ANTEPARTUM CEREBRAL VENOUS THROMBOSIS (APCVT): OUTCOMES IN A HOSPITAL-BASED COHORT FROM INDIA

Abstract

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon but important cause of stroke in young women due to acquired or inherited hypercoagulable state. CVST occurring during antenatal period can affect foeto-maternal outcome. Data focusing specifically on antepartum CVST remain limited. Objectives: To evaluate clinical profile, radiological pattern, treatment, and long-term outcome of antepartum CVST. Methods: Pregnant women with radiologically confirmed antepartum CVST were included from the teaching hospital based CVST registry. Information collected included demographic profile, gravida status, duration of pregnancy, hospital stay, clinical and laboratory data, neuroimaging findings, treatment details, outcome at discharge and follow-up. Results: Fifteen women with antepartum CVST (mean 25.87; SD 3.7 years) were included from the CVST registry. CVST onset was during first trimester in majority (86.67%). Presenting symptoms included headache (93.33%), seizures (73.33%) focal neurological deficits (66.66%), and impaired consciousness (40.0%). Fourteen patients had venous infarction (superficial venous territory 12, deep venous territory 1, combined 1). Five patients including the two women who required decompressive craniectomy successfully continued the pregnancy on heparin therapy followed by warfarin. Eight women opted for medical termination of pregnancy. Two patients succumbed and excellent outcome was observed in 6 patients at discharge, 10 patients at three months and 11 patients at last follow-up. Conclusion: Antepartum CVST was most common during first trimester in our cohort with excellent long-term outcome in most. Majority of the women opted for termination of pregnancy due to concerns of disease outcome, need for prolonged parenteral anticoagulation. Decompressive craniectomy had beneficial effect.