1. Cerebral sinus and venous thrombosis in postpartum women
BACKGROUND:
Pregnancy and puerperium are risk factors for Cerebral Venous Thrombosis (CVT). In pregnancy venous stroke is the most frequent type of stroke. The main reason for the increased risk of thrombosis in pregnancy and postpartum is hypercoagulability, which has likely evolved to protect women from the bleeding challenges of miscarriage and childbirth. CSVT usually presents in pregnancy or puerperium till 6 weeks’ after birth. Hypercoagulability plays an important role in development of CVT during pregnancy and puerperium. The hypercoagulability, instrumental delivery or caesarean section will lead to thrombosis. Occlusion of cerebral veins leads to cytotoxic and vasogenic edema, and infarction while occlusion of major sinuses leads to intracranial hypertension. Major clinical features include headache, focal deficits, seizures and mental status changes.
CONCLUSIONS:
Postpartum CVT and sinus thrombosis represent still a diagnostic challenge. It is important to evaluate postpartum headache as it is the most neglected clinical sign and in the meantime the chief complaint in CSVT.
It is important to differentiate this condition from others associated postpartum central nervous system (CNS) disorders i.e. eclampsia, and postpartum cerebral angiopathy.
It is also important to exclude arterial strokes, parenchymal hemorrhages unrelated to CVT, subarachnoid hemorrhage and CNS infections.
METHODS: In this retrospective study, we evaluated the clinical, laboratory, and neuroimaging findings of 13 postpartum women diagnosed with CSVT. RESULTS: - Median age of the patients was 24 years old. -The onset of symptoms was acute. Median appearance of symptoms was at day 10 postpartum - Diagnosis of eclampsia was made in five of them. -Six of them had caesarean delivery. -Anemia was detected in four of them. -Three of them had postpartum infections. -Chief complaint was headache. -Seven of them showed a hemorrhagic component in neuroimaging. -Median time from the patient presentation to diagnosis was 2 days, especially in those presenting only with headache
Fjorda Myslimi*, Altin Kuqo*, Liro Buda*,Fjorda Tuka*, Mira Rakacolli**, Jera Kruja** UHC Mother Teresa, Neurology Service, Tirana, University of Medicine Tirana, Albania
References:
Risk of a Thrombotic Event after the 6-Week Postpartum Period
Hooman Kamel, M.D., Babak B. Navi, M.D., Nandita Sriram, B.S., Dominic A. Hovsepian, B.S., Richard B. Devereux, M.D., and Mitchell S.V. Elkind, M.D. N Engl J Med 2014; 370: April 3, 2014