Objective To discuss the possible cause, clinical symptoms, radiologic characteristics, diagnosis
and our treatment strategies of cerebral venous sinus thrombosis (SCVT) in pregnancy.
Methods We presented 12 cases of pregnancy with emergent SCVT admitted between 1993 and
2013 in the Department of Neurology, Peking Union Medical College (PUMC) hospital. The
average age was (26±5) (19~34). Computed tomography (CT)/magnetic resonance imaging (MRI)
was performed in all 12 patients in acute/subacute period; magnetic resonance venography (MRV)
in 9 and digital subtraction angiography (DSA) in 6. The possible pathogenesis, clinical symptoms,
radiological findings, diagnosis and treatment strategies were discussed.
Results Of the 12 pregnant or maternity patients with SCVT, 7 got the disease in early pregnancy,
1 in late pregnancy, 4 within 2 weeks after delivery, 1 after abortion. The accompanied diseases
were:one with protein S deficiency, one with hyperhomocystinemia, one with idiopathic
thrombocytopenia purpura, one with infection, one with anemia. Clinical onset was acute or
subacute. Twelve patients had headache, 5 had epilepsy, 5 had focal neurological signs (including weakness, Babinski signs, numbness, ataxia, peripheral facial paralysis), 1 had visual loss, 4
had disturbance of consciousness. All 12 patients had MRI during acute or subacute period, 9
had abnormal parenchymal signals--7 had infarction or hemorrhagic infarction, 1 had cerebral
hemorrhage, and 1 had cerebral edema. Transverse sinus and sigmoid sinus were involved in 9
cases, superior sagittal sinus in 8, straight sinus and inferior sagittal sinus in 2, jugular vein in
2. Treatment:pregnancy was timely terminated in 6 pregnant patients; 1 patient whose family
disagreed to terminate pregnancy aggravated and went back home. Ten patients accepted
heparinized anti-coagulation as soon as possible, and all of them got better when they were
discharged.
Conclusion When pregnant women had acute/subacute headache, epilepsy and other local signs,
the possibility of SCVT should be suspected. Abnormal parenchymal signals in draining area of
venous sinus (especially hemorrhagic infarction) could be a clue to diagnosis. Timely termination of
pregnancy and anti-coagulation could lead to a good prognosis.
