CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Arxer, A.
Right arrow Articles by Villalonga, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Arxer, A.
Right arrow Articles by Villalonga, A.
Canadian Journal of Anesthesia 51:1050-1051 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

Dural sinus thrombosis in a late preeclamptic woman

Antoni Arxer, MD, Berta Pardina, MD, Itziar Blas, MD, Lluís Ramió, MD and Antonio Villalonga, MD PhD

Catalonia, Spain

To the Editor:

We describe a case of left transverse and sigmoid sinus thrombosis in a patient with late postpartum preeclampsia. Preeclampsia/eclampsia is the major leading cause of stroke in the peripartum period.1

A 32-yr-old woman delivered a healthy girl. Neither epidural nor spinal labour analgesia were attempted. Her medical history was negative for venous thrombosis, trauma, malignancy, prolonged immobilization, diabetes mellitus or oral contraceptive use. On the third postpartum day she developed hypertension (blood pressure of 212/119 mmHg), proteinuria (3 g•24 hr–1), severe headache and visual disturbances. Nifedipine was started. Two hours later she experienced two generalized tonic-clonic seizures. Intravenous phenytoin and diazepam were administered by the obstetrician. The patient was admitted to the recovery room with the diagnosis of eclampsia. Antihypertensive and anticonvulsant therapies were initiated and maintained with a magnesium sulfate infusion. Physical examination was otherwise normal. Computed tomography and magnetic resonance imaging scans were both reported as normal. The neurology housestaff suggested a diagnostic lumbar puncture and a magnetic resonance venography (MRV). The cerebrospinal fluid evaluation reported a negative bacterial culture and immunoglobulins, protein, glucose, white and red blood cell counts within normal limits. The MRV revealed a left transverse and sigmoid sinus thrombosis (FigureGo). Full anticoagulation with iv heparin was initiated immediately. The following investigations were reported within normal limits: complete blood count, electrolytes, prothrombin time, activated partial thromboplastin time, antithrombin III activity, lupus anticoagulant, activated protein C, protein S and resistance, anticardiolipin G and M, prothrombin 20210, homocysteine and factor V Leiden. The patient was discharged home without neurologic sequelae with warfarin for six months and antihypertensive treatment (atenolol). Six months later a follow-up MRV did not show the dural sinus thrombosis (DST).



View larger version (151K):
[in this window]
[in a new window]
  		FIGURE The magnetic resonance venogram (MRV) shows non-filling of the left transverse and sigmoid sinuses compared with normal filling on the unaffected righ side. There were no areas of signal alteration involving the brain to suggest ischemia or infarction.

 
DST is commonly misdiagnosed, because there are no pathognomonic signs or symptoms. It has been reported to occur during pregnancy and up to two months postpartum. The superior sagittal sinus is not commonly involved. Pregnancy-related hypertension and Cesarean delivery are important risk factors.2,3 The stroke rates are approximately five to 13 times higher than in nonpregnant women of the same age, leading some authors to suggest that pregnancy itself is a risk factor for stroke.3 The present case highlights the importance of the differential diagnosis when a preeclamptic woman develops seizures in the postpartum. Anticoagulant therapy is indicated for three to six months and during future pregnancies.4,5

References

1 Vilela P, Duarte J, Goulao A. Cerebrovascular disease in pregnancy and puerperium (Portuguese). Acta Med Port 2001; 14: 49–54.[Medline]

2 Kittner SJ, Stern BJ, Feeser BR, et al. Pregnancy and the risk of stroke. N Engl J Med 1996; 335: 768–74.[Abstract/Free Full Text]

3 Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke 2000; 31: 1274–82.[Abstract/Free Full Text]

4 Fink JN, McAuley DL. Cerebral venous sinus thrombosis: a diagnostic challenge. Intern Med J 2001; 31: 384–90.[Medline]

5 Pannake T. Cerebral venous sinus thrombosis. Ann Emerg Med 1991; 20: 813–6.[Medline]





This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Arxer, A.
Right arrow Articles by Villalonga, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Arxer, A.
Right arrow Articles by Villalonga, A.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS