Case Report: A Missing Surgical Window in Postpartum Cerebral Venous Thrombosis: A Case Report and Clinical Reflection

<ns3:p>Cerebral Venous Thrombosis (CVT) is a rare and anatomically specific form of stroke that occurs in the cerebral veins, with pregnant and postpartum women at particular risk. Obstetric CVT carries high mortality due to its atypical presentation, often mimicking or being masked by other conditions such as preeclampsia. We report a case of a 37-year-old Sasak woman who, on the 32nd day postpartum following a cesarean section, experienced more than five seizures beginning with left arm weakness and heaviness. Upon presentation to the emergency department, the patient was conscious but complained of a severe headache and left-sided limb weakness. Her vital signs showed blood pressure of 152/87 mmHg, pulse of 84 beats/min, and a temperature of 37.1°C. During her stay in the ER, she experienced three additional seizures. Initially treated as eclampsia with magnesium sulfate by the obstetrics team, the patient underwent urgent brain MRI and MR venography, which confirmed a diagnosis of CVT in the superior sagittal sinus, complicated by intracranial hemorrhage, cerebral edema, and uncal herniation. The patient did not respond to anticoagulant therapy and subsequently underwent delayed decompressive craniectomy. To further manage elevated intracranial pressure, barbiturates were administered as a third-tier treatment. This case emphasizes the diagnostic challenges and high-risk nature of postpartum CVT, underlining the need for rapid neuroimaging and multidisciplinary intervention in postpartum women presenting with seizures and neurological deficits.</ns3:p>