Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST), a condition which nowadays is treated non-operatively. Decompressive craniectomy is reserved only for emergency settings. We present a 22-year-old pregnant lady, who was transferred at the emergency department with a reduced level of consciousness, headache, and nuchal rigidity. Her MRI study showed CVST, causing hemorrhagic infarct and midline shift. She underwent decompressive craniectomy with partial removal of the hemorrhagic parenchyma. Remarkably, she recovered without any neurological deficits regardless of the substantial temporal lobe damage, while the thrombus nearly resolved using anticoagulation. Decompressive craniectomy can be life-saving in selected CVST patients, followed by anticoagulantion to augment the recanalization process.
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Conflict of interest
The authors declare that they have no conflict of interest. The patient has consented to the submission of the case report for submission to the journal.
De Sousa DA, Canhão P, Ferro JM (2016) Safety of pregnancy after cerebral venous thrombosis: a systematic review. Stroke 47:713–718CrossRefGoogle Scholar
Duman T, Uluduz D, Midi I, Bektas H, Kablan Y, Goksel BK et al (2017) A multicenter study of 1144 patients with cerebral venous thrombosis: the VENOST study. J Stroke Cerebrovasc Dis 26:1848–1857CrossRefPubMedGoogle Scholar
Ebke M, Jürgens KU, Tomandl B, Merten U, Kastrup A (2011) Surgical treatment of space occupying edema and hemorrhage due to cerebral venous thombosis during pregnancy. Neurocrit Care 15:166–169CrossRefPubMedGoogle Scholar
Ferro JM, Canhão P (2014) Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep 16:523CrossRefPubMedGoogle Scholar
Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F et al (2017) European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology. Eur Stroke J 2:195–221CrossRefPubMedPubMedCentralGoogle Scholar
Kashkoush A, Ma H, Agarwal N, Panczykowsky D, Tonetti D, Weiner GM et al (2017) Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review. J Clin Neurosci 39:9–15CrossRefPubMedGoogle Scholar
Ruiz-Sandoval JL, Chiquete E, Bañuelos-Becerra LJ, Torres-Anguiano C, González-Padilla C, Arauz A et al (2012) Cerebral venous thrombosis in a Mexican multicenter registry of acute cerebrovascular disease: the RENAMEVASC study. J Stroke Cerebrovasc Dis 21:395–400CrossRefPubMedGoogle Scholar
Saposnik G, Barinagarrementeria F, BrownJr RD, Bushnell CD, Cucchiara B, Cushman M et al (2011) Diagnosis and management of cerebral venous thrombosis. Stroke 42:879CrossRefGoogle Scholar
Swartz RH, Cayley ML, Foley N, Ladhani NN, Leffert L, Bushnell C et al (2017) The incidence of pregnancy-related stroke: a systematic review and meta-analysis. Int J Stroke 12:687–697CrossRefPubMedGoogle Scholar
Yamamoto J, Kakeda S, Takahashi M, Idei M, Nakano Y, Soejima Y et al (2013) Severe subarachnoid hemorrhage associated with cerebral venous thrombosis in early pregnancy: a case report. J Emerg Med 45:849–855CrossRefPubMedGoogle Scholar