20 hours ago Spontaneous cerebral venous sinus thrombosis is a rare problem that may be encountered in patients with underlying thrombophilic disorders. It has also been reported as a postoperative … >> Go To The Portal
2 Department of Neuromedicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal. Dural Venous Sinus Thrombosis is the formation of blood clot within the cerebral sinus. It is very rare case with varying clinical presentation.
Common symptoms of occlusion of dural sinus thrombosis include seizure, focal neurologic deficit, and altered mental status. History with venous sinus thromboses is varied depending on the location, extent, and symptoms of sinus thrombosis.
Dural venous sinus thrombosis (DVST) is an unusual complication of pregnancy, with an incidence of 1:10,000 [1] to 1:25,000. [2] We report a case of postpartum transverse sinus thrombosis after attempted epidural analgesia, complicated by postdural puncture headache (PDPH), and epidural blood patch (EBP).
If diagnosed and appropriately treated, outcomes from VST are good. In the international study on cerebral vein and dural sinus thrombosis (ISCVT), approximately 57% of patients had no residual symptoms or deficits at a median follow up time of 16 months.[19] In that same study, about 2% of patients had severe deficits, and 8% of patients died.
Cerebral venous sinus thrombosis during pregnancy or puerperium is not a rarity. Nevertheless, it is often misdiagnosed. With the increasing use of regional anaesthesia in obstetrics the differential diagnosis of postdural puncture headache is often difficult. The case of a patient is reported who s …
Background and Purpose- Pregnancy and the postpartum period are generally considered to be risk factors for cerebral venous thrombosis (CVT), but no controlled studies have quantified the risk. Methods- Case-control study using data of consecutive adult patients with CVT from 5 academic hospitals an …
Cerebral venous thrombosis (CVT) refers to thrombus formation in either the deep or superficial venous drainage systems of the brain. The etiology is multifactorial and the presentation is variable, with diagnosis requiring a high index of suspicion
Dural venous sinus thrombosis during the puerperium usually occurs during the first 7 postpartum days. [1] The most frequent presenting symptom is headache. [11,12] Other neurologic signs include papilledema, focal deficits, seizures, and coma. [13] The mechanism for these neurologic changes is thought to be thrombosis of the cerebral venous sinuses and arachnoid granulations, resulting in inadequate venous and cerebral spinal fluid drainage, with increased intracranial pressure, seizures, and focal neurologic deficits. [2]
According to the National Center for Health Statistics, there were more than 4 million live births performed in the United States in 1991, [3] with 16% (approximately 640,000) receiving epidural anesthesia. [4] There is a reported incidence of unintentional dural puncture during epidural placement that ranges from 1% to 7.6% [5,6]; therefore, the occurrence of wet tap would range between 6,400 and 48,640 incidents annually. The incidence of DVST during pregnancy has been reported from 1 in 10,000 to 1 in 25,000, [2] representing approximately 160–400 episodes per year. If epidural anesthesia with subsequent unwanted dural puncture does not affect the incidence of DVST, then, by chance, one might predict that as many as 4.8 patients annually might suffer inadvertent dural puncture followed by DVST. Gibbs* reported that recent data indicate that 29% of deliveries are performed using epidural anesthesia; this would almost double the numbers discussed earlier. When patients who received intentional dural puncture (i.e., spinal anesthesia or combined spinal-epidural anesthesia) are considered, the number of potential occurrences of dural puncture with subsequent DVST could increase.
[12] The etiology of puerperal DVST is unclear, but two of the suggested mechanisms are [1] : (1) damage to venous sinuses due to fluctuations in intracranial pressure during delivery, and (2) an increased thrombotic tendency due to changes in various coagulation factors. The hypercoagulable state of pregnancy, which may contribute to its association with DVST, has been attributed to increased platelet adhesion and an increase in clotting factors (fibrinogen and factors VII, VIII, and X). [13] Other conditions associated with increased risk of DVST include hereditary antithrombin III deficiency [17] and dysfunctional protein C with decreased free protein S concentration. [18] Hereditary protein S deficiency has been associated with DVST in a patient taking oral contraceptives. [19]
Magnetic resonance imaging is a sensitive test for the detection of DVST and may be the investigation of choice when this disorder is suspected. [14] Our patient's magnetic resonance image ( Figure 1) showed increased signal intensity instead of the normal flow void in the left transverse sinus. This finding persisted in other planes and other pulse sequences. Dural venous sinus thrombosis results in increased signal intensity instead of the normal flow void. [15] Magnetic resonance angiography ( Figure 2) was used to confirm the diagnosis of DVST in our patient. This technique is based on gradient-refocused scans that show increased signal intensity instead of a flow void for flowing blood. These scans are then reconstructed into a three-dimensional format for the magnetic resonance angiogram or venogram; computed tomography may be inadequate, and angiography should be reserved for difficult cases. [16]
Dural venous sinus thrombosis (DVST) is an unusual complication of pregnancy, with an incidence of 1:10,000 [1] to 1:25,000. [2] We report a case of postpartum transverse sinus thrombosis after attempted epidural analgesia, complicated by postdural puncture headache (PDPH), and epidural blood patch (EBP).
No laboratory evidence of a lupus anticoagulant or antinuclear antibody was noted. The patient's headaches decreased in severity and were controlled using oral pain medications. She was discharged after 8 days of hospitalization (the 16th postpartum day). Eight days after discharge, her headaches resolved completely.