title: Cerebral venous sinus thrombosis in pregnancy and puerperium: A pooled, systematic review.
abstract: Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST); however studies describing diagnosis and management in this population are limited. The objective of this study was to amalgamate published case reports and series regarding diagnosis and management of CVST in pregnancy and puerperium. Searches of PubMed and the Cochrane library were performed using search terms "pregnancy"/"puerperium" and "sinus occlusion"/"sinus thrombosis". Studies were included in our pooled analysis if they included individual patient symptoms, management approach and follow-up condition. Multivariate regression was utilized to assess the effect of non-modifiable factors on excellent outcome (mRS 0). Sixty-six patients were included. Mean duration of symptom onset to diagnosis was 5.9days (95% CI 4.2-7.6). Clot involvement of the superior sagittal sinus was seen in 67% of cases, the transverse/sigmoid in 64% and of the deep venous system in 15% of cases. Management approaches included anticoagulation (91% of patients), IA (intra-arterial) thrombolysis alone (26%), and IA thrombectomy with IA thrombolysis (8%). Fifty-nine percent of patients were mRS 0 at follow-up; 94% were mRS 0-2. Presentation with headache alone was associated with excellent outcome on multivariate analysis (p=0.04); coma/obtundation predicted against excellent outcome (p=0.03). As compared to IA thrombolysis alone, patients undergoing IA thrombolysis with IA thrombectomy demonstrated a trend toward better outcome (p=0.10).
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: aik8@pitt.edu.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Kashkoush
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: hem53@pitt.edu.
authors.forename: Henry
authors.initials: H
authors.lastname: Ma
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: agarwaln@upmc.edu.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: panczykowskidm@upmc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Panczykowski
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: tonettida@upmc.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tonetti
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: weinergm@upmc.edu.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Weiner
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: areswj@upmc.edu.
authors.forename: William
authors.initials: W
authors.lastname: Ares
authors.affiliation: Department of Neurology, 811 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address: kenmuircl@upmc.edu.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kenmuir
authors.affiliation: Department of Neurology, 811 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address: jadhavap@upmc.edu.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Jadhav
authors.affiliation: Department of Neurology, 811 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address: jovitg@upmc.edu.
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.affiliation: Department of Neurological Surgery, UPMC, Suite B-400, 200 Lothrop St., Pittsburgh, PA 15213, USA. Electronic address: jankbt@upmc.edu.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Jankowitz
authors.affiliation: Department of Neurology, 811 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address: grossb2@upmc.edu.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
mesh_terms: D000328:Adult; D003128:Coma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D017131:Thrombectomy / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Cerebral venous sinus thrombosis; Endovascular; Pregnancy; Sinus thrombosis; Stroke; Thrombectomy