December 2016 · Volume 5 · Issue 12 Page 4095 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Marwah S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Dec;5(12):4095-4098 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Review Article Diagnosis and management of obstetric cerebral venous thrombosis: a stringent challenge Sheeba Marwah 1 *, Ritin Mohindra 2 INTRODUCTION Thrombosis of cerebral veins and sinuses is a distinct stroke, mostly afflicting young middle aged population with female to male ratio being 3: 1. 1 It is responsible for 0.5% of all stroke cases in developed countries, whereas in developing realms like India it contributes 10-17% of all cases. 2,3 Pregnancy and puerperium account for 20% of CVT cases in Indian population accounting for 4.5/1000 obstetric admissions and 1/250 deliveries. 2,4 In the pre-antibiotic era post-infective CVT was more prevalent, whereas nowadays aseptic CVT is more frequent. 5 The precise incidence of this ailment is not known because of dearth of available scientifically intended epidemiological studies in the literature. However its prevalence is much less when contrasted with arterial stroke. ETIOLOGY More than 100 causes of CVT have been expounded in literature. 2,4-6 However, despite of extensive investigations, the cause may be elusive in up to 20-25% of patients. 6 Currently, infective causes account for less than 10% of patients, while inherited pro-thrombotic tendencies account for 10-15% of cases. 2,7 Pregnancy and puerperium have long been recognized as periods of increased susceptibility. 7-11 Significantly increased risk has been associated with caesarean delivery, increased maternal age, hyperemesis, inter-current infection and maternal hypertension. Increased risk during pregnancy and puerperium is due to a hypercoagulable state caused by increased levels of fibrinogen, Factors VII, VIII and X, Diminution in inhibitors of Protein S coagulant, Increase in inhibitors of Protein C level, increased ability to neutralize Heparin. 10-14 Also oral contraceptive pills 1 Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi 110029, India 2 Department of Medicine, VMMC and Safdarjung Hospital, New Delhi 110029, India Received: 23 October 2016 Accepted: 20 November 2016 *Correspondence: Dr. Sheeba Marwah, E-mail: sheebamarwah@yahoo.co.in Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Cerebral venous thrombosis is an uncommon but serious neurologic disorder in young adults with a peculiarly high preponderance for females. Diagnosis is frequently overlooked or deferred due to its subacute or lingering onset and the wide spectrum of clinical symptoms. Headache is the most frequent symptom occurring in up to 95% of all cases. One must consider stroke in all cases of neurological deterioration in pregnancy and puerperium. Imaging plays a primary role in diagnosis with magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) having proven to be the best both for diagnosis and follow-up of these women. Current therapeutic measures used include the utilization of anticoagulants such as dose-adjusted intravenous heparin or body weight adjusted subcutaneous low-molecular-weight heparin (LMWH), the use of thrombolysis and symptomatic therapy including control of seizures and elevated intracranial pressure. Recurrence in future pregnancy is usually low. Keywords: Cerebral venous thrombosis, Management, Pregnancy, Puerperium, Stroke DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20164310