AUTHOR=Wang Chuan , Hu Xing , Lio Ka U. , Lin Jianhua , Zhang Ning 

TITLE=Cerebral venous thrombosis as a rare cause of nausea and vomiting in early pregnancy: Case series in a single referral center and literature review

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.912419

DOI=10.3389/fneur.2022.912419

ISSN=1664-2295

ABSTRACT=Abstract
Objectives: Cerebral venous thrombosis (CVT) in early pregnancy is extremely rare with evidence limited to only a few published reports. This study aims to present our experience and summarize available literature to further elucidate the clinical manifestations, treatment, and outcomes of CVT in early pregnancy.
Methods: A retrospective case series of seven patients diagnosed with CVT in early pregnancy (less than 12 weeks of gestations) in a tertiary referral center (2018 ~2021), along with a review of published literature. 
Results: All patients presented with nausea, vomiting, headaches, and neurological symptoms including aphasia (n=5, 71.4%), limb weakness (n=4, 57.1%), seizures (n=2, 28.6%), altered mental status (n=3, 42.9%) and blurred vision (n=2, 28.6%). All patients were diagnosed with CVT by neuroimaging which revealed various extents of sinus involvement, with transverse sinus being the most common site (n=7, 100%), followed by sigmoid sinus (n=5, 71.4%). All patients received subcutaneous low-molecular-weight heparin once the diagnosis was confirmed. Two patients with rapid deterioration underwent venous thrombectomy, one patient subsequently underwent decompressive craniotomy however died despite the above interventions. All other patients proceeded with induced abortion after stabilization and were discharged on oral anticoagulation for one year. At 12-month follow-up, Magnetic resonance imaging/Magnetic resonance venography (MRI/MRV) revealed recanalization of sinuses and resolution of thrombi. 
Conclusions: CVT in early pregnancy represents a diagnostic challenge given its rarity and nonspecific overlapping clinical features with nausea and vomiting of pregnancy/hyperemesis gravidarum (NVP/HG), which could lead to a delay in diagnosis and result in rapid deterioration. Persistent or aggravating headaches or/and combined with other focalizing neurological symptoms in patients with NVP/HG patients could be an initial sign of CVT. Urgent neuroimaging with MRI/MRV remains the cornerstone for the diagnosis and immediate anticoagulation is the key for disease prognosis. Glasgow coma scale (GCS) evaluation on admission probably correlated with the prognosis. Early pregnancy combined with CVT is not a contraindication of continued pregnancy.