We present a unique case of a young postpartum female who presented with fevers, headaches, nausea and vomiting days after receiving a traumatic epidural during her delivery. She was found to have pneumocephalus along with signs of central brain sagging. She was eventually diagnosed with splenium stroke due to CVST.

Cerebral venous sinus thrombosis (CVST) is a rare presentation of thromboembolism. However, it is recognized as being more common in the post-partum period due to hypercoagulable state.

Case Report

A 20-year-old female, 1-week post-partum presented to the emergency room with fever, postural headache, dizziness with nausea and vomiting lasting for several days. However, she showed no neurological deficits. Her initial CT imaging was consistent with pneumocephalus caused by a traumatic epidural administered during her delivery along with signs of cerebral edema and small subdural fluid collections. A subsequent MRI showed restrictive diffusion and downward drooping in the splenium of the corpus callosum with central brain sagging. Magnetic resonance venography (MRV) showed irregularity in the Vein of Galen as well as the posterior aspect of the inferior sagittal sinus. Angiogram was subsequently performed which was significant for partial thrombosis of the Vein of Galen and inferior sagittal sinus. Patient was discharged on anticoagulation. Outpatient imaging six months after this episode showed complete resolution of CVST.

We postulate that the central sagging of the brain caused distortion of venous structures. This in turn resulted in reduced venous flow causing development of CVST in a patient with a hypercoagulable state.