Postpartum superior sagittal, left transverse sinus and right internal jugular vein thrombosis with left parietal infarct: A case report

Abstract

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.

Keywords: Cerebral infarction; Cerebral venous sinus thrombosis; Internal jugular vein; Postpartum thrombosis; Superior sagittal; Transverse sinus thrombosis.

Fig. 1

Hyperintense signals are noted in cortical and adjacent subcortical area of left parietal lobe with corresponding diffusion restriction on ADC suggestive of infarct. Note that the same area has hyperintense signals on T1 suggesting hemorrhagic nature of infarct.

Fig. 2

MRV-TOF coronal images showing flow voids in superior sagittal sinus, left transverse sinus and right internal jugular vein as indicated by arrow, suggestive of cerebral venous thrombosis.