Clinical Profile of Postpartum Cerebral Venous Thrombosis and Its Management

BACKGROUND: Cerebral Venous Thrombosis (CVT) refers to the thrombosis of dural venous sinuses or the cerebral veins, which is more common in females especially in puerperal period. Once considered as rare disease, Cerebral Venous Thrombosis is now being considered with increasing frequency in South Asian countries especially India. Though prognosis is very good in majority of patients, it is a potentially life threatening complication in puerperium requiring early clinical suspicion and prompt diagnosis. But the diagnosis is challenging in certain cases due to varied clinical presentation with difference in predisposing factors, presentation, therapeutic options and the outcome. The objective of the present study is to determine the clinical profile of Cerebral Venous Thrombosis in the pueperium focussing on the radiological and the prognostic characteristics of the disease in puerperal patients admitted in Government Mohan Kumaramangalam Medical College Hospital, Salem. METHODOLOGY: This was open labelled prospective observational non-interventional study done on 75 puerperal patients admitted in our hospital satisfying both inclusion and exclusion criteria. This study was conducted for a period of eighteen months from February 2018 to July 2019. Detailed antenatal history, risk factors, neurological examination, Brain imaging with Computed Tomography (CT) or Magnetic Resonance Imaging with Magnetic Resonance Venogram or Magnetic Resonance Venogram or Magnetic Resonance Venogram Arteriogram (MRI with MRV, MRA), routine and specific laboratory investigation as required were done in all patients and the results were analysed. RESULTS: In our sudy number of patients studied was 75 out of which 7 patients died. The mortality was 9.3%. Second week of puerperium was the most common crucial period for the developement of puerperal Cerebral Venous Thrombosis, more common in primipara. Highest incidence was observed in 20-25 years & in people who belonged to rural area. Highest incidence was in patients who underwent LSCS (52%), 64% of patients are anemic, 48% of patients are of Hypertensive disorders of pregnancy. Headache was commonest symptom, followed by convulsions,altered sensorium. Superior Sagittal Sinusus was most commonly involved in 65.3% of patients, followed by transverse sinus. Coma at admission were associated with poor prognosis. CONCLUSION: Cerebral Venous Thrombosis in puerperium has a wide range of clinical presentation. Cerebral Venous Thrombosis in puerperium should be suspected if ◆ Whenever a young peripartum primipara presents with symptoms and signs of raised intracranial tension with or without other neurological symptoms. ◆ Whenever the imaging of brain shows haemorrhagic infarcte especially in non arterial territories. ◆ Anemia must be corrected whenever found during antenatal period, regular antenatal check up must be encouraged. To conclude, any headache with or without hypertension in the puerperal period should not be ignored, has to be evaluated. Though the prognosis is good in puerperal Cerebral Venous Thrombosis, extravigilance may be required in patients who present with poor prognostic factors