The hidden dangers of cerebral venous sinus thrombosis: insights into maternal morbidity and mortality during pregnancy.

BACKGROUND

Cerebral venous sinus thrombosis (CVST) is a rare but potentially fatal neurological emergency during pregnancy and the puerperium. Data on its prognosis in early pregnancy and the risk of recurrence in subsequent pregnancies remain limited, particularly in Chinese populations. This study aimed to identify risk factors associated with the occurrence and prognosis of pregnancy-associated CVST and to evaluate the outcomes of subsequent pregnancies in affected women.

METHODS

We conducted a retrospective case-control study at a tertiary referral center in China from January 2010 to June 2024. The study included 20 consecutive pregnant or postpartum women diagnosed with CVST and 198 controls without CVST. Clinical characteristics, laboratory indicators, neuroimaging findings, and treatment outcomes were compared between groups. Surviving patients were followed up for a median of 90.6 months to assess subsequent pregnancy rates and CVST recurrence.

RESULTS

Of the 20 CVST patients, 7 (35.0%) occurred during early pregnancy and 13 (65.0%) in the postpartum period. The early pregnancy group had higher rates of intracerebral hemorrhage (85.71% vs. 7.69%), cerebral infarction (57.14% vs. 30.77%), and mortality (42.86% vs. 7.69%) compared with the postpartum group. Lower apolipoprotein A1 (APO-A1) levels were associated with CVST occurrence (OR = 0.005, 95% CI: 0.000-0.158, p = 0.003). During follow-up, 3 of 16 surviving patients (18.75%) had subsequent pregnancies, and no CVST recurrence was observed.

CONCLUSION

Early pregnancy CVST is associated with a more severe clinical course and higher mortality than postpartum CVST, warranting vigilant monitoring. Lower APO-A1 levels may serve as an associative marker for CVST risk. Based on our limited data, a prior history of CVST may not be an absolute contraindication to future pregnancy, though individual risk assessment and multidisciplinary management are essential.