Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases

Abstract

Background and purpose: Cerebral venous thrombosis is characterized by its clinical pleomorphism and pathogenetic variability. We studied 67 patients with cerebral venous thrombosis associated with pregnancy and puerperium and compared them with 46 other cases unrelated to obstetric causes to disclose differences in their clinical presentation, neuroradiological findings, clinical course, and prognosis.

Methods: In this retrospective study, we analyzed the clinical, laboratory, and neuroimaging findings of 113 patients collected consecutively at our institute. The diagnosis of cerebral venous thrombosis was confirmed by angiography, magnetic resonance imaging, or neuropathological study.

Results: Patients with cerebral venous thrombosis associated with pregnancy and puerperium were younger (average age, 26 versus 36 years), and in most, the onset of symptoms was acute (82% versus 54%; P = .003). The evolution of symptoms reached a plateau within 10 days in 70% of patients with thrombosis from obstetric causes, compared with only 45% in those from other causes (P = .01). Anemia was more frequent in the obstetric group (64% versus 26%; P = .00001). There were no differences regarding neurological and neuroradiological findings. Although the initial severity of illness was similar in both groups, the final outcome was considered good in 80% of patients with obstetric causes, compared with 58% of patients with other causes (P = .01); mortality rates were 9% and 33%, respectively (P = .002).

Conclusions: Cerebral venous thrombosis associated with pregnancy and puerperium has a more acute onset and a better prognosis than thrombosis due to other causes. These findings might be helpful in the diagnostic and therapeutic strategies for patients with cerebral venous thrombosis.