Mechanical thrombectomy for superior sagittal sinus thrombosis in early pregnancy: a case report.

Abstract

Introduction: Cerebral venous sinus thrombosis is a rare but life-threatening cause of stroke in pregnancy, typically occurring in the third trimester or postpartum. First-trimester presentations are exceptionally uncommon. We report a case of superior sagittal sinus thrombosis at 6 weeks of gestation successfully managed with mechanical thrombectomy and anticoagulation.

Case presentation: A 20-year-old primigravida at 6 weeks of gestation with no significant history and family history of cerebrovascular event, presented with a three-day history of vomiting followed by generalized seizures and a headache. Neurological examination revealed a Glasgow Coma Scale of 14/15 and right lower limb paresis (3/5). Neuroimaging (MRI/MRV) confirmed superior sagittal sinus thrombosis with multiple venous infarcts and hemorrhagic transformation.

Investigations and management: Autoimmune and antiphospholipid workup was negative. A multidisciplinary team of neurologists, obstetricians, and interventional radiologists initiated therapeutic low-molecular-weight heparin at 1 mg/kg twice daily and cerebral oedema control. Due to extensive clot burden and neurological deficits, mechanical thrombectomy was performed, retrieving a 25 cm thrombus and achieving successful recanalization. The patient showed complete neurological recovery at a 2-week follow-up. Following patient counselling regarding maternal-fetal risks and the unplanned nature of the pregnancy, a medical termination was later performed.

Conclusions: Cerebral venous sinus thrombosis should be considered in pregnant women presenting with seizures or focal deficits, even in early gestation. While low-molecular-weight heparin is the gold standard, this case demonstrates that mechanical thrombectomy is a feasible and effective escalation of care for patients with extensive thrombosis and neurological deterioration, even during the first trimester.