SÜMEYRA NERGİZ AVCIOĞLU, SÜNDÜZ ÖZLEM ALTINKAYA, SELDA DEMİRCAN SEZER, Mert KÜÇÜK, Hasan YÜKSEL

Postpartum hemorajik enfarkt İle komplike serebral sinüs venöz tromboz

Serebral venöz tromboz (SVT) serebrovasküler hastalıklar arasında nadir görülen bir tablodur (%0.5). Yaklaşık olarak bir milyonda 5 kişide görülmektedir. Daha çok gençlerde ve kadınlarda görülür. Serebral venöz tromboz (SVT)un en sık görüldüğü durumlar; gebelik, puerperium ve oral kontraseptif (OKS) kullanımını da içine alan hormonal değişim süreçleridir. Gebelikle ilişkili tromboembolik hastalık insidansı %0.13tür ve gelişmiş ülkelerde maternal morbidite ve mortalitenin önemli nedenidir. SVTde başvuru şikayeti değişkendir. Bazı hastalar sadece hafif bir baş ağrısı ile başvururken, bazısı fokal nörolojik defisit ve çok az bir kısmı ise koma ile başvurur. Serebral venöz sinüslerin trombozu özellikle süperior sagittal veya lateral sinüs ve kortikal, derin venlerin açıldığı sinüslerde görülmekte ve ciddi nörolojik sendromlara yol açabilmektedir. Son 30 yılda, serebral anjiyografi (DSA)nin tanınması ve yaygın kullanımı, Bilgisayarlı Beyin Tomografisi (BBT) ve son olarak da Kraniyal Manyetik Rezonans Görüntüleme (MRG) ve Manyetik Rezonans Venografi SVTun erken tanınmasını ve böylelikle tedavi sonrası prognozun da iyileşmesini sağlamıştır. Bu vaka sunumunda 30 yaşında, postpartum dönemde faktör 5 Leiden heterozigot mutasyonuna ve ergonovin kullanımına bağlı olarak geliştiği düşünülen sinüs venöz tromboz vakası bildirilmiştir. Hastanın koagulasyon profilinde Faktör 5 heterozigot mutasyonu dışında herhangi bir anormallik saptanmamıştır. Hasta antikoagulan tedavi ile postoperatif 10.günde taburcu edilmiştir.

Cerebral venous thrombosis complicated by hemorrahic infarction in postpartum period

Cerebral venous trombosis (CVT) is a rare disease among cerebrovascular diseases.(0.5%) It is seen nearly 5 in one million people. This disease is generally seen in young women. CVT mostly occurs in hormonal fluctation periods like pregnancy, puerperium and oral contraceptive usage. Incidence of thromboembolic disorders related to pregnancy is %0.13. They are most common reasons of maternal mortality and morbidity in developed countries. Initial complaint in CVT is variable. Although some patients are referred with only complaint of mild headache, some of these patients have focal neurologic defisits or are in coma at the beginning. Cerebral venous thrombosis mostly affects superior sagital sinus or lateral sagital sinus and sinuses which drain into deep cortical veins.It may also cause serious neurologic complications. In last 30 years,increase in avalibility and use of cerebral angiography (DCA), computer brain tomography, cranial magnetic rezonans imaging (MRI), magnetic rezonans venography have provided early diagnosis of cerebral sinus venous thrombosis resulting in improvement in prognosis of disease. In this case report, we present a case of cerebral sinus venous thrombosis seen in 30 year old patient, in postpartum period which was supposed to be caused by heterozygotic Factor 5 Leiden mutation and methyl ergonovine use In her coagulation profile, all parameters were normal except for Factor 5 Leiden heterozygotic mutation.This patient was discharged from hospital in postpartum 10th day with prescribing anticoagulation drug threapy.

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