Previous Cerebral Venous Sinus Thrombosis in Pregnancy: Clinical Challenges and Outcomes - A Case Report

Cerebral venous sinus thrombosis (CVST) is a rare vascular disorder caused by partial or complete occlusion of the dural venous sinuses. It accounts for approximately 0.5-3% of all cerebrovascular occlusive diseases and is associated with significant morbidity and mortality. The incidence is higher in women of reproductive age, particularly during pregnancy and among users of hormonal contraception. Prothrombotic factors such as pregnancy and hormonal contraceptive use contribute substantially to disease occurrence.

A reproductive-aged woman (G4P2A1) with a two-year history of CVST presented with worsening headache at 37 weeks of gestation. The patient had a prior diagnosis of CVST and continued exposure to hormonal contraceptives despite the diagnosis. She had a history of depot medroxyprogesterone acetate (DMPA) injections prescribed by healthcare providers and combined injectable contraception used on her own initiative after being diagnosed with CVST. During pregnancy, anticoagulation management was suboptimal because warfarin therapy was continued until pregnancy was recognized and subsequently discontinued by the patient. Delivery was performed via cesarean section due to worsening headache. Postpartum symptoms were controlled with medical therapy and both maternal and neonatal outcomes were favorable.

Special consideration is required when administering antithrombotic therapy during pregnancy and delivery. This case highlights the importance of appropriate contraceptive counseling in women with a history of CVST and the need for pregnancy-safe anticoagulation strategies to minimize thrombotic complications and optimize maternal and fetal outcomes. Management of CVST in pregnancy should involve a multidisciplinary team to determine the safest mode of delivery and optimize maternal and fetal outcomes.