Zavala-García A, Mancera-Reséndiz MA, Gomezpedroso-Rea FJ, Iturralde-Rosas-Priego P, Arauz-Góngora A, Martínez-Monter J, Hernández-Ramos R, Díaz-Villaseñor A

Language: Spanish
References: 16
Page: 480-488
PDF size: 396.59 Kb.

ABSTRACT

Background: cerebral venous thrombosis is infrequent, but with the highest incidence during pregnancy and puerperium.
Objetive: to review the most recent bibliography and propose a treatment option for the patient with cerebral venous thrombosis during puerperium.
Clinical case: a 30 year old patient with a history of two pregnancies and two Cesarean sections. On the seventh day of puerperium she presented edema of the lower limbs, high blood pressure, headache and visual disorders. Antihypertensive treatment with nifedipine and neuroprotection with magnesium sulfate, hypertension was controlled although the headache and blurry vision and double vision symptoms persisted. The MRI results reported: venous thrombosis of the left lateral transverse sinus. With anticoagulant treatment there was significant decrease of neurological symptoms.
Conclusions: since preeclampsia and eclampsia can hide symptoms of cerebral venous thrombosis, it is important to always consider both conditions for the timely diagnosis and treatment of both.

REFERENCES

1. Razmara A, Bakhadirov K, Batra A, Feske S. Cerebrovascular complications of pregnancy and the postpartum period. Current Cardiology Reports 2014;16:532-40.

2. McCaulley JA, Pates JA. Postpartum cerebral venous thrombosis. Obstet Gynecol 2011;118:423-5.

3. Cantu-Brito C, Arauz A, Aburto Y, et al. Cerebrovascular complications during pregnancy and postpartum: Clinical and prognosis observations in 240 Hispanic women. Eur J Neurol 2011;18:819-25.

4. Tepper NK, Boulet SL, Whiteman MK, et al. Postpartum venous thromboembolism, incidence and risk factors. Obstet Gynecol 2014;123(5):987-96.

5. Spiering ELH, Sabin TD. De novo headache during pregnancy and puerperium. Neurologist 2016;21:1-7.

6. Heit JA, Kobberving CE, James AH, Petterson TM, Bailey KR, Melton LJ III. Trends in the incidence of venous thromboembolism during pregnancy and post- partum: a 30-year population-based study. Ann Int Med 2005;143:697-706.

7. Ilkhchoui Y, Szabo EE, Gerstein NS, Jaime F. Cerebral venous thrombosis complicating severe preeclampsia in the postpartum period: A diagnostic challenge. J Clin Anesthsia 2014;26:143-6.

8. American College of Obstetricians and Gynecologists. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period Committee Opinion. Washington, DC: American College of Obstetricians and Gynecologists 2015;623.

9. Guenther G, Arauz A. Trombosis venosa cerebral: Aspectos actuales del diagnóstico y tratamiento. Neurología 2011;26:488-9.

10. Thromboembolism in Pregnancy. Practice Bulletin No. 123. American College of Obstetrics and Gynecologists. Obstet Gynecol 2011;118:718-29.

11. Barinagarrementeria F, Arauz A. Evaluation and management of a patient with possible cerebral venous thrombosis. Neurol Clin Pract 2014;4(5):394-401.

12. Criterios médicos de elegibilidad para el uso de anticonceptivos. Organización Mundial de la Salud, 5a ed., 2015. Disponible en: www.who.int/reproductivehealth/topics/ family_planning.

13. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. American College of Obstetrics and Gynecologists. Obstet Gynecol 2013;1122-31.

14. Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Thromboembolism During Pregnancy and the Puerperium: Acute Management. Green-top Guideline No. 37a. London: RCOG; 2015.

15. Tukur J. The use of magnesium sulphate for the treatment of severe pre-eclampsia and eclampsia. Ann African Med 2009;8(2):76-80.

16. Sibai B. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol 2005;105(2):402-10