Cerebral venous sinus thrombosis (CVST) is a neurological emergency caused by occlusion of the dural venous sinus and/or the cerebral veins. It is more common in women during pregnancy and puerperium. Described here is a woman with an expanding CVST diagnosed at 36 weeks of gestation who had a successful vaginal delivery at 38 weeks of gestation with meticulous anticoagulation and labour management, multidisciplinary team input and close monitoring.
AlgahtaniHBazaidAShirahB,et al.Cerebral venous sinus thrombosis in pregnancy and puerperium: a comprehensive review. Brain Circ2022; 8: 180–187.
2.
CoutinhoJMFerroJMCanhãoP, et al.Cerebral venous and sinus thrombosis in women. Stroke2009; 40: 2356–2361.
3.
FerroJMCanhãoPStamJ, et al.ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke2004; 35(3): 664–670. doi: https://doi.org/10.1161/01.STR.0000117571.76197.26.
4.
VarriasDSpanosMKokkinidisDG, et al.Venous thromboembolism in pregnancy: challenges and solutions. Vasc Health Risk Manag2023; 19: 469–484.
5.
BatemanBTBermanMFRileyLE,et al.The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg2010; 110: 1368–1373.
6.
SheldonWRBlumJVogelJP, et al.WHO Multicountry Survey on Maternal and Newborn Health Research Network. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the world health organization multicountry survey on maternal and newborn health. BJOG2014; 121: 5–13.
7.
Al-ZirqiIVangenSForsénL,et al.Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Am J Obstet Gynecol2009; 201: 273.e1–9.
8.
BlondonMCasiniAHoppeKK, et al.Risks of venous thromboembolism after cesarean sections: a meta-analysis. Chest2016; 150: 572–596.
9.
KamelHNaviBBSriramN, et al.Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med2014; 370: 1307–1315.
TseEKhuranaRClarkeG,et al.Using anti-Xa level for adjusting intravenous unfractionated heparin infusion in peripartum thromboembolic disease. Obstet Med2019; 12: 146–150.
16.
YelnikCMPorterTFBranchDW, et al.Brief report: changes in antiphospholipid antibody titers during pregnancy: effects on pregnancy outcomes. Arthritis Rheumatol2016; 68: 1964–1969.
17.
ArachchillageDJMackillopLChandrathevaA, et al.Thrombophilia testing: a British society for haematology guideline. Br J Haematol2022; 198: 443–458.
18.
Aguiar de SousaDCanhãoPCrassardI, et al. ISCVT-2-PREGNANCY Investigators. Safety of pregnancy after cerebral venous thrombosis: results of the ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis)-2 pregnancy study. Stroke2017; 48: 3130–3133.
19.
AlvesSSousaNCardosoLÍ,et al.Multidisciplinary management of idiopathic intracranial hypertension in pregnancy: case series and narrative review. Braz J Anesthesiol2022; 72: 790–794.
20.
ThallerMWakerleyBRAbbottS, et al.Managing idiopathic intracranial hypertension in pregnancy: practical advice. Pract Neurol2022; 22: 295–300.
21.
BaggaRJainVDasCP, et al.Choice of therapy and mode of delivery in idiopathic intracranial hypertension during pregnancy. MedGenMed2005; 7: 42.
22.
HallanDRLinACTankamCS, et al.Pregnancy and childbirth in women with idiopathic intracranial hypertension. Cureus2022; 14: e30420.
23.
ShatryNWrightAEskandarOS. Cerebral venous thrombosis in pregnancy: a case report. J Case Rep Images Obstet Gynecol2022; 8: 1–3.
24.
SiongKHChanOLYipCS,et al.Cerebral venous sinus thrombosis in pregnancy: a case report. Hong Kong J Gynaecol Obstet Midwifery2020; 20: 88–91.
25.
MonthRCVaidaSJ. Spinal anesthesia for cesarean delivery in a patient with cerebral venous sinus thrombosis. Can J Anaesth2008; 55: 658–659.
26.
AnsonJAVaidaSGiampetroDM,et al.Anesthetic management of labor and delivery in patients with elevated intracranial pressure. Int J Obstet Anaesth2015; 24: 147–160.
27.
FerroJMBousserMGCanhãoP, et al.European Stroke Organization. European stroke organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol2017; 24: 1203–1213.
28.
BückePHellsternVCimpocaA, et al.Endovascular treatment of intracranial vein and venous sinus thrombosis-a systematic review. J Clin Med2022; 11: 4215.
29.
ViegasLDStolzECanhãoP,et al.Systemic thrombolysis for cerebral venous and dural sinus thrombosis: a systematic review. Cerebrovasc Dis2014; 37: 43–50.
30.
ZhouBHuangSSHuangC,et al.Cerebral venous sinus thrombosis in pregnancy: a case report. World J Clin Cases2022; 10: 309–315.
31.
GuoXBFuZSongLJ,et al.Local thrombolysis for patients of severe cerebral venous sinus thrombosis during puerperium. Eur J Radiol2013; 82: 165–168.
32.
ZhangRSunDChenX, et al.Successful hybrid endovascular treatment for refractory cerebral venous sinus thrombosis in pregnancy: a case report. Heliyon2023; 9: e22262.
33.
GiotiIFaropoulosKPicolasC,et al.Decompressive craniectomy in cerebral venous sinus thrombosis during pregnancy: a case report. Acta Neurochir (Wien)2019; 161: 1349–1352.