A STUDY OF CEREBRAL VENOUS THROMBOSIS IN PREGNANCY AND PUERPERIUM- A RETROSPECTIVE ANALYSIS

BACKGROUND Cerebral venous thrombosis (CVT) is a neurological emergency caused due to thrombus formation in the cerebral veins or sinuses. CVT has a varied presentation and its ability to mimic other conditions makes diagnosis of CVT difficult. Aims and Objectives: 1. To analyse pregnant and puerperal patients with cerebral venous thrombosis. 2. Identifying the possible risk factors, clinical presentations and prognosis of CVT in pregnant and puerperal women. MATERIALS AND METHODS Demographic and obstetric history, clinical features, management and prognostic details were retrospectively collected and recorded in a proforma. Results were expressed in terms of frequency. Chi-square test was used as the test of significance. RESULTS The observational study showed mean age to be 23.6 +/- 3.90 years. Higher proportions of cases were from rural areas (60%), low socioeconomic status (66.7%), multipara (56.7%) and presented within 10 days postpartum (53.5%). Headache was present in all patients. Other symptoms included seizures (60%), altered level of consciousness (20%), visual disturbances (26.7%), papilloedema (53.3%), focal neurological deficits (10%) and cranial nerve palsy (3.3%). Superior sagittal sinus (63.3%) and transverse sinus (70%) were the most commonly involved sinuses. CT was normal in 26.7% of the cases, but magnetic resonance venogram showed positive signs even in CT negative cases. Recovery was good in 86.7% of the cases and ended in mortality in 13.3% of the cases. CONCLUSION Pregnant and puerperal women of 21-25 years of age were most commonly affected. Most of the cases presented within 10 days postpartum. Headache was the most frequently encountered symptom. Altered consciousness, cranial nerve involvement and headache of more than 24 hours of duration were associated with poor prognosis. CT was normal in 26.7% of the cases, but MRV was conclusive of CVT in these cases. Superior sagittal sinus and transverse sinus were the commonly affected venous channels. Involvement of superior sagittal sinus showed good prognosis, whereas involvement of deeper cortical veins showed poor prognosis. If adequate treatment is initiated before patient progresses to altered level of consciousness, almost complete recovery is possible.