Cerebral venous thrombosis - epidemiology, diagnosis and treatment

Cerebral venous sinus thrombosis cases detected in on-call CT venographies in Sweden, 2019-2022

No well-established criteria exist for assessing the risk of cerebral venous sinus thrombosis (CVST). Here, we sought to gain an understanding of CVST cases and associated risk factors, based on the rates of emergency CT venographies (CTVs) performed after hours. Furthermore, we aimed to assess possible correlations between CVST rates and COVID-19, including at the start of the COVID-19 vaccination campaign. We collected reports of emergency CTVs performed after hours at 56 Swedish hospitals between 1/1/2019 and 12/31/2022, and divided them into five groups: (I) from 1/1/2019 to 1/31/2020, before the emergence of COVID-19 cases in Sweden; (II) from 2/1/2020 to 12/26/2020, after the emergence of COVID-19 but before vaccination rollout; (III) from 12/27/2020 to 7/28/2021, from the start of the COVID-19 vaccination campaign until 50% of the adult population in Sweden had been vaccinated; (IV) from 7/29/2021 to 2/1/2022, from when 50% of the adult population was vaccinated until restrictions were lifted; and (V) from 2/2/2022 to 12/31/2022, after restriction measures were suspended. For all included patients, we collected information on demographics and clinical history, including pregnancy, recent partum, and use of oral contraceptives or post-menopausal hormone replacement therapy. In total, we collected 430 reports (92% female, 8% male). The CVST positivity rate was 22.2% in men vs. 2.3% in women. None of the pregnant (n = 49) or postpartum (n = 12) women had CVST positivity. The frequency of CTV examinations was lowest in group 2; during this period, the average time between patients being imaged was 7 days. The frequency of CTV examinations was highest in group IV; during this period, a patient underwent this type of scan every 1.5 days, on average. The frequency of CVST-positive scans was lowest in group II; during this period, a positive case was found every 66 days, on average. The frequency of CVST-positive scans was highest in group IV; during this period, a positive case was found every 62 days, on average, and no statistical difference with respect to group II was observed. Pregnancy and recent partum were not significant risk factors for CVST. The elevated CVST positivity rate observed during the height of the COVID-19 pandemic suggested that patients with less likelihood for positive CVST had fewer emergency visits. The positivity rate did not increase with the start of the COVID-19 pandemic or the rollout of COVID-19 vaccination.

Postpartum Cerebral Venous Sinus Thrombosis: A Case Report

Introduction

Cerebral venous thrombosis (CVT) remains one of the most frequent cause of stroke in young adults although it is a rare disorder. It has a serious emergency manifestation during pregnancy and postpartum. It is frequently under diagnosed and limited publications in developing countries especially sub-Saharan Africa.

Case Presentation

Here, we report the case of a 35-year-old female, para 8 and gravida 8, brought to emergency department on her ninth day postpartum, having severe headaches and confusion; during her admission to emergency, she suffered two episodes of generalized seizure. On admission, the patient's blood pressure was 200/120 mmHg. The patient was firstly diagnosed with postpartum eclampsia and managed with magnesium sulfate for seizures and hydralazine for blood pressure control. On ward admission, she continued having seizures and her level of consciousness decreased with left side weakness. An urgent MRI of head and MR venography performed immediately revealed acute thrombosis involving the anterior aspect of superior sagittal sinus and the left transverse sinus. The patient was moved to the ICU. Anti-coagulant LMW enoxaparin and anticonvulsant were started. After improving on clinical and biochemical tests, the patient was transferred to the inpatient ward on fifth day. Another two days later in the ward, she improved significantly, and then a head CT (contrast) angiography/venography was performed before she was discharge and showed no evidence of filling defect in cortical/dural venous sinuses.

Conclusion

Cerebral venous sinus thrombosis (CVST) and postpartum eclampsia may have similar manifestations in young women of reproductive age. Early prompt diagnosing and therapeutic intervention of CVST can prevent further neurological deterioration and immediately improve the patient.

Case Reports of Pregnancy-Related Cerebral Venous Thrombosis in the Neurology Department of the Emergency Clinical Hospital in Constanta

Cerebral venous thrombosis accounts for 0.5–1% of all cerebrovascular events and is one type of stroke that affects the veins and cerebral sinuses. Females are more affected than males, as they may have risk factors, such as pregnancy, first period after pregnancy, treatment with oral contraceptives treatment with hormonal replacement, or hereditary thrombophilia. This neurological pathology may endanger a patient’s life. However, it must be suspected in its acute phase, when it presents with variable clinical characteristics, so that special treatment can be initiated to achieve a favorable outcome with partial or complete functional recovery. The case study describes the data and the treatment of two patients with confirmed cerebral venous thrombosis with various localizations and associated risk factors, who were admitted to the neurology department of the Sf. Apostol Andrei Emergency Hospital in Constanta. The first patient was 40 years old and affected by sigmoid sinus and right lateral sinus thrombosis, inferior sagittal sinus, and right sinus thrombosis, associated with right temporal subacute cortical and subcortical hemorrhage, which appeared following a voluntary abortion. The second case was a patient aged 25 who was affected by left parietal cortical vein thrombosis, associated with ipsilateral superior parietal subcortical venous infarction, which appeared following labor. The data are strictly observational and offer a perspective on clinical manifestations and clinical and paraclinical investigations, including the treatment of young patients who had been diagnosed with cerebral venous thrombosis and admitted to the neurology department.