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Postpartum cerebral venous sinus thrombosis — SCE Acute Medicine MCQ

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HardNeurology and ophthalmologyPostpartum cerebral venous sinus thrombosisSCE Acute Medicine

A 32-year-old woman 2 weeks postpartum presents with severe headache, vomiting and a focal seizure. CT head shows a small parasagittal haemorrhagic infarct; platelet count is normal and blood pressure is 128/74 mmHg. MR venography shows absent flow in the superior sagittal sinus. What is the most appropriate next step in management?

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Correct answer: E — Start therapeutic anticoagulation unless a clear contraindication exists

Cerebral venous sinus thrombosis is treated with therapeutic anticoagulation even when venous haemorrhagic infarction is present, unless there is a specific contraindication. Antiplatelet therapy is inadequate. Postpartum state and parasagittal haemorrhagic infarction are important clues.

Reference: European Stroke Organisation guideline on cerebral venous thrombosis; RCOG thromboembolism guidance