Cerebral venous thrombosis in Latin America: A critical review of risk factors, clinical and radiological characteristics

Abstract

BackgroundCerebral venous thrombosis (CVT) is a rare disease that frequently occurs in young women of childbearing age, with variable clinical presentation in regions with limited access to diagnostic imaging or specialized neurological care. In the last decade, there has been an increase in the number of studies on CVT in Latin America, which may contribute to a better epidemiological description of the disease in this region and, consequently, its early diagnosis.ObjectivesOur study aims to review the risk factors, clinical and radiological characteristics of CVT in Latin America, being critically compared with data from world literature.MethodsPubMed, ScienceDirect, BVS, and Scopus were searched to identify studies reporting CVT in Latin American countries published up to July 2022. We excluded case reports and case series reporting <5 patients later in the final analysis.ResultsWe identified a total of 3714 studies and 26 qualified for the quantitative analysis, which described 1486 cases of CVT. Headache was the most frequent symptom (82.1%) and the use of oral contraceptives in women was the main risk factor (46.7%). The transverse sinus was the most frequent location of the thrombus (52%). The treatment used most in the acute phase was heparin (88.5%) and oral anticoagulation was widely used at hospital discharge (67.8%). The mortality was low (6.5%), and most patients achieved complete recovery (75.3%).ConclusionDespite considerable dissimilarities in studies between countries, particularities were identified in the risk factors of CVT in Latin America compared to other regions of the world.

Angulation of the dural venous sinuses of the posterior cranial fossa: Anatomical study with clinical and surgical applications

“…Moreover, several studies have shown the transverse sinus (TS) to be the most common CVST location, its occurrence increasing further in multiple-DVS involvement or when both sides are considered (Bezerra et al, 2022;Duman et al, 2017;Ferro et al, 2004). Regarding the etiological causes of CVST, several well-known general risk factors such as oral contraceptive use, pregnancy, infections, malignancy, and hypercoagulable states have been documented (Bezerra et al, 2022;Duman et al, 2017;Ferro et al, 2021Ferro et al, , 2004Jianu et al, 2018;Zhou et al, 2022Zhou et al, , 2023. Furthermore, other structural factors such as intraluminal bands, intraluminal arachnoid granulations, TS stenosis, absent TS, and extraluminal tumors have been discussed as causes of venographic filling defects and venous flow abnormalities, and are probably implicated in the mechanisms of development of diseases affecting the DVSs such as CVST (Altafulla et al, 2020;Guduri et al, 2023;Iwanaga et al, 2020;Strydom et al, 2010).…”

“…However, multiple‐DVS involvement can occur. Moreover, several studies have shown the transverse sinus (TS) to be the most common CVST location, its occurrence increasing further in multiple‐DVS involvement or when both sides are considered (Bezerra et al, 2022; Duman et al, 2017; Ferro et al, 2004). Regarding the etiological causes of CVST, several well‐known general risk factors such as oral contraceptive use, pregnancy, infections, malignancy, and hypercoagulable states have been documented (Bezerra et al, 2022; Duman et al, 2017; Ferro et al, 2021, 2004; Jianu et al, 2018; Zhou et al, 2022, 2023).…”

“…Furthermore, other structural factors such as intraluminal bands, intraluminal arachnoid granulations, TS stenosis, absent TS, and extraluminal tumors have been discussed as causes of venographic filling defects and venous flow abnormalities, and are probably implicated in the mechanisms of development of diseases affecting the DVSs such as CVST (Altafulla et al, 2020; Guduri et al, 2023; Iwanaga et al, 2020; Strydom et al, 2010). Although it is a multifactorial condition, some studies report the etiology of CVST as idiopathic in up to 43%–44% of cases, and the reason for a higher predilection to TS thrombosis is unknown (Bezerra et al, 2022; Duman et al, 2017; Ferro et al, 2004).…”

Serum Levels of Ferritin, Iron, and Total Iron Binding Capacity in Cerebral Venous Sinus Thrombosis

“…The main risk factors of CVST include thrombocytosis (polycythemia), hemodynamic changes (stasis or turbulence of blood flow), vascular endothelial damage, pregnancy, oral contraceptive pills consumption, anticoagulation therapy, lumbar puncture, blood disorders, like myeloproliferative diseases, hereditary thrombophilia, hyperhomocysteinemia, and paroxysmal nocturnal hemoglobinuria (PNH) (5). Different studies have demonstrated an association between intravenous sinus thrombosis and iron deficiency anemia (IDA), and several mechanisms have been proposed to explain this relationship (6,7).…”