25-09-2024 | Intracranial Hypertension | Lessons Learned
A Serious Headache: Lessons Learned from the Management of Pregnancy-Associated Venous Sinus Thrombosis in a Region with Limited Abortion Access
Published in: Neurocritical Care
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A 23-year-old woman presented to the emergency department after being found unresponsive by family. On arrival she was intubated for poor Glasgow Coma Scale (GCS). The family reported that she had suffered a week of frequent vomiting and several days of severe headache. An emergent noncontrast head computed tomography (CT) scan demonstrated severe cerebral edema (Fig. 1a); a hyperdense signal within the interhemispheric fissure, concerning for acute superior sagittal sinus thrombus (Fig. 1a); and a left cerebellar hemorrhage (Fig. 1b). A CT venogram confirmed extensive cerebral venous sinus thrombosis (CVST) (Fig. 1c).
Fig. 1
Noncontrasted head computed tomography (CT) scan demonstrating a hyperdense “cord” sign (arrow) in the superior sagittal sinus (a) and lower section demonstrating the concurrently present intraparenchymal hemorrhage in the left cerebellar lobe (b). CT venogram demonstrating lack of opacification of the superior sagittal sinus with contrast, the “empty-delta” sign, which confirmed extensive thrombus (c). The repeat head CT scan completed 24 h later, prior to suboccipital craniectomy, demonstrating worsening cerebellar hemorrhage, obliteration of the cerebral aqueduct, and evolving hydrocephalus (d)
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