Highlights
- •Review of 58 cases of cerebral venous sinus thrombosis (CVST) after neuraxial block.
- •Accidental dural puncture (ADP) in 40%; post-dural puncture headache (PDPH) in 79%.
- •A change in nature of headache is a key red-flag symptom of CVST.
- •The reported incidence of ADP and PDPH lend support to their association with CVST.
- •Therapeutic anticoagulation with multidisciplinary input is mainstay of management.
Abstract
Background
Cerebral venous sinus thrombosis (CVST) is a rare complication of pregnancy. It usually
presents with a headache and may mimic a post-dural puncture headache (PDPH) in women
who receive a neuraxial block.
Methods
Medline, CINAHL and EMBASE databases were searched to identify postpartum cases of
CVST following neuraxial block. The aim was to delineate the characteristics, presentation,
investigations, and outcomes of postpartum women who presented with CVST.
Results
Forty-nine articles with 58 case reports were identified. Forty-two women (72.4%)
had an epidural attempted whilst 16 women (27.6%) received a spinal anaesthetic. Accidental
dural puncture (ADP) was reported in 17 women (40.5%). Headache was the presenting
symptom in 57 women (98.3%); 26 women (44.8%) also experienced seizures. Post-dural
puncture headache was reported in 46 (79.3%) and an epidural blood patch was performed
in 26 women (44.8%). Superior sagittal sinus, transverse sinus, and cortical veins
were the most common sites of thrombosis. The median time to diagnosis was 6.5 days
from delivery. Magnetic resonance imaging was the most common diagnostic neuro-imaging
modality. Full neurological recovery was reported in 48 (82.8%), whilst neurological
deficits were reported in six (10.3%) women.
Discussion
The diagnosis of CVST may be overlooked in women who present with headache following
neuraxial block. A change in character of headache with loss of postural element,
and focal neurological signs are the key clinical features that could help anaesthetists
differentiate headache of CVST from PDPH. The high reported rates of ADP and PDPH
lend support to their possible association with CVST.
Keywords
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Article info
Publication history
Published online: September 15, 2021
Accepted:
September 6,
2021
Identification
Copyright
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