Cerebral Venous Thrombosis: A Complicated Anaesthetic Scenario for Caesarean Section Karan Pratap Singh Panaych 1* , Amarjyoti Hazarika 1 , Hemant Bhagat 1 and Anjana Verma 2 1 Post Graduate Institute of Medical Education and Research, Chandigarh, India 2 Indira Gandhi Medical College, Shimla, India * Corresponding author: Karan Pratap Singh Panaych, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India, Tel: +917411263255; E-mail: kpsp15@gmail.com Received date: June 16, 2016; Accepted date: September 12, 2016; Published date: September 19, 2016 Copyright: © 2016 Panaych KPS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Cerebral venous thrombosis is a rare cerebrovascular disease and causes 0.5% of all strokes. Headache is one of the usual symptoms along with nausea, vomiting and seizures which are lesser common. Focal neurological deficits may also occur. Both genetic and acquired conditions may predispose to cerebral venous thrombosis. Management of a caesarean section in this situation poses significant anaesthetic challenges in view of anticoagulation, haemodynamic stability, and neurological outcomes. We present a case of a 30 year old lady who was primigravida associated with cerebral venous thrombosis posted for caesarean section. Keywords: Cerebral venous thrombosis; Spinal anaesthesia; Casarean section Introduction Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular disease that can occur at any age and is responsible for 0.5% of all strokes [1]. Isolated headache without focal neurological fndings or papilledema occurs in approximately 25% of patients with CVT which leads to confusion in its clinical diagnosis [2]. Focal or generalized seizures can also occur in these patients [3]. Comorbid conditions (eg: thrombophilias, infammatory bowel disease), transient physiological changes (egpregnancy, dehydration), medications such as oral contraceptives, substance abuse, and events such as head trauma are some predisposing conditions in addition to Virchow’s triad [3]. Both genetic and acquired prothrombotic conditions can contribute to CVT [4]. We aimed to fnd out the safety of spinal anaesthesia as an alternative to general anaesthesia for caesarean section in haemodynamically stable patients with timely recognized cerebral venous thrombosis. Case Report A primigravida of 30 years old at 37 weeks of gestation was admitted to our hospital for elective caesarean section (CS). Prior exposure to anaesthesia was a diagnostic laparoscopy for endometriosis two years earlier. She had regular antenatal check-ups during the frst two trimesters which were uneventful. However in the third trimester she complained of headache which was continuous in nature, unilateral and lasted for fve to six days. She had no complaints of altered consciousness, altered vision, nausea, vomiting or seizures. As per advice by the neurologist she underwent an MRI which showed a right transverse sinus and superior sagittal sinus thrombosis (Figures 1 and 2). Figure 1: (MRI Transverse)-MRI Angiogram in transverse plane showing right transverse sinus thrombosis. Accordingly she was started on enoxaparin (low molecular weight heparin) (LMWH) 60 mg subcutaneous (SC) twice daily. Tree days prior to CS, enoxaparin was changed to unfractionated heparin 5000 units SC twice daily. On the day of surgery afer confrming her fasting status and laboratory investigations (Hb-12.4 g%, Plt-252000 c/mm 3 , TLC-8000 c/mm 3 , APTT-22.9 seconds, INR-1.24) she was shifed into the operating room. Standard ASA monitoring was done along with real time arterial blood pressure monitoring. Spinal anaesthesia was given using 10 mg of hyperbaric bupivacaine via a 26 G Quinke Babcock needle. Vitals were monitored throughout the procedure which was stable. A healthy male baby was born with an Apgar score of 9/10. Te surgery lasted approximately one hour and was uneventful. Post- surgery strict monitoring for any neurological signs like headache, change in consciousness level was done. However there were no such complaints. Enoxaparin was restarted 24 hours afer surgery. Panaych et al., J Anesth Clin Res 2016, 7:9 DOI: 10.4172/2155-6148.1000661 Case Report Open Access J Anesth Clin Res, an open access journal ISSN:2155-6148 Volume 7 • Issue 9 • 1000661 J o u r n a l o f A n e s t h e s i a & C l i n i c a l R e s e a r c h ISSN: 2155-6148 Journal of Anesthesia & Clinical Research