Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Case Report Volume 6 Issue 4

Post-Traumatic Vein of Labbe Thrombosis Presenting as Hemorrhagic Venous Infarct in a Pregnant Female: An Interesting Rare Entity with Diagnostic Challenges

Rakesh Kumar1, Pushpanjali R Ojha2*, Uday K. J. Khasage3 and Praveen K. Biradar4

11Junior Resident, Emergency Medicine, BLDE ( Deemed to be University/ Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India
2Assistant Professor of Pathology, Ranchi University/Rajendra Institute of Medical Sciences, Jharkhand, India
3Associate Professor, Emergency Medicine, BLDE ( Deemed to be University/ Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India
4Assistant Professor, Emergency Medicine,BLDE ( Deemed to be University/ Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India

*Corresponding Author: Pushpanjali R Ojha, Assistant Professor of Pathology, Ranchi University/Rajendra Institute of Medical Sciences, Jharkhand, India.

Received: December 30, 2022; Published: March 13, 2023

Abstract

Vein of Labbe thrombosis is an uncommon subtype of cerebral venous thrombosis (CVT). It clinically presents as headache, focal seizures, mass effect or altered sensorium. Severity of illness is multifactorial: degree of thrombosis, patency, blockage or hypoplasia of opposite vein, presence or absence of collateral anastomosing circulation, proximity with ventricles, size of infarct etc. Though it’s a rare site to be involved by thrombosis but most frequent among young pregnant women as a subtype of CVT. There are five variants of Vein of Labbe reported in literature among which left sided type I Vein of Labbe variant is more common among young females. Therapeutic dose of Low molecular weight heparin (LMWH) is the treatment of choice in acute event of CVT during pregnancy followed by prophylactic dose till postpartum period. We present a rare and interesting case of Vein of Labbe thrombosis in which history of trauma misled the early diagnosis. A young pregnant female presented to ED with complaints of loss of consciousness, vomiting, generalized headache and right ear bleeding within 24hours of encountering a road traffic accident. The patient was evaluated as cerebral injury and Vein of Labbe (left) thrombosis was an incidental finding noticed in MRV imaging with normal platelet counts and coagulation profiles. She was managed conservatively and show drastic improvement without administration of LMWH. Antithrombotic agents were not used in this case because of her progressive clinical improvement, reduction in size of infarct with time, no evidence of development of new infarct, normal coagulation profile and post-traumatic thrombotic event. This case is presented to emphasize that CVT may develop secondary to trauma and not always as a consequence of hypercoagulable state in pregnancy, vein of Labbe thrombosis must be looked into consideration in traumatic case of CVT if patient is a young pregnant women and antithrombotic agents are not mandatory in treatment if coagulation profile is normal. This case is interesting in its clinical presentation, development of CVT in spite of normal coagulation profile, rare site of thrombosis (Vein of Labbe), clinical improvement without administration of anti-thrombotic agents, good clinical outcome and prognosis with no residual effects.

Keywords: Cerebral Venous Thrombosis (CVT); Vein of Labbe; Pregnancy; Antithrombotic Agents

References

  1. Poradovsky K., et al. “Importance of the parametrium for labor activity in the 1st stage of labor”.Czech Gynaecology 28 (1963): 466-469.
  2. Mageid R., et al. “Vein of Labbe thrombosis, a near-miss”. Brain Circulation 4 (2018): 188-190.
  3. Coutinho JM., et al. “The incidence of cerebral venous thrombosis: A cross-sectional study”. Stroke 43 (2012): 3375-3377.
  4. Davie CA and O’Brien P. “Stroke and pregnancy”. Journal of Neurology, Neurosurgery and Psychiatry 3 (2008): 240-245.
  5. Ramsawak L., et al. “Isolated thrombosis of the vein of Labbe-Clinical and imaging features”. Journal of Acute Medicine 6 (2016): 73-75.
  6. Durmuș B., et al. “Cerebral venous thrombosis in women of childbearing age: diagnosis, treatment, and prophylaxis during a future pregnancy”. Therapeutic Advances in Neurological Disorders (2020):
  7. Liang Z., et al. “Clinical characteristics and prognosis of cerebral venous thrombosis in Chinese women during pregnancy and puerperium”. Scientific Reports 7 (2017):
  8. Enevoldson TP and Russell RW. “Cerebral venous thrombosis: new causes for an old syndrome?” Quarterly Journal of Medicine 284 (1990): 1255-1275.
  9. Ghuman MS., et al. “Cerebral venous sinus thrombosis in closed head trauma: A call to look beyond fractures and hematomas!”. Journal of Emergencies, Trauma, and Shock 1 (2016): 37-38.
  10. Minca DI., et al. “A New Classification of the Anatomical Variations of Labbe Inferior Anastomotic Vein”. Tomography 8 (2022): 2182-2192.
  11. Sasaki CT., et al. “Cerebral cortical veins in otologic surgery”. Archives of Otorhinolaryngology 103 (1977): 730-734.
  12. Naidoo J., et al. “Anatomical variations of dominant anastomotic veins in the superficial cortical venous system”. Translational Research in Anatomy 28 (2022): 100105.
  13. Boukobza M., et al. “Labbé vein thrombosis”. Neuroradiology8 (2020): 935-945.

Citation

Citation: Pushpanjali R Ojha., et al. “Post-Traumatic Vein of Labbe Thrombosis Presenting as Hemorrhagic Venous Infarct in a Pregnant Female: An Interesting Rare Entity with Diagnostic Challenges". Acta Scientific Neurology 6.4 (2023): 22-27.

Copyright

Copyright: © 2023 Pushpanjali R Ojha., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate32%
Acceptance to publication20-30 days

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"

Contact US