Cerebral venous sinus thrombosis viewed as a postpartum complication
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke caused by a clot forming in one of the cerebral sinuses and subsequent blockage in blood drainage. The clinical presentation of this disease can be atypical and diagnosis might be challenging. The patient in this case study was a 33-year-old woman admitted to the perinatology clinic at 39+5 weeks of gestation to perform a planned caesarean section, who had previously been discharged home in good condition. The patient was readmitted to the hospital because of a headache, tingling sensation, and elevated D-dimers. A performed Computed Tomography scan revealed low contrast signal in the left cerebral sinuses and the left internal jugular vein. The diagnosis was CVST, with blood clots present in all mentioned vessels. Subsequent magnetic resonance imaging revealed hemorrhagic venous infarctions in the left cerebral and cerebellar hemispheres. The patient was successfully treated with painkillers and heparin. No additional coagulation defect was detected.
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke caused by a clot forming in one of the intracranial sinuses and subsequent blockage in blood drainage. Even though venous thromboembolism affects 0.1% of the population, CVST is a rare disease that occurs in 5 people per 1 million, annually and is responsible for 0.5% of all strokes (Ferro, 2007; Devasagayam et al, 2016; Heit et al, 2016; Luo et al, 2018; Johns Hopkins Medicine, 2020). The disease may be observed at any age, but is most likely to be diagnosed among young people, especially women (Alvis-Miranda, 2013). Though it is a relatively rare disease in the general population, it is one of the most common cerebrovascular complications in pregnancy, affecting 1.6 out of 100 000 deliveries (Saposnik et al, 2007). Like any other thrombotic process, the CVST is well explained by the traditional Virchow triad (hypercoagulability, vessel wall damage, and blood stasis) (Kumar, et al, 2018).
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