Zhang K, Li TX, Gao BL, Zhu LF, Wang ZL. Endovascular recanalization of extensively-thrombosed cerebral venous sinuses in early pregnancy: A case report.
Medicine (Baltimore) 2022;
101:e30266. [PMID:
36086789 PMCID:
PMC10980448 DOI:
10.1097/md.0000000000030266]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
RATIONALE
The incidence of pregnancy-related cerebral venous sinus thrombosis (CVST) is rare, and cerebral hemorrhage caused by CVST in the early pregnancy period is even rarer. Only 3 cases of cerebral hemorrhage caused by CVST had been reported in the early pregnancy period in the literature. In this study, we reported successful endovascular treatment of such a case.
PATIENT CONCERNS
A 27-year-old woman presented with rapidly progressive neurologic decline in her second pregnancy for 8 weeks. She was afebrile and completely conscious, without neurological deficits. She did not have any previous history of venous thrombosis, hematologic, or autoimmune diseases.
DIAGNOSIS
Urgent brain computed tomography demonstrated parietal-occipital hemorrhage surrounded by a large hypodense area and full brain swelling. Magnetic resonance venography showed complete occlusion of the right sigmoid sinus, transverse sinus, and two-thirds of the superior sagittal sinus. Transvaginal sonography demonstrated early intrauterine pregnancy, with the size of gestation sac being 6 × 7 × 6 mm and the fetal heart not being detected. CVST-related cerebral hemorrhage was confirmed based on the clinical and imaging data.
INTERVENTIONS
The CVST in this pregnant woman was treated endovascularly with a 6 Fr Navien catheter for aspiration, thrombolysis, and anticoagulation.
OUTCOMES
Ten days after treatment, the cerebral hemorrhage had gradually been absorbed. Follow-up angiography performed 2 weeks later demonstrated complete recanalization of her cortical veins and sinuses. Two months later, the patient was completely recovered without cognitive or neurological dysfunction.
LESSONS
Pregnancy-related CVST can be successfully treated with a combined endovascular approach of aspiration, thrombolysis, and anticoagulation to complete recovery.
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