Rehman Muhammad Naveed Ur, Khan Dr Ubaid, Aslam Ayesha
Department of Medicine, King Edward Medical University Lahore, Pakistan.
Department of Neurology, Mayo Hospital, Lahore, Pakistan.
Radiol Case Rep. 2022 Apr 5;17(6):1911-1915. doi: 10.1016/j.radcr.2022.03.037. eCollection 2022 Jun.
Cerebral venous sinus thrombosis is a rarely occurring condition. Pregnancy and postpartum are both known risk factors for cerebral venous sinus thrombosis. Early detection and treatment are critical, as CVST can be potentially life-threatening. Here, we present a case of a patient who developed left transverse and superior sagittal sinus thrombosis 15 days after normal vaginal delivery. The patient presented to the emergency department with complaints of irritability and an altered state of consciousness for two days. The patient also developed seizures extending from the lower limb to the upper body. Laboratory investigations revealed abnormalities in the complete blood count report and urine complete examination. The patient's coagulation profile was totally abnormal, indicating a presence of a thrombus. All the other diagnostic techniques, including Electrocardiogram, Carotid Doppler Scan, and Ultrasound abdomen, revealed no findings. However, Magnetic resonance venography + Magnetic resonance imaging showed partial superior sagittal sinus thrombosis in the anterior and upper parietal regions, right internal jugular vein thrombosis, and left transverse thrombosis with associated left parietal infarcts. The presence of thrombosis in sinuses and jugular vein resulted in seizures, altered state of consciousness, and other associated symptoms. The patient was treated with sodium valproate, heparin, and other medications accordingly. The above-mentioned case was unique due to the involvement of unusual sinuses (transverse sinus) as previous studies have only reported cases of thrombus presence in the superior sagittal sinus. This case study will discuss patient diagnosis and management with Heparin and Diazepam to stop altered state of consciousness and seizures in females.
脑静脉窦血栓形成是一种罕见的病症。妊娠和产后都是已知的脑静脉窦血栓形成的危险因素。早期检测和治疗至关重要，因为脑静脉窦血栓形成可能会危及生命。在此，我们报告一例患者，该患者在正常阴道分娩15天后发生左侧横窦和上矢状窦血栓形成。患者因烦躁不安和意识状态改变两天就诊于急诊科。患者还出现了从下肢延伸至上身的癫痫发作。实验室检查显示全血细胞计数报告和尿液全面检查存在异常。患者的凝血指标完全异常，提示存在血栓。所有其他诊断技术，包括心电图、颈动脉多普勒扫描和腹部超声，均未发现异常。然而，磁共振静脉造影 + 磁共振成像显示前顶叶和上顶叶区域部分上矢状窦血栓形成、右侧颈内静脉血栓形成以及左侧横窦血栓形成伴左侧顶叶梗死。窦和颈静脉内血栓的存在导致了癫痫发作、意识状态改变及其他相关症状。患者相应地接受了丙戊酸钠、肝素和其他药物治疗。上述病例较为独特，因为累及了不常见的窦（横窦），而此前的研究仅报道过上矢状窦存在血栓的病例。本病例研究将讨论女性患者使用肝素和地西泮进行诊断和治疗以终止意识状态改变和癫痫发作的情况。
