Sagittal sinus thrombosis in pregnancy: A case report

Cerebral venous sinus thrombosis (CVST) is a rare but serious cause of maternal morbidity. It most frequently occurs during late pregnancy and puerperium, and occurs due to pregnancy-induced hypercoagulability. The present report documents a 37-year-old multiparous woman diagnosed with acute superior sagittal sinus thrombosis involving multiple dural sinuses at 6 weeks gestation. The patient was managed with therapeutic low-molecular-weight heparin (enoxaparin 100 mg twice daily) under multidisciplinary supervision throughout pregnancy; at 33 weeks, recurrent headaches and vomiting occurred, but imaging showed no new thrombosis. Delivery by elective cesarean section at 38 weeks resulted in a healthy neonate. Postpartum anticoagulation was transitioned to apixaban for 3 months with complete neurological recovery. Early diagnosis, appropriate anticoagulation and multidisciplinary management are key to favorable maternal and fetal outcomes in CVST during pregnancy. The present case report contributes to the literature that sagittal sinus thrombosis can present in early pregnancy with symptoms, such as headache and vomiting, which overlap with the normal symptoms of pregnancy; therefore, a high index of suspicion should be kept in mind.