Dilshath, S (2011) Critical analysis of causes and course of cerebral venous thrombosis in pregnancy and puerperium. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: Women in pregnancy or puerperium can suffer from several neurological disorders but a few of them can occur or deteriorate because of pregnancy. The classic cerebrovascular accident during pregnancy and puerperium is cerebral venous thrombosis. Primary cerebral venous thrombosis occurs in puerperium in young women and is a major cause of stroke in young females in India. Puerperal CVT is 10-12 times more common in India compared to west and accounts for 10-12% cases of stroke in young with CT / MRI evidence of haemorrhagic or ischemic infarcts in brain. Puerperal CVT is primary in contrast to the secondary CVT seen both in men and women after brain injury, infections, metastatic and non metastatic lesions. Mortality could be high in CVT 10-30% but with supportive, symptomatic as well as specific therapy with heparin, mortality has been reduced and in most of the cases, recovery is excellent without any residual disability. AIM OF THE STUDY: The aims of the study are: a) To find out the incidence of cerebral venous thrombosis at Government Rajaji Hospital, Madurai. b) To analyse the symptoms, causes, course, prognosis, morbidity and mortality in cerebral venous thrombosis. c) To study the importance of early diagnosis and early introduction of planned therapy. MATERIALS AND METHODS: This prospective study was under taken at Government Rajaji Hospital attached to Madurai Medical College, Madurai during the period of October 2009 – October 2010. During this period our hospital has recorded13,164 obstetric admissions. 52 consecutive patients admitted with impairment of consciousness, seizures or focal neurological deficit were evaluated. The inclusion criteria for the patients : Following criteria were utilized in selecting patients for this study. Antenatal or postnatal patients admitted with complaints of 1. Headache, 2. Impaired consciousness, 3. Seizures, 4. Focal neurological deficit. The exclusion criteria for the patients The following patients were excluded from the study 1. Known epileptic patients, 2. Post partum eclampsia (Occurrence of illness within 48 hours of delivery and absence of focal neurological deficits.), 3. CNS infection, 4. Head injury. SUMMARY: 1. The incidence of CVT in Government Rajaji Hospital, Madurai is 3.9 per 1000 obstetric admissions. 2. The rural population (66.7%) was affected more than the urban population(33.33%), the ratio of the affected rural to urban population being 2 : 1. 3. 73% of cases belonged to the low socio economic group. 4. The age incidence varied 18-35 years. The maximum age incidence (77%) was in the III decade. 5. The disease is more common in multiparous (55.7%) than primiparous(44.3%) women. 6. 61.5% of cases occured in the first two weeks of puerperium. This observation favours the fact that the disease is due to hypercoaguability of blood and the maximum coaguability of blood is seen during the first 10 postpartum days. 7. 62.5% of cases were seen after full term normal delivery. 8. The occurrence of the disease was less with institutional deliveries indicating that the disease is common where proper asepsis is not observed. 9. Fatal cases tend to be deeply unconscious from the onset, had extensive paralysis and numerous fits. 10. Those with parenchymal involvement, thrombophilia, APLAS had greater risk to be left with neurological sequelae. 11. MRI and MRA/MRV is used as first line diagnostic tool in cases of high clinical suspicion. 12. Heparin reduces the mortality and residual disability. 13. Corticosteroids are beneficial by ameliorating the symptomatology since they reduce the vasogenic oedema. 14. Mortality is as high as 15%. CONCLUSION: 1. Primary cerebral venous thrombosis occurs in puerperium in young women and is a major cause of stroke in young females. 2. Apart from hypercoagulable state, anaemia, lack of aseptic precautions during delivery and prolonged dehydration after delivery are the major causative factors. 3. MRI / MRA / MRV has revolutionized neuro diagnosis and has a firmly established place in the early diagnosis of CVT. 4. Early initiation of specific treatment with heparin helps to avoid mortality in most cases resulting in excellent recovery without any residual disability.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Critical analysis ; causes and course ; cerebral venous thrombosis ; pregnancy ; puerperium. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 05 Dec 2017 02:09 |
| Last Modified: | 05 Dec 2017 02:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4250 |
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