Clinico-Radiological Profile and Outcome of Antepartum Cerebral Venous Thrombosis - A Retrospective Hospital-Based Study
Avani Bhadang1, Saroja A.O.1
1Neurology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, India
Objective:
We aimed to evaluate the risk factors, clinical-radiological profile, and outcome of antepartum cerebral venous thrombosis (CVT) at a tertiary care center.
Background:
CVT refers to the thrombosis of cerebral veins and dural sinuses and is more prevalent in younger females. The risk factors include hematological disorders, hyperhomocystinemia, thrombophilia, antiphospholipid syndrome, pregnancy etc. The incidence of CVT during pregnancy and puerperium is 7.8% however the incidence of antepartum CVT is not well described.
Design/Methods:
Thirteen patients with radiologically proven CVT in their antepartum period were included between 2002 and 2022. Clinical, laboratory and radiological data were gathered, and functional outcomes were assessed using Modified Rankin Scale score (mRS) at discharge. The risk factors and treatment modalities were analyzed.
Results:
Of 1001 CVT patients, 343 were women, with 133 having pregnancy related CVT. Antepartum CVT was identified in 13 of these patients. Mean age, symptom duration and GCS were 25.8 years, 10.46 days and 13 respectively. Symptoms included headache (12), seizures (10), altered sensorium, and neurological deficits (4/13). Predisposing factors included Anemia (4), B12 deficiency (1) and thrombophilia (1). Mean hemoglobin and total white count were 10.9g/dl and 12900/microliter respectively. Neuroimaging findings were normal parenchyma (2) and venous infarct (11). Superior sagittal sinus involvement was most common (10) and multiple sinus occlusion was seen in (8). All patients received anti-edema measures and anticoagulation. One patient died and (9) patients had mean follow up duration of 33.8 months. (3) had uneventful deliveries with good fetal outcomes and (6) underwent MTP as they refused parenteral anticoagulation. The mean mRS at discharge and at 3 months were 1.2 and 1 respectively.
Conclusions:
The overall prevalence of antepartum CVT was 0.13%. Anemia was the most common risk factor. Maternal outcomes were favorable. Adequate counseling and prompt treatment of antepartum CVT may result in good maternal and fetal outcomes.
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