Cerebral venous thrombosis following hysterectomy done under
Cerebral venous thrombosis (CVT) is an unusual complication after spinal anesthesia. Published in the Journal of Anaesthesiology Clinical Pharmacology, the authors report a case of a woman who after an uneventful vaginal hysterectomy under spinal anesthesia developed cortical vein thrombosis which got confirmed by CT angiography. The patient treated with anticoagulants, physiotherapy, and made complete recovery.

A 43-year-old female with a history of dysfunctional uterine bleeding was operated for vaginal hysterectomy under spinal anesthesia with 0.5% bupivacaine 15 mg + fentanyl HCl 10 mcg at L3–L4 level. Surgery completed uneventfully with hemodynamics maintained with intravenous (IV) fluid, Ringer's lactate 1.5 L.

On 2nd postoperative day, patient complained of headache and vertigo, referred to anesthetist and neurophysician. Neurophysician transferred under and was advised plain CT brain and CT angiography neck and brain. Treatment included Injection Fosolin 150 mg BD, injection mannitol 100 ml TDS, injection Clexane 0.6 ml s/c BD, injection Lopez 10 mg, tablet acitrom 3 mg OD, and tablet Ace-proxyvon BD, with antibiotic cover.

CT angiography revealed as CVT involving superior sagittal sinus, right transverse, and sigmoid sinus extending in upper cervical part of the right internal jugular vein with a paucity of cortical vein on the right side.

CT plain brain revealed hyperdense hematoma with mild perifocal edema in parietotemporal lobes causing effacement of the right atrium; small hematoma was also seen in right superior parietal lobe with mild perifocal edema. There was minimal midline shift to the left side, diffuse cerebral edema and normal brain and cerebellar hemispheres.

On 3rd postoperative day, patient had one episode of focal seizure involving left arm. For that injection Epsolin 100 mg was advised. On 5th postoperative day, patient was fully conscious, moving all limbs, and had no neurological deficit. Physiotherapy was continued. On 8th postoperative day, patient was discharged with the advice to regular follow-up.

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