Successful management of an extensive intracranial sinus thrombosis in a patient undergoing IVF: case report and review of literature.
OBJECTIVE
To report a successfully managed case of extensive intracranial sinus thrombosis that occurred during an IVF cycle, and to review the literature.


METHODS
Case report and review of literature.


METHODS
University-affiliated teaching hospital.


METHODS
A 38-year-old nulliparous woman who developed severe ovarian hyperstimulation syndrome on luteal day (LD) 5 during an IVF cycle. Hemoconcentration was corrected, ascitis drained, and heparin prophylaxis started. On LD7, the patient complained of severe headache and neck pain. A magnetic resonance imaging (MRI) study of the head showed extensive cortical vein and dural sinus thrombosis, including the superior sagittal sinus and transverse sinuses.


METHODS
The patient was fully heparinized using low-molecular-weight heparin. On LD15 she was discharged home on warfarin, after confirming a negative pregnancy test. Complete thrombophilia work-up was negative.


METHODS
Clinical outcome.


RESULTS
Repeat MRI 2 months later revealed patent superior sagittal sinus and transverse sinuses, unremarkable cortical veins, and no evidence of flow obstruction. The patient was asymptomatic, with no neurologic sequelae.


CONCLUSIONS
Extensive intracranial sinus thrombosis in women undergoing IVF may present with minimal symptoms and can occur in the absence of pregnancy and thrombophilia and despite heparin prophylaxis and correction of hemoconcentration. Medical management was successful and left the patient with no neurologic sequelae.
Edris
Fawaz
F
Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada. fawazedris@yahoo.ca <fawazedris@yahoo.ca>
Kerner
Cecelia M
CM
Feyles
Valter
V
Leung
Andrew
A
Power
Stephen
S
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005307:Fertilization in Vitro; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D020767:Intracranial Thrombosis / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D016896:Treatment Outcome
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight