Cerebral venous thrombosis in Saudi Arabia. Clinical variables, response to treatment, and outcome

To investigate cerebral venous thrombosis [CVT] clinical presentations, risk factors, and response to treatment in Saudi Arabia. Retrospective analysis of the King Fahad Medical City, Riyadh, acute stroke database from April 2005 through February 2008 revealed 22 patients with CVT. Hypercoagulable work-up and neuroimaging were performed. Sixteen patients were female [72.7%], and the median age was 35 years. Clinical presentations included: headache [77.3%], seizures [54.5%], focal neurological signs [54.5%], and decreased level of consciousness [50%]. Over two-thirds [n=11; 69%] of female patients had a history of oral contraceptive use, which was the most common risk factor. Protein S deficiency [n=3], antiphospholipid antibody syndrome secondary to systemic lupus erythematosus [SLE] [n=1], rhinocerebral mucormycosis [n=1], leukemia [n=1], non-Hodgkin's lymphoma [n=1], sepsis [n=1], and unknown [n=6] were causes. Affected areas included superior sagittal [n=13], transverse [n=16], sigmoid [n=14], straight [n=6] and cavernous sinus [n=1]; internal cerebral vein [n=2]; vein of Galen [n=3]; cortical veins [n=10]; and internal jugular vein [n=12]. Two patients had quadriparesis, and 2 patients died. The remainder [n=18, 81.8%] improved. Bilateral hemorrhagic presentation or venous infarction, deep venous system thrombosis, and underlying malignancy had less favorable results. Presentations in our series were similar to those in other reports, although altered consciousness and seizures were more common, Cortical vein involvement was also higher than commonly reported. Oral contraceptive use was a primary risk factor in female patients. Outcomes were favorable in 81.8% of patients

unusual presentation of postpartum ovarian vein thrombosis

Ovarian vein thrombosis is a rare but potentially serious complication following childbirth. The majority of patients present during the first week postpartum, with fever and right lower quadrant abdominal pain. We report an unusual case of postpartum ovarian vein thrombosis who presented with fever, low backache, and painful thighs. A high index of suspicion is crucial to diagnose and treat this condition in order to avoid serious consequences