Neuropsychiatric Manifestations, As a Rare Presentation of Venous Sinus Thrombosis Two Weeks After Cesarean Section: First Report in the Gambia
Asmell Ramos Cabrera, Humberto Acosta Pupo, Yamilet Hinojosa, Duhirlin Otilia Pérez Ferrer, Kehinde O Oduntan, Jennifer Shallop, Onyia Onyema
Cerebral venous sinus thrombosis (CVST) is a rare and potentially fatal condition, accounting for about
0.5% of all cerebrovascular disease cases globally. It is challenging to diagnose due to its rarity and
diverse clinical presentations that can mimic other acute neurological conditions [1]. The reported
worldwide incidence of CVST during pregnancy and postpartum is approximately 3 to 4 cases per
million, with superior sagittal sinus thrombosis (SSST) being the most prevalent type. Risk factors
include the prothrombotic state of pregnancy in the third trimester, obesity, accidental dural puncture,
deficiencies in protein C and S, antiphospholipid syndrome, and the use of oral contraceptives among
others. Symptoms typically manifest within the first three weeks postpartum, with severe headache
being the most common complaint. The low number of reported cases in sub-Saharan Africa suggests
underdiagnosing or underreporting, with infection being the primary cause in this region. We report a
case at our facility who, two weeks after a cesarean section, presented with severe headache, confusion,
irritability, restlessness, and later developed a focal motor deficit. Imaging studies were crucial in
diagnosing SSST and ruling out other conditions causing acute brain injury. This is the first reported
case in The Gambia, and one of the few described in West Africa related to an obstetric procedure. The
onset, characterized by neuropsychiatric symptoms, is unusual and interesting, as these manifestations
are less common than the typical headache, seizure, and focal motor deficit described in the literature.
