DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20184050

Evaluation of cerebral venous thrombosis by computed tomography/MRI and magnetic resonance venography in pregnant and postpartum women: a prospective study

Neelam Singh, Dinesh Udainiya, Sonal Kulshreshtha, Jyoti Bindal

Abstract


Background: Diagnosis of Cerebral venous thrombosis (CVT) is challenging as it is an uncommon cause of stroke with varied clinical presentations, predisposing factors, imaging findings, and outcomes. Prompt and accurate diagnosis is important for timely intervention in order to reverse and significantly reduce the acute and long-term sequel. Aims and objectives was to study cerebral venous thrombosis in pregnant and post-partum women.

Methods: Hundred pregnant and postpartum women having CVT were studied at Kamla Raja Hospital and JA Group of Hospital at GR Medical College, Gwalior Madhya Pradesh for study period of 2016 to 2017. All the women had undergone CT/MRI and MRV.

Results: Age of CVT patients ranged from 18-35 years with a maximum incidence (84%) in the 2nd decade (20-30 years). Sixty two percent women had infarction; out of that 53% had hemorrhagic infarction. Frontal lobe (10%) and temporal lobe (10%) were more affected. Superior sagittal sinus (SSS) was most commonly involved (71%) followed by transverse sinus (66%) and sigmoid sinus (45%). Superficial venous system was involved in 32 patients while deep venous system was involved in 20 patients. Majority of (82%) patients had combination of sinuses and venous involvement.

Conclusions: CVT was more prevalent in young pregnant and postpartum women. Hemorrhagic infarction were common and affecting frontal and temporal lobe. SSS were mostly affected in CVT. MRV should be the first line diagnostic tool for diagnosis of CVT in pregnant and postpartum women.


Keywords


Haemorrhagic infarction, Pregnancy, Neuroimaging

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References


Ribes M. Des recherché faitessur la phlébite. Revue Médicale Francaiseet Etrangére et J Clinique de L’Hôtel-Dieu et de la Charité de Paris. 1825;3:5-41.

Bousser MG, Chiras J, Berics J, Castagine P. Cerebral venous thrombosis-a Review of 38 cases. Stroke 1985;16(2):199-213.

Nagaraja D, Taly AB. Puerperal venous sinus thrombosis in India. In: Sinhakked Progress in Clinical Neurosciences, Ranchi NSI, Publications. 1985;5:165-77.

Bansal BC, Gupta RR, Prakash C. Stroke during pregnancy and puerperium in young females below the age of 40 years as a result of cerebral venous/sinus thrombosis. J Heart J. 1980;21:171-83.

Ein Haupl KM, Villringer A, Meister W, Mehracin S, Garner C, Pellkofer M,et al. Heparin treatment in sinus thromobosis. Lancet. 1993;38:597-600.

Lee I, James Leach, Thomas Tomsick, Matthew L. Flaherty. Pearls and Oy-sters: cerebral venous sinus thrombosis involving a persistent falcine sinus. Neurology. 2015;85:e162-4.

Nagpal RD. Dural sinus and cerebral venous thrombosis. Neurosurg Rev. 1983;6:155-60.

Srinivasan K, Natarajan M. Cerebral venous and arterial thrombosis in pregnancy and puerperium. Neurol India. 1974;22:131-40.

Srinivasan K, Natarajan M. Cerebral venous and sinus thrombosis in pregnancy and puerperium. A study of 135 patients. Angiology. 1983;34:731-46.

Ferro JM, Correia M, Ponter C. For ISCVT investigators. Prognosis of cerebral venous and dural sinus thrombosis, results of ISCVT. Stroke. 2004;35:664-70.

Narayan D, Kaul S, Ravishankar K, Suryaprabha T, Bandaru VCSS, Mridula KR, et al. Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: insights from Nizam’s Institute Venous Stroke Registry, Hyderabad (India). Neurol India. 2012;60(2):154-9.

Panagariya A, Maru A. Cerebral venous thrombosis in pregnancy and puerperium-a prospective study. J Assoc Physicians India. 1997;45(11):857-9.

Kasmaei HD, Baratloo A, Soleymani M. A 33-year-old woman with severe postpartum headache. Emergency. 2013;1(1):27-9.

Rizzo L, Crasto SG, Ruda R, Gallo G, Tola E, Garabello D et al. Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting. Radiol Med. 2010;115(2):313-25.

Saposnik G, Barinagarrementeria F, Brown RD, Jr, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke J Cerebral Circulation. 2011;42(4):1158-92.

Sasikala R, Jagan A, Dilshath S. Clinical profile of cerebral venous thrombosis in pregnancy and puerperium in South India. Inter J Reprod Contra Obs Gynaecol. 2017;6(7):3124-8.

Cantu CC, Bariniagerrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium: Review of 67 cases. Stroke. 1993;24:1880-4.

Kasmaei HD, Baratloo A, Nasiri Z, Soleymani M, Shirafkan A, et al. Report of nineteen cerebral vein thrombosis referrals to an emergency department: a case series and literature review. Arch Neurosci. 2015;2(2):e20552.

Cakmak S, Hermier M, Montavont A, Derex L, Mauguière F, Trouillas P, et al. T2 weighted MRI in cortical venous thrombosis. Neurol. 2004;63(9):1698.

Treadwell SD, Thanvi B, Robinson TG. Stroke in pregnancy and the puerperium. Postgrad Med J. 2008;84(991):238-45.