneous vaginal delivery was planned for a 20-year-old primigravida patient with patient-controlled epidural analgesia. Next morning, the patient complained of an occipital headache. An epidural blood patch was performed for diagnostic and therapeutic purpose with 10 ml of autologous blood. That night, she had an episode of seizures. Endotracheal intubation was done to secure the airway. She was transferred to an intensive care unit. Brain CT angiography and MRI showed superior sagittal sinus thrombosis with acute infarct and mild subarachnoid haemorrhage. For cerebral venous thrombosis treatment, heparin was injected and for intracranial pressure control, a hypertonic solution was injected. Despite this medical treatment, intracranial pressure continued to rise. The next day, her mental state changed to stupor. Emergency decompressive craniectomy was performed. Her mental state improved rapidly after surgery. A week later, she was transferred to a general ward. Her health recovered and she was discharged. Conclusions: We experienced postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache. We hope that this case report would be helpful in situation which a postpartum young woman complains severe headache in spite of management for headache including autologous epidural blood patch.

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“…Pregnancy up to 8 weeks postpartum is a prothrombotic state, with the reported incidence of CVT being 0.018-0.20% (Kontogiorgi et al 2012). After ruling out thrombophilias, risk factors of importance to the anesthesiologist are dural puncture and dehydration.…”

Section: Discussionmentioning

confidence: 99%

Peripartum neurological complications and labor epidural: an anesthesiologist predicament

Sarkar

Inbaraj

Rao

2022

Ain-Shams J Anesthesiol

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Background Dismissing the process of labor, postpartum neurological complications tend to implicate anesthetic interventions as the cause, a predicament to the anesthesiologist mandating utmost periprocedural vigilance. Case presentation Two obstetric patients with no comorbidities received uneventful labor epidurals. They presented with rare peripartum neurological complications. Conclusions Unrecognized dural puncture is often a retrospective diagnosis made with the onset of symptoms in a presumed uneventful epidural. Negative aspiration of cerebrospinal fluid (CSF) during epidural insertion does not completely rule out the dural puncture. Th dural puncture can be obscured by initial dural tenting and tear without loss of CSF, followed by a breach in the weakened arachnoid during maternal efforts (Reynolds and Speedy, Anaesthesia 45:120-3, 1990). Obstruction of the TUOHY l umen with clot or ligamentum flavum, preventing CSF flow into the needle and subarachnoid migration of a subdurally placed catheter, is another cause. Delay in management of neurological complications resulting from unrecognized dural punctures can occur.

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Postpartum fatal cerebral vein thrombosis: A case report and review

Cited by 5 publications

References 12 publications

Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report

Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report

Case report: postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache

Peripartum neurological complications and labor epidural: an anesthesiologist predicament

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