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How to distinguish puerperal cerebral venous thrombosis from arterial thrombosis
How does the physician clinically distinguish puerperal cerebral venous thrombosis from arterial thrombosis?
Cerebral venous thrombosis usually occurs in the first three postpartum weeks and commonly presents with headache, focal or generalized seizures, stupor or coma, transient focal deficits, and/or signs of increased intracranial pressure.
Rare thromboses include superior sagittal sinus thrombosis, with paraplegia and sensory deficits of the leg and bladder dysfunction, and Rolandic vein thrombosis, with sensory and motor deficits of the leg, hip, and shoulder, sparing the face and arm.
Mortality in sagittal sinus thrombosis approaches 40% but may be reduced to 20% with intensive care and anticoagulants.
Recovery of survivors is usually complete.
Arterial thrombosis is rarer than either arterial embolus or venous thrombosis, is more likely to occur in the second or third trimester than in the puerperium, and commonly presents with persistent focal deficit, such as hemiparesis, without alteration of consciousness, seizures, or signs of increased intracranial pressure. An immune mechanism has been hypothesized for a significant percentage of pregnancy-related venous and arterial thromboses. The presence of antiphospholipid antibodies should be sought, especially when a history of previous miscarriages or preeclampsia is obtained.
Sources
- Fox MW, Harms RW, Davis DH: Selected neurologic complications of pregnancy. Mayo Clin Proc 65:1595-1618, 1990.
- North RA, McCowan LM, Dekker GA, Poston L et al.: Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. BMJ 342:d1875, 2011.
- Lo JO, Mission JF, Caughey AB: Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol 25:124-132, 2013 Lo JO, Mission JF, Caughey AB: Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol 25:124-132, 2013.
- Duley L, Henderson-Smart DJ, Chou D: Magnesium sulphate versus phenytoin for eclampsia (Review). Cochrane Database Syst Rev (10):CD000128, 2010.
- Duley L, Henderson-Smart DJ, Walker GJA, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev (12):CD000127, 2010.
