Obstetric Cerebral Venous Thrombosis- A Clinical Dilemma QC10-QC13
Dr. Charu Sharma,
Flat No. 402/3, AIIMS Residential Complex, Jodhpur Basni Phase 2, Jodhpur, Rajasthan, India.
Introduction: Cerebral Venous Thrombosis (CVT) is one of the important causes of stroke which is not very common. It has a varied clinical presentation and pathogenesis. It most often involves the superior sagittal sinus but may occur anywhere in the cerebral venous circulation. Pregnancy and puerperium are in itself a high-risk factor for its occurrence.
Aim: To assess the frequency of different clinical features, risk factors and prognostic outcome of patients diagnosed as CVT.
Materials and Methods: A hospital based observational study was conducted in the Department of Obstetrics and Gynaecology and the Department of Medicine at Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India, from January 2015 to December 2016. All cases of cerebrovascular accidents were followed and those diagnosed as CVT on the basis of Computed Tomogram (CT), Magnetic Resonance Imaging (MRI) and/or Magnetic Resonance Venogram (MRV) were included in the study, managed and followed till discharge from the hospital and at three months post-delivery. Means and percentages were used as statistical analysis.
Results: Out of total of 4,767 deliveries in the study period, we found six cases of puerperal CVT. The incidence of puerperal CVT in our study population came out to be 125.8 per 100,000 deliveries. The mean age of women presenting with CVT was 23.6±3.204 years. The most common presenting symptom was headache (6/6, 100%) followed by seizure (4/6, 66.6%), hemiparesis (1/6), diplopia (1/6) and blindness (1/6). The most common area of infarct was superior sagittal sinus (6/6, 100%). The average period between the onset of symptoms and consultation was 1.8 days. Mortality at discharge was 16.6% (1/6).
Conclusion: In CVT precise diagnosis is decisive as based on the diagnosis timely and suitable therapy can be started which can reverse the disease process.