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?
- Blurred vision, double vision, dimness of vision
- Fits or convulsions
- Weakness of hands or legs especially on one half of the body
- 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)
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.
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DR. SUDHIR KUMAR MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad