CEREBRAL VENOUS

THROMBOSIS (CVT)

Dr.T. Lavanya
 31 Years female P2 L2, 21st postnatal day (normal delivery)
thrown 5 episode of seizure since morning.
 H/O presenting illness

 Generalized Tonic colonic seizures 5 episodes since morning.

 Each Lasted for 1 min 30 sec ,interval between seizure 45 min

to 60 min.
 Associated Post ictal confusion present.

 H/o vomiting one episode present

 H/o 3 days severe headache most on right side frontal region

 No history of neck stiffness and fever and bowel & bladder

incontinence.
 Marital history; 6yrs, Ncm
 Obs. H/o

1st pregnancy: Boy, 5yrs, normal vaginal delivery birth

wt. 3kg ,no pregnancy complication baby alive and healthy.
2nd pregnancy: 1st and 2st trimester unevenful.
3rd trimester; she was diagnosed gestational hypertension at
38wks.
In view of gestation hypertension induction done. alive Boy baby
delivered Normal vaginal delivery on 1/12/2018. post partum mild
PPH managed with medical treatment. No H/o blood transfusion.
Post natal period: she was not taking adequate fluids,
H/o prolong immobilization. Post natal follow up, her Blood
pressure was normal
 Past H/o: She was hypothyroid on thyroxin 50mcg.
No h/o seizure episode in the past, DM/HT/Heart
disease, bronchial asthma, kidney disease.
 Family History: Both mother and father have diabetes,
hypertension.
 Personal history: Bladder and bowel habit normal
General Examination:
Conscious, confused GCS E2V3M5, PERL+, 3mm, move all limbs
mild pallor, no pedal edema, no cyanosis, no clubbing
vitals 150/100 mmHg, PR-98/min. RR-20/min, Tem - 98.4F
Systemic examination: Normal
Abdominal examination: No visible abdominal distention
Palpation: soft, no tenderness, no organomegaly
Pervaginal examination: normal, lochia healthy.
 Diagnosis: 32 yrs para 2 live 2, 21 post natal day (normal vaginal
delivery) with H/o of hypothyroid with post partum seizure.
DD FOR POSTPARTUM SEIZURE

 Post partum eclampsia

 Epilepsy

 Hypertensive encephalopathy

 Cerebral vascular occlusion

 Cerebral venous thrombosis

 Meningitis

 Encephalitis
INVESTIGATION:

 MRI: Acute thrombosis in the right transverse and sigmoid sinus. Right
internal jugular vein and posterior aspect of straight sinus.
 PT and APTT - Normal
 Protein C, protein s - Normal
 Trombo profile normal
 Factor v leiden mutation – Negative
 Homocysteine – Normal level.
 ECHO – NORMAL

DIAGNOSIS

 Cerebral venous thrombosis

CEREBRAL VENOUS THROMBOSIS
 Thrombosis of dural sinus and cerebral veins
 5 to 8 per 1 million population

 Female 61%CVT in 20 to 35 yrs

 0.5 to 1% of stroke

 50 % of stroke during pregnancy and puerperium.

 Risk factors

 In herited thrombophilia

Factor v leiden mutation, prothrombin gene mutation,protein c,s deficiency,

anti thrombin deficiency, homocysteinemia, dysfibrogenemia.
 Acquired disorder

Malignancy,surgery,trauma,pregnancy,ocp,APLA,CHF,Nephrotic
syndrome,multiple myeloma
THANK YOU