An Observational Analysis of Clinical Presentation and Prognosis in Pregnancy-Related Cerebral Venous Sinus Thrombosis

A J Thompson; R Patel; E M O’Connell; S Iqbal; L K Bennett

Authors

A J Thompson Department of Clinical Neuroscience, King’s College London, London WC2R 2LS, UK Author
R Patel Department of Clinical Neuroscience, King’s College London, London WC2R 2LS, UK Author
E M O’Connell Neuroimmunology Unit, University College London Hospitals NHS Foundation Trust, London WC1E 6AU, UK Author
S Iqbal Neuroimmunology Unit, University College London Hospitals NHS Foundation Trust, London WC1E 6AU, UK Author
L K Bennett Department of Clinical Neuroscience, King’s College London, London WC2R 2LS, UK Author

Keywords:

Venous Sinus Thrombosis, CVST , puerperal period

Abstract

Background: Cerebral venous sinus thrombosis (CVST) represents an uncommon yet severe vascular complication associated with pregnancy and the puerperium, presenting with diverse clinical manifestations. Limited data are available regarding its prognostic indicators during the acute phase, as well as outcomes of subsequent pregnancies and recurrence risk. This study aimed to evaluate the clinical characteristics and prognosis of pregnancy-related CVST in a Chinese population.

Methods: Clinical records of 41 women diagnosed with CVST during pregnancy or the puerperal period between January 2007 and March 2018 at Shengjing Hospital were retrospectively reviewed. A poor outcome was defined as a modified Rankin Scale (mRS) score ≥3 at discharge. Independent prognostic factors were determined using multivariate logistic regression analysis. Follow-up outpatient interviews were conducted to assess future pregnancy outcomes and CVST recurrence.

Results: The incidence of CVST was approximately 2.4 times higher during the puerperium (29 cases) compared to pregnancy (12 cases). Headache was the most frequent presenting symptom (90%), followed by focal neurological deficits (61%), seizures (59%), visual disturbances (37%), and altered consciousness (29%). Multivariate analysis identified elevated D-dimer levels (>1134 µg/L; OR=18.67, 95% CI: 1.79–194.84) and impaired consciousness (OR=33.85, 95% CI: 3.14–365.45) as independent predictors of poor outcomes during the acute phase. Long-term follow-up was completed for 28 patients (68%). Three women experienced multiple pregnancies (six in total), though none resulted in childbirth. One patient experienced CVST recurrence three years later, unrelated to pregnancy or puerperium.

Conclusions: CVST occurred predominantly during the puerperium. Elevated D-dimer levels above 1134 µg/L and impaired consciousness were strong indicators of poor prognosis. The rates of subsequent pregnancy and CVST recurrence were low among this cohort of Chinese women.