Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report
Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular condition that causes obstruction of venous blood flow or cerebrospinal fluid circulation, leading to intracranial hypertension symptoms such as syncope and vomiting. Transurethral Resection of the Prostate (TURP) syndrome, a complica...
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Elsevier
2025-02-01
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| Series: | AJOG Global Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666577825000073 |
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| author | Yongqing Zhang, MD Hongxing Ye, MD Danqing Chen, MD, PhD Guohui Yan, MD Zhanfu Li, MD Qianhui Xie, MD Guodong Shan, MD Zhaoxia Liang, MD, PhD |
| author_facet | Yongqing Zhang, MD Hongxing Ye, MD Danqing Chen, MD, PhD Guohui Yan, MD Zhanfu Li, MD Qianhui Xie, MD Guodong Shan, MD Zhaoxia Liang, MD, PhD |
| author_sort | Yongqing Zhang, MD |
| collection | DOAJ |
| description | Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular condition that causes obstruction of venous blood flow or cerebrospinal fluid circulation, leading to intracranial hypertension symptoms such as syncope and vomiting. Transurethral Resection of the Prostate (TURP) syndrome, a complication of hysteroscopic surgery, can also present with cerebral edema and symptoms similar to CVST, making differentiation challenging. Cases of unexplained recurrent syncope posthysteroscopy diagnosed as CVST have not been previously reported. We present a case of a 33-year-old woman who underwent hysteroscopy for abnormal uterine bleeding. Five hours postoperation, she experienced syncope, which resolved spontaneously. Ten hours later, she had recurrent syncope, nausea, and vomiting. Head computed tomography suggested cerebral edema, potentially indicating TURP syndrome. However, the brief surgery and minimal fluid imbalance (200 mL) made TURP syndrome unlikely. Further investigation with cranial magnetic resonance venography revealed multiple venous sinus thromboses, explaining the recurrent syncope linked to minimal fluid volume expansion postsurgery. Subsequent screening identified hyperhomocysteinemia as a contributing factor. Treatment with anticoagulants, folic acid, and vitamin B6 led to a favorable outcome. This case involves recurrent syncope after hysteroscopy secondary to CVST. If symptoms such as recurrent syncope, nausea, and vomiting, indicating increased intracranial pressure, arise posthysteroscopy and cannot be attributed to typical TURP syndrome, primary intracranial vascular conditions like CVST should be considered, as even a minor increase in blood volume can exacerbate these intracranial pressure symptoms. |
| format | Article |
| id | doaj-art-57d4f9d6bd174b7983bf51b84ea2bb0e |
| institution | Kabale University |
| issn | 2666-5778 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJOG Global Reports |
| spelling | doaj-art-57d4f9d6bd174b7983bf51b84ea2bb0e2025-01-31T05:12:30ZengElsevierAJOG Global Reports2666-57782025-02-0151100446Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case reportYongqing Zhang, MD0Hongxing Ye, MD1Danqing Chen, MD, PhD2Guohui Yan, MD3Zhanfu Li, MD4Qianhui Xie, MD5Guodong Shan, MD6Zhaoxia Liang, MD, PhD7Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China (Zhang, Chen, Yan, and Liang); Department of Obstetrics and Gynecology, People's Hospital of Haixi Autonomous Prefecture, Delingha, Qinghai, China (Zhang, Li, Xie, and Liang)Department of Neurosurgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China (Ye); Department of Neurosurgery, People's Hospital of Haixi Autonomous Prefecture, Delingha, Qinghai, China (Ye)Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China (Zhang, Chen, Yan, and Liang)Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China (Zhang, Chen, Yan, and Liang)Department of Obstetrics and Gynecology, People's Hospital of Haixi Autonomous Prefecture, Delingha, Qinghai, China (Zhang, Li, Xie, and Liang)Department of Obstetrics and Gynecology, People's Hospital of Haixi Autonomous Prefecture, Delingha, Qinghai, China (Zhang, Li, Xie, and Liang)Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University, Hangzhou, China (Shan); Department of Gastroenterology, People's Hospital of Haixi Prefecture of Qinghai Province, Delingha, China (Shan)Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China (Zhang, Chen, Yan, and Liang); Department of Obstetrics and Gynecology, People's Hospital of Haixi Autonomous Prefecture, Delingha, Qinghai, China (Zhang, Li, Xie, and Liang); Corresponding author: Zhaoxia Liang, MD, PhD.Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular condition that causes obstruction of venous blood flow or cerebrospinal fluid circulation, leading to intracranial hypertension symptoms such as syncope and vomiting. Transurethral Resection of the Prostate (TURP) syndrome, a complication of hysteroscopic surgery, can also present with cerebral edema and symptoms similar to CVST, making differentiation challenging. Cases of unexplained recurrent syncope posthysteroscopy diagnosed as CVST have not been previously reported. We present a case of a 33-year-old woman who underwent hysteroscopy for abnormal uterine bleeding. Five hours postoperation, she experienced syncope, which resolved spontaneously. Ten hours later, she had recurrent syncope, nausea, and vomiting. Head computed tomography suggested cerebral edema, potentially indicating TURP syndrome. However, the brief surgery and minimal fluid imbalance (200 mL) made TURP syndrome unlikely. Further investigation with cranial magnetic resonance venography revealed multiple venous sinus thromboses, explaining the recurrent syncope linked to minimal fluid volume expansion postsurgery. Subsequent screening identified hyperhomocysteinemia as a contributing factor. Treatment with anticoagulants, folic acid, and vitamin B6 led to a favorable outcome. This case involves recurrent syncope after hysteroscopy secondary to CVST. If symptoms such as recurrent syncope, nausea, and vomiting, indicating increased intracranial pressure, arise posthysteroscopy and cannot be attributed to typical TURP syndrome, primary intracranial vascular conditions like CVST should be considered, as even a minor increase in blood volume can exacerbate these intracranial pressure symptoms.http://www.sciencedirect.com/science/article/pii/S2666577825000073cerebral venous sinus thrombosishyperhomocysteinemiahysteroscopysyncope |
| spellingShingle | Yongqing Zhang, MD Hongxing Ye, MD Danqing Chen, MD, PhD Guohui Yan, MD Zhanfu Li, MD Qianhui Xie, MD Guodong Shan, MD Zhaoxia Liang, MD, PhD Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report AJOG Global Reports cerebral venous sinus thrombosis hyperhomocysteinemia hysteroscopy syncope |
| title | Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report |
| title_full | Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report |
| title_fullStr | Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report |
| title_full_unstemmed | Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report |
| title_short | Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report |
| title_sort | recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis a case report |
| topic | cerebral venous sinus thrombosis hyperhomocysteinemia hysteroscopy syncope |
| url | http://www.sciencedirect.com/science/article/pii/S2666577825000073 |
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