[Clinical characteristics and outcomes of cerebral venous sinus thrombosis during pregnancy and puerperium]

Qi Zhou, Feng-ying Wang, Peng Zhang, Xiao-yu Long, Xiao-yan Sun, Tong Liu
Zhonghua Fu Chan Ke za Zhi 2010, 45 (5): 358-62

OBJECTIVE: To explore the clinical features and outcomes of patients with cerebral venous sinus thrombosis (CVT) during pregnancy and puerperium.

METHODS: A retrospective study was performed in 24 cases of pregnant women with CVT among 15 625 deliveries in Xuanwu Hospital from January 2002 to October 2009, including 7 cases happened during pregnancy and 17 during puerperium. The etiology, clinical presentations, imaging examination results, other relevant examinations, and pregnant outcomes of these patients were analyzed.

RESULTS: (1) Incidence and etiology: the incidence of CVT during pregnancy and puerperium was 0.15% (24/15 652) and 29% (7/24) of the patients fell ill during pregnancy and 71% (17/24) during puerperium. Five were complicated with severe preeclampsia, while another 5 complicated with hyperemesis. One woman was complicated with anemia. CVT was identified after spontaneous delivery in 9 cases and 8 after cesarean section. (2) CLINICAL PRESENTATIONS: Among the 24 CVT cases, 22 (92%) suffered from headache, 16 (67%) reported nausea and vomiting, 15(63%) experienced hyperspasmia and 6 (25%) complained of blurred vision. On admission, 8 (33%) patients were unconscious, 3 (13%) with hemiplegia, and 8 (33%) were febrile. (3) Imaging and laboratory examinations: twelve patients underwent digital subtraction arteriography (DSA) and were diagnosed. Fifteen women showed superior sagittal sinus thrombosis in MRI and magnetic resonance intravenous angiograph (MRV). Examination of the fundus found papilledema in 4 cases. Normal cerebral sinus fluid and laboratory routine tests were reported in 13 cases, but 6 cases of hyperlipidemia, 7 cases of abnormal activated partial thromboplastin time (APTT), 5 cases of abnormal international normalized ratio (INR), 3 cases elevated platelet count, 4 cases of positive D-dipolymer, 1 cases of low hemoglobulin level (<10 g/L), 4 cases with abnormal hematocrit, and 10 cases of elevated fibrinogen (>4 g/L) were identified. (4) Management and pregnancy outcomes: among the 7 cases happened during pregnancy, 2 were complicated with severe preeclampsia and delivered through cesarean section immediately and discharged after proper management including depressurization, spasmolysis, dehydration and anticoagulant therapy. Five of the 7 cases presented with CVT during early pregnancy, among which 1 was discharged after dilation and curettage followed by anticoagulant therapy, 2 received endovascular thrombolysis after which one was discharged and the other one left with right hemiparesis and 2 patients died. Among the 17 patients presented with CVT during puerperium, 10 received anticoagulant therapy after which 4 were fully recovered, 5 left with functional disturbance (3 with hemiplegia, 1 with incomplete motor aphasia and hemiparesis and 1 with blurred vision) and one died. Among the rest 7 cases who underwent endovascular thrombolysis, 3 were fully recovered, 3 left with functional impairment (1 with blind and headache and 2 with hemiplegia), and one died. Altogether, there were 14 patients underwent systemic anticoagulant therapy after which 7 were fully recovered, 5 left with dysfunction and 2 died. Among the 10 cases received endovascular thrombolysis, 4 were fully recovered, 4 remained some dysfunction and 2 died.

CONCLUSIONS: CVT, mostly presented as superior sagittal sinus thrombosis, are more common in puerperium than during pregnancy and DSA is the golden standard for the diagnosis of CVT. Anticoagulant therapy and endovascular thrombolysis are effective in the treatment of CVT, but may left the patients with functional disturbance or even death. Prompt diagnosis and treatment ensure a better outcome for pregnant women complicated with CVT.

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