Superior Sagittal Sinus Thrombosis Presenting with Hallucinations in the Puerperium: A Case Report

Abstract

Cerebral venous sinus thrombosis is an uncommon cause of stroke presenting with varied presentation patterns. We report a case of a 21-year-old woman with superior sagittal sinus (SSS) thrombosis (SSST) developing after childbirth, presenting with visual hallucinations, severe headache, and tonic-clonic seizures. Time-of-flight magnetic resonance angiography (TOF-MRA) demonstrated the presence of thrombus in SSS. She was treated with low molecular weight heparin (LMWH) followed by warfarin. She had excellent recovery a few weeks after admission and was regularly followed up. Although this condition can be presented with different neurological symptoms, it does not typically present with hallucinations. We suggest that CSVT should be suspected even when a patient presents with an atypical picture in a category of patients at higher risk. (Int J Biomed. 2016; 6(4):294-297.)

Complete Superior Sagittal Sinus Thrombosis Along With Subarachnoid Hemorrhage During Early Postpartum Period, Presented by Left Hemiparesis: A Rare Case Report

“…The initial anticoagulation therapy for CVST is to prevent thrombus growth, to facilitate recanalization, and to prevent deep venous thrombosis or pulmonary embolism. Post-acute treatment with oral anticoagulants is recommended for 6 and up to 12 months [7].…”

“…Women are particularly vulnerable prior to delivery and during the postpartum period because of the hypercoagulable state that accompanies pregnancy. Apart from pregnancy and puerperium, the etiological factors for CVST include oral contraceptives, carcinoma, hypercoagulable state, leiomyoma, vasculitis, inflammatory bowel disease, head trauma, intracranial or systemic infections, dehydration, substance abuse, and Behcet's disease [5,7].…”

“…SSST may present with unilateral paralysis that extends to the other side, secondary to extension of the clot into the cerebral veins. Because of the location, this may present as a unilateral lower extremity weakness or paraplegia [5,7]. Various imaging techniques are used to confirm the diagnosis, with CT angiography and magnetic resonance imaging (MRI) being most sensitive and specific [6].…”