Friday, June 17, 2011

POST-PARTUM CEREBRAL VENOUS THROMBOSIS (CVT)

POST-PARTUM CVT (CLOTTING OF BLOOD IN BRAIN VEINS)

Introduction

Pregnancy and delivery are normal physiological processes, which are experienced by more than 95% of women. Delivery and arrival of a newborn is a cause of joy and celebration all across the world. However, due to the normal physiological changes (and certain other factors), mothers in the post-natal period are prone to develop certain diseases. Cerebral venous thrombosis is one such major illness.

What happens in cerebral venous thrombosis?

Brain has two kinds of blood vessels- arteries that transport blood to the brain from the heart, and veins that drain the blood out of brain towards the lungs for purification. In CVT, blood in the brain veins clot (get thrombosed), which impedes the blood flow.

What are the clinical features of CVT?
  • Headache
  • Vomiting
  • Blurred vision, double vision, dimness of vision
  • Fits or convulsions
  • Weakness of hands or legs especially on one half of the body
Who are the women prone to develop cerebral venous thrombosis?

  • Women with severe blood loss during delivery- such as after caesarian section, etc.
  • Those who already had low hemoglobin (less than 10 gm%) before delivery
  • Women who are dehydrated- such as after prolonged labor, those who can't eat or drink properly after delivery, extreme weather conditions, etc. (In India, in certain cultures, women after delivery are kept isolated in a room, and they fast, which makes them dehydrated too)
  • Those with post-partum infections
  • Those with deficiency of anti-clotting factors (which increases the clotting tendencies)
How can CVT be diagnosed?

If any woman in post-natal period develops features suggestive of CVT (such as headache, drowsiness, seizures, weakness, visual problems, etc), they should immediately contact the neurologist.

CT scan or MRI scan with venography can be done within a few minutes and the diagnosis of CVT can be confidently made.

Further tests (blood tests) may be done to detect the reasons for blood clotting in the brain.

How is CVT treated?

1. Patients are started on hepain injections, which are anticoagulants, as early as possible. After a period of 5-7 days, they are changed over to oral anticoagulants (warfarin, etc), which may be required for 3-6 months.
2. Anti-epileptic drugs are used for those with fits.
3. Certain medicines (steroids, mannitol) are given to reduce the brain swelling.
4. Glucose and saline infusions are given to maintain hydration.
5. Anemia is corrected (blood transfusion may be required in more severe cases)
6. Any co-existing infections are treated.

What is the outcome of CVT after treatment?

Patients do very well and recover fast. Most women recover fully, without any neurological deficits. A minority may have seizures or mild weakness or other neuro deficits.

If you require any further information, please send me an email at drsudhirkumar@yahoo.com

DR. SUDHIR KUMAR MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
Phone- 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com

13 comments:

Anonymous said...

I recently was diagnosed with CVT when my son was 6 weeks old. I had what I believe they call a thunderclap headache and went to the ER. After a CT scan and an MRI, I was admitted to the hospital. The doctors attempted an angiography that was unsuccessful. They put me on heparin during my 13 night stay and I am now home and on warafin. I developed double vision while I was in the hospital and have had it for more than 3 weeks now. I am not on any steroids or anything to decrease the swelling of the brain. Do you think my vision will return to normal? If so, how long will that take?

Dr. Sudhir Kumar said...

Double vision in CVT is usually due to increased intra-cranial pressure-ICP- (when the sixth cranial nerve gets stretched). The evidence of raised ICP can be seen on MRI. Fundus examination by an ophthalmologist can also help (when it shows papilledema- swelling over the optic disc). Irrespective of the underlying cause, double vision generally improves over 6-8 weeks with proper medical treatment.

kb said...

Thank u very much doc for this helpful blog. I delivered my first child in feb 2010. 2 days later I had convulsions and post a MRI a clot was discovered in the occipital lobe. After medication I was fine and have been already taken off all medications for the same. My question is that whenever I plan a second pregnancy, will I be asked to take heparin injections every day during pregnancy and possible after? Is there any alternative to these horrifyingly painful injections? Maybe some oral medicine to control blood clotting?
Would be very grateful for ur comments, thanks.

kb said...

Hello Doctor, I was very happy to see this blog because I have suffered the same problem. After delivering my child through c-section, 2 days later I had a severe headache followed by multiple convulsions... On doing a MRI they discovered a blood clot in the occipital lobe in the brain. On administering medication I was fine immediately, and was on medication like aspirin and anti seizure medicines for almost a year. It's been 2.5 years since that episode. My question was that whenever I do plan a second issue, is it necessary to take heparin injections during and after pregnancy to avoid any such clotting problem to recur? They are such painful injections, are there any alternatives to it? Would be grateful for ur response. Thanks.

Dr. Sudhir Kumar said...

Thank you for your feedback. Recurrence of CVT in the subsequent pregancy(ies) is extremely rare. Therefore, there is no need for you to take heparin injections in the next pregnancy prophylactically. Oral medications like warfarin may have teratogenic effects on the foetus, hence, they should be avoided during pregnancy. Thrombophilia profile (including protein C, S and ATIII) should be tested in your case to determine if you have a risk of developing CVT in the future too. Dr SUDHIR KUMAR

Khush said...

Dear Doc, I have been a migraine patient before pregnancy. After birth the headache is increased due to lack of sleep. These days I suddenly feel so sleepy that there is pressure on my eyelids and they swell, I keep feeling dizzy and there is this constant dragging feeling. I sudddenly feel nervous and scared for nothing at all. Little things around start bothering me. The other day I felt as if my one leg just did not want to walk. My leg bones hurt. What do I do? I want to get up fresh, feel good. These days, I just want to go home and sleep. My baby is 10 mths 3 weeks old. Please advice...

Vidya Rangaraju said...

Dear Doc,

My sister had a pre-mature delivery, the baby was 1 month early as she had high BP. Post pregnancy, she had severe headaches, vomitings and was immediately admitted to the hospital. It was detected that she had CVT. Its been a week since diagnosis and she has difficulty in speaking certain words and recalling things from the past. PLEASE suggest how long it would take for her to get this distortion alright, we are really worried as she has to take care of her baby as well. Can you pl advice why is that and how long will it take for her to get back to normal..

Vidya Rangaraju said...

Dear Doc,

My sister had a pre-mature delivery, the baby was 1 month early as she had high BP. Post pregnancy, she had severe headaches, vomitings and was immediately admitted to the hospital. It was detected that she had CVT. Its been a week since diagnosis and she has difficulty in speaking certain words and recalling things from the past. PLEASE suggest how long it would take for her to get this distortion alright, we are really worried as she has to take care of her baby as well. Can you pl advice why is that and how long will it take for her to get back to normal..

Dr. Sudhir Kumar said...

Dear Vidya,

Thank you for sharing your sister's details. In CVT, clotting with or without hemorrhage (bleeding) occurs in certain parts of brain, causing problems in brain functions. If the clot occurs in left side of brain, one may have language dysfunction (such as word findig difficulty, problems in speaking, naming, reading, etc). These problems tend to resolve over time. I hope she would completely recover in a few weeks.

Dr Sudhir Kumar

Khushman Bhathena said...

Dear Doc, I have been a migraine patient before pregnancy. After birth the headache is increased due to lack of sleep. These days I suddenly feel so sleepy that there is pressure on my eyelids and they swell, I keep feeling dizzy and there is this constant dragging feeling. I sudddenly feel nervous and scared for nothing at all. Little things around start bothering me. The other day I felt as if my one leg just did not want to walk. My leg bones hurt. What do I do? I want to get up fresh, feel good. These days, I just want to go home and sleep. My baby is 10 mths 3 weeks old. Please advice...

Dr. Sudhir Kumar said...

Dear Khushman,

Thank you for sharing your details. You seem to suffering from aggravation of migraine. In addition, please ensure if your diet is adequate. Deficiency of vitamins, protein and calcium can contribute to your problems. Are you gettig adequate sleep at night? You may need to get your hemoglobin and thyroid functions checked.

Dr Sudhir Kumar

Anonymous said...

Yesterday i had an episode of complete body numbness, double vision, coldness, n confusion with muscle twitches. Could that be a cvt. Im currently at the hospital bout to undergo an mri n eeg. The doctor has a hunch that its a cvt. Im very scared because im very unsure n im scared the episode will come back n i have a some in the nicu im one week postpartum.

Anonymous said...

18 years ago I suffered a major stroke three weeks after my son was born I was 21, since then I have had 3 more clots arterial, dvt and another Venus. I am on life long heparin and have a incredibly complicated history with several life threatening issues. I am constantly in fear that my next round will be the last, I was diagnosed with saggy brain syndrome after 8 weeks in hospital numerous complications etc. I really need to find a reason and or figure out why it's only me in my family who suffers this way, I am left with memory, fatigue and chronic pain, I take more meds than my patients at times and I am a nurse, any advice