A study of clinical, radiological and etiological profile of cerebral venous sinus thrombosis at a tertiary care center

Abstract

Background: A prospective, observational study was done at a tertiary care hospital in Western Maharashtra to describe the etiologies, clinical features, diagnosis and prognosis of cerebral venous sinus thrombosis in an Indian population. Methods: 54 patients with clinical and MRI features suggestive of cerebral venous sinus thrombosis (CVST), were studied with detailed clinical evaluation and pro-thrombotic work up. All were followed up monthly for 6 months, to assess the response to therapy and clinical outcomes. Results: The mean age of presentation was 35 years. Headache was the most common presenting symptom (94%) and hemi paresis (22%) was the most common neurological sign. The most common sinus involved was transverse sinus in 77% of cases. In the unprovoked CVST subset (n = 29), elevated factor VIII (72%) and protein C deficiency (24%) were the common prothrombotic states identified. In the provoked CVST subset (n = 18), puerperium (44%) and para-infectious (22%) accounted for majority cases. Idiopathic CVST accounted for 13% (7/54) in this study. A Modified Rankin Scale (MRS) of 0-1 was achieved in 96% of patients at the end of 6 months follow up with no mortality in this study. Conclusion: CVST is an important yet under recognized cause of intracranial hypertension and stroke in young. Clinical presentation is extremely varied and a high index of suspicion is needed. Magnetic Resonance Imaging (MRI) brain with Magnetic Resonance Venography (MRV) is the current diagnostic modality of choice. Elevated factor VIII and puerperium are the common etiologies in an Indian population. Management with anticoagulants is safe and has excellent clinical outcomes.

Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study

“…[7] Transverse sinus is the most commonly affected sinus in 77% of cases in a study. [16] In our study, the most effected sinus was transverse sinus in both groups similar to the other studies. However sagittal sinus involvement was higher in NIH group than IH group.…”

“…The remarkable use of MRI and especially the increase in the use of MRV has made this diagnosis easier. [11] In previous studies, it is shown that MRI combine with MRV are current diagnostic modality of choice and are the best imaging technique for diagnosis of CVST in patients with unclear findings on CT. [16,17] DSA is the more effective for early diagnosis of dural sinüs lesions but the American Heart and Stroke Association recommend MRI and MRV as a preferred tests for the diagnosis of dural sinus lesions. [18] In our study, 92.3% patients underwent detailed radiological work-ups, including MRI and MRV to put the diagnosis easily.…”

Clinical Characteristics, Etiology, Recanalization Rates and Neurological Outcomes in CVT

“…In this cohort also, thrombophilia was the commonest etiology and constituted one-fourth of the cases (25.3%) followed by puerperal CVT (15.6%). Similar to Anadure et al ,[ 10 ] we found elevated factor VIII to be an important genetic thrombophilia causing CVT. In fact, both our male patients with CVT recurrence had highly elevated factor VIII levels {218% and 357% (normal factor VIII:60%–150%)}.…”

“…[ 3 8 ] Indeed, two recent studies from western India indicate that inherited thrombophilias may be replacing puerperal CVT as the dominant etiology in our country too. [ 9 10 ]…”

Predictors and Outcomes of Status Epilptecus in Patients With Cerebral Venous Thrombosis

“…(13) While Anadure et al reported the incidence of generalized, focal and focal with secondary generalized seizure in patients with CVT 65% , 25% and 10 % respectively. (14) In the present study, 55% patients had acute symptomatic seizure and 45% late seizure, which is quite higher than the reported by Mahale et al studied seizures in CVT and found that 46% of patients with CVT had acute seizures. (15) In this study male cases represent 6.9 % And female represent 93.1% of patients and this disagree with , Sha et al found that female patients represented 55 % of patients.…”