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- Title
A Rare Case Of Superior Sagittal Sinus Thrombosis In A Patient With An Invasive Mole: A Case Report.
- Authors
Saxena, Y. K.; Singh, Abha; Anand, Rama
- Abstract
Lady Hardinge Medical College at New Delhi receives a fairly large number of patients with Gestational trophoblastic tumours. Here we report the rare development of Superior Sagittal Sinus thrombosis (SST) in a patient of invasive mole on cancer chemotherapy. A 28 year old female P?L? with 8 weeks of amenorrhoea presented with complaint of bleeding per vagina (spotting). USG pelvis showed bulky uterus with evidence of a vesicular echogenic mass measuring 51x32 mm that was filling the endometrial cavity with innumerable uniformly distributed cystic spaces within it, suggesting a molar pregnancy. Patient was investigated. CBC, PT, Liver, kidney and thyroid functions, chest X-Ray were found to be normal. Patient's Blood group was B positive. ?-hcg value was 2.7 lakhs mIU/ml. Patient underwent suction and evacuation (S&E). Histopathological examination (HPE) was suggestive of partial mole. Post suctionevacuation patient was followed up with ?hcg titer. During follow up patient's B-hcg titer increased from the post S&E value of 1.59 lakhs mIu/ml to 3.05 lakhs mIU/ml. Repeat USG revealed that the uterus was enlarged and distended with heteroechoic contents measuring 8.7x6 cm. Myometrium was thinned out (>left) which was noticed by the patient's attendant when patient woke up in the morning. Subsequently, patient also complained of extreme weakness, giddiness and headache. The Patient was reassessed. There was no history of fever, vomiting and seizure. On examination patient was fully conscious though little drowsy, cooperative and well oriented to time, place and person. Patient was afebrile and the Pulse rate was 62/min, regular, BP 110/70 mmHg. CVS and chest were normal. On CNS examination, higher mental function was normal. Sensory functions were normal and patient had grade 4 power in all limbs. There were no local rise of temperature and bilateral periorbital puffiness (right>>left) and mild conjunctival erythema were present. There was no Cranial nerves deficit. Fundus was also normal. Patient was managed with supportive treatment, and in the meanwhile a CT scan was also advised to rule out any intracranial lesion. The patient showed gradual improvement with supportive care. Non-Contrast CT head showed evidence of central filling defect with surrounding enhancing dura noted in the superior sagittal sinus (empty delta sign) which was suggestive of thrombosis. A filling defect was also noted in the right sigmoid sinus with extension in to the right internal jugular vein. However there was no evidence of parenchymal changes. Patient was planned for MR venogram, meanwhile she was started with Inj Enoxaparin. MR venogram showed evidence of partial recanalization of superior sagittal sinus thrombosis. The superior sagittal sinus appeared attenuated than the rest of normal sinuses. Rest of the sinuses and veins were normal. Inj Enoxaparin and chemotherapy were continued with modification of the regimen. Methotrexate was completely withdrawn, dose reduction done for etoposide and steroids in any form were stopped in pre-chemo or post chemo prescription. Patient tolerated chemotherapy well and blood parameters were normal with occasional history of nausea/ vomiting (grade 1) during chemotherapy. The B-hcg titer was monitored regularly and prior to 5th cycle of chemotherapy, the ?-hcg value at 5.78 mIu/ml was almost normal (Normal value - < 5 mIU/mL). Patient was advised 2 more cycles of combination chemotherapy to consolidate the clinical gains. Patient completed 7 cycles of chemotherapy. Ultrasonography of the pelvis was normal with no evidence of residual disease. As of now, the patient is doing well and is on follow up. The medical literature mentions a number of causative factors viz. hypercoagulation conditions, head injury, malignancy, certain chemotherapy drugs (such as cisplatin, methotrexate, L-asparginase, Tamoxifen, steroids), infections, inflammatory disease, dehydration, high altitude which often lead to cranial venous thrombosis. Cranial venous thrombosis is a rare phenomenon and warrants an urgent medical attention to avoid devastating complications such as venous infarction, subarachnoid haemorrhage, pulmonary embolism, epilepsy. An exhaustive literature and internet search was done but report of invasive mole with cranial venous thrombosis could not be found and this citation appears to be first reported case We are publishing this case report in view of rarity of SST developing during the treatment of invasive mole.
- Subjects
NEW Delhi (India); SINUS thrombosis; MOLAR pregnancy; VENOUS thrombosis; HEART beat; JUGULAR vein; CANCER chemotherapy
- Publication
Journal of Cancer Research & Therapeutics, 2017, Vol 13, pS228
- ISSN
0973-1482
- Publication type
Article