This case involves a 36-year-old pregnant woman who had experienced debilitating headaches throughout her pregnancy. She was admitted to the hospital due to preeclampsia. Prior to the delivery, the patient continued to have excruciating headaches. The patient had a normal delivery, after which her headaches began to subside. After almost 48 hours in the hospital, the patient’s headaches appeared stable. No imagining was conducted and the patient was discharged. The following night, the patient developed slurred speech and intense headaches while at home. The patient’s husband brought her back to the emergency department and imaging revealed a cerebral hemorrhage and venous sinus thrombosis. The patient was initiated on anticoagulation and required a decompressive craniectomy, which caused the patient persistent neurological deficits.
Question(s) For Expert Witness
1. How frequently do you treat patients with venous sinus thromboses?
2. If the thrombosis had been identified and treated earlier, how would the prognosis have changed?
Expert Witness Response E-036010
Our neuroscience ICU, in which I am an attending physician, admits approximately 4-7 cases of cerebral venous thrombosis (CVT) every year. The diagnosis is in the differential for many more women we see with acute headache and neurological signs and symptoms. Some of these patients require mechanical thrombectomy in the interventional radiology suite in addition to anticoagulation. I also consult on women with headaches, seizures, and focal neurological deficits in our OB-GYN wards as a neurocritical care specialist. Early diagnosis is, of course, paramount to management, since this is a syndrome which is particularly responsive to anticoagulation with heparin and early therapy may ameliorate neurological deficits. The index of suspicion for CVT should be high in the peri-partum period in women. Head CT may be normal, but MRI with MRV is very sensitive to diagnosing the problem. Heparinization, in the setting of CVT, can prevent thrombus propagation and potentially gives the patient a better chance of avoiding hemorrhage expansion, and cerebral edema, which, as may have happened in this case, leads to the need for decompressive craniectomy to prevent herniation.
About the author
Victoria Negron
Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.
Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.
Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.
