Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases

Abstract

Background: Headache is the most frequent symptom in cerebral venous thrombosis (CVT), and usually the first. However, it has rarely been reported as the only symptom of CVT. Objectives: To study the characteristics of patients in whom headache was the only presentation of CVT in the absence of intracranial hypertension, subarachnoid haemorrhage (SAH), meningitis, or other intracranial lesion. Methods: From a prospective study of 123 consecutive patients with CVT only those with isolated headache and normal brain computed tomography (CT) scan and cerebrospinal fluid (CSF) examination were included in the present study. All patients underwent an extensive systematic aetiological work-up and were given intravenous heparin followed by oral anticoagulants. A detailed description of the headache was obtained. Results: Headache was only sign of CVT in 17 patients. The lateral sinus was the most frequently involved sinus (n = 15). Onset of headache was progressive in 11, acute in 3, and thunderclap in 3 patients. Once established, the headache was continuous in 15, diffuse in four and unilateral in 13, usually ipsilateral to the occluded lateral sinus. No specific risk factor or cause was found. All had a favourable evolution. Conclusion: The pathogenesis of isolated headache in CVT in the absence of intracranial hypertension, SAH, meningitis or intracerebral lesion is unknown but may involve changes in the walls of the occluded sinus. Hence MRI/MRV should be used to look for signs of CVT in all patients with recent headache (progressive or thunderclap) even when the CT scan and CSF examination are normal.

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

“…19 Headache may be the only neurological sign in patients with CVST. 13,16 Papilledema can be observed in slowly developing CVST (in 28.3-47%).…”

Cerebral sinus venous thrombosis

“…A study from a French group identified 17 patients (13.8%) out of 123 in whom headache was the only manifestation of CSVT in the absence of focal deficit, or any parenchymal lesion. 13 Headache as sole manifestation with normal MRI brain was higher in present study (33.3%). This highlights evaluation of venous system of brain in patients presenting with isolated headache.…”

Trombosis de senos venoso cerebrales: características epidemiológicas, clínicas imaginológicas y pronóstico

“…La presentación clínica en este grupo de pacientes también es similar a la descrita en estudios anteriores, en los que la cefalea aparece como el síntoma más frecuente, seguida de las convulsiones y la focalización neurológica (7). Debido a estos síntomas, la enfermedad tiene una manifestación inicial inespecífica, por lo que deben tenerse en cuenta múltiples diagnósticos diferenciales, entre los cuales se destacan las cefaleas primarias, el síndrome de hipertensión intracraneal idiopática, la hemorragia subaracnoidea, las lesiones que ocupan espacio y el accidente cerebrovascular (8).…”