Case A twenty year primigravida with uneventful antenatal period presented at 30 weeks gestation with unilateral headache. Her BP varied from 140/90mmHg to 160/110mmHg and had urinary protein of 0.32g/24 hrs and, blood tests were normal. Ultrasound scan showed growth restricted baby with reduced umbilical artery end diastolic flow and oligohydramnios.
Patient continued to have headache, and developed blurring of vision and paraesthesia in both lower limbs over a period of one week. A CT scan with venogram was performed which revealed a large superior sagittal sinus thrombosis extending into the right transverse and sigmoid sinus. Patient was started on therapeutic enoxaparin for antihypertensive, betamethasone for fetal lung maturity and both mother and baby were closely monitored. Baby was delivered at 34 weeks by caesarean section under spinal anaesthesia. Postnataly, patient developed severe pre-eclampsia. She recovered well and was discharged home after 5 days. On the follow-up she had no residual complication and CT venogram showed complete resolution of the thrombus and thrombophilia screen was negative.
Conclusions CVST in pregnancy can present with subtle clinical signs and symptoms. They may mimic common symptoms of pregnancy and preeclampsia leading to delay in the diagnosis. Seeking neurology review for all patients with headache and visual disturbances is not practicable. However, lesson from this case is that when symptoms are persisting and evolving overtime and do not fit well with other diagnostic criteria of severe pre-eclampsia or other obvious diagnosis, neurologist should be involved and neuroimaging should be performed.
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