CEREBRAL VENOUS THROMBOSIS COMPLICATING HYPEREMESIS GRAVIDARUM RARE INCIDENCE REPORT OF 2 CASES

Abstract

Cerebral venous sinus thrombosis (CVT) is a rare life threatening condition. CVT occurred 10 to 13 times more often during puerperium than during pregnancy. Amongst all pregnant patients, CVT occurred more frequently in the  second and third trimesters. Overall mortality of patients with CVT is now thought to be about 10. Incidence of CVT during puerperium is 1 in 3000 deliveries and first trimester CVT being 1 in 100000 pregnancies. The most common  mechanism is the hypercoagulable state of pregnancy that is aggravated by dehydration as in our case. These are two rare and interesting condition of hyperemesis gravidarum complicated to CVT- as first trimester incidence of thrombosis is extremely rare. Severe dehydration should be considered in pregnant patients who present with bizarre neurological symptoms. 1. A 32 years old Primi gravida came to   Emergency department at 11 weeks gestational age with excessive vomiting for 10 days and inability to move her left upper and lower limbs for 1 day, she also had history of  headache for 1 month. She presented with tonic clonic    seizures at admission. 2. A 22 year old female presented to Emergency department at 8 weeks of pregnancy, this was her third pregnancy with previous one live child. She came with complaints of intense headache for past 1 week. She had history of hyperemesis for the past 15 days. Both the patient had hyperemesis and dehydration in common and their  investigations for connective tissue disorders and cardiac status were normal. There was no peripheral neurological deficit noted. Both had normal fundus examination. And MR Venogram brain showed CVT. Managed with anticoagulants and they gradually improved. The outcome of CVT remains largely unpredictable and so is the prognosis. It is not unusual to note deeply comatose or severely hemiplegic patients  recover dramatically, without any sequelae. Conversely,  patients presenting only with headache as the main   presenting complaint can suddenly deteriorate. Diagnosis can be confirmed by MR imaging in most cases. Early recognition of the condition and instigation of appropriate therapy  probably reduces mortality. Treatment of the cause with anticoagulation and monitoring of the response is highly  recommended.