Severe cerebral venous thrombosis initially presenting as puerperium psychiatric and behavioral symptoms: one case report

Abstract

Objective To report a case of severe cerebral venous thrombosis (CVT) with an initial presentation of puerperium psychiatric and behavioral abnormalities, and to summarize and analyze its clinical manifestations and imaging changes, to enhance clinicians' awareness of this condition. Methods and Results A 34-year-old female patient developed psychiatric and behavioral abnormalities one month postpartum. She was initially presumed by her family to have "postpartum depression", and subsequently diagnosed at an external hospital as "psychiatric disorder of undetermined etiology". Following treatment with antipsychotic medications, the patient's psychiatric and behavioral abnormalities progressively aggravated. Upon the patient's development of right-sided limb weakness, a definitive diagnosis of severe CVT was ultimately established, corroborated by imaging findings. After a therapeutic regimen comprising fluid repletion, anticoagulation, reduction of fibrinogen level, corticosteroid anti-inflammatory therapy, and antipsychotic medications, the patient's psychiatric and behavioral abnormalities and right-sided limb weakness ameliorated, with a good prognosis. Conclusions CVT manifesting with psychiatric and behavioral abnormalities is relatively uncommon. Its clinical presentation overlaps with that of various psychiatric disorders. Particularly in puerperium patients exhibiting psychiatric and behavioral abnormalities, a misdiagnosis of "postpartum depression" is frequent. Consequently, when such patients demonstrate an inadequate response to antipsychotic medications, the potential for CVT should be vigilantly considered, and comprehensive multimodal imaging should be pursued promptly to prevent misdiagnosis and inappropriate treatment.

Keywords

• venous thrombosis
• cerebral veins
• magnetic resonance imaging
• postpartum period
• mental disorders