Structural Imaging Characteristic, Clinical Features and Risk Factors of Cerebral Venous Sinus Thrombosis: A Prospective Cross-Sectional Analysis from a Tertiary Care Hospital in Pakistan

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that accounts for 0.5–1.0% of all strokes. Clinical presentation, predisposing factors, neuroimaging findings, and outcomes of CVST are extremely diverse, which causes a high index of suspicion in diagnosis. Therefore, early diagnosis of CVST is crucial for prompt treatment to prevent morbidity and mortality. Objective: The purpose of this prospective study is aimed at assessing the clinical characteristics, potential risk factors, and neuro-radiological features along with the topography of venous sinus involved in CVST patients in a tertiary care hospital, Lahore, Pakistan. Material and Methods: Consecutive patients enrolled in this study had a computed tomography (CT) scan, magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) along with a clinical presentation to confirm the diagnosis of CVST. Categorical data were presented as percentages. Continuous variable and categorical data were compared (parenchymal lesions vs. non-parenchymal lesions) using the Student’s t-test and Chi-square test, respectively. Results: A total of 3261 patients with stroke were presented during the study period. Out of all patients, 53 confirmed patients with CVST (1.6%) were recruited; the predominant population was female (84.91%), having a male to female ratio of 1:4. Mean age of the cohort was 28.39 ± 7.19 years. Most frequent symptoms observed were headache (92.45%) followed by vomiting (75.47%), seizures (62.26%), papilledema (54.72%), visual impairment (41.51%), and altered consciousness disturbance (52.83%). The presumed risk factors associated with CVST were puerperium (52.83%), use of oral contraceptives (13.21%), antiphospholipid syndrome (7.55%), elevated serum levels of protein C and S (5.66%), and CNS infection (3.77%). On cranial CT scans, 50 patients (94.33%) showed abnormalities while 32 patients exhibited various parenchymal lesions. Seizures were more frequent in CVST patients with parenchymal lesions compared with subjects lacking parenchymal lesions. Seventy-two sinuses, either single or in combination, were involved in CVST patients, being more common in patients with parenchymal lesions than those without parenchymal lesions. The most frequent locations of CVST were the superior sagittal and transverse sinus. Conclusion: In short, non-contrast CT brain may be used as a first line investigation in suspected cases of CVST. Our study also demonstrates some regional differences in the clinical features, risk factors, and neuroimaging details of CVST as described by some other studies. Therefore, care must be taken while diagnosing and predicting the outcome of the CVST.

Was Antiphospholipid Syndrome a Risk Factor of Stroke? A Systemic Review and Meta-Analysis of Cohort Studies

“…In total, 2767 articles were retrieved from the databases according to the study strategy. After screening based on the inclusion and exclusion criteria, 17 cohort studies [ 7 – 23 ] were enrolled ultimately ( Figure 1 ). There were a total of 7144 people participating in all these studies, including 1289 males ( Table 1 ).…”

Clinical features of patients with cerebral venous sinus thrombosis at plateau areas

“…CVST patients in plateau areas (altitude ≥ 4000 m) and plain areas (altitude ≤ 1000 m) were recruited from the inpatient service of a tertiary hospital in plateau area and The General Hospital of Western Theater Command in Chengdu, respectively, from June 2020 to December 2021. The diagnosis of CVST was made according to the clinical symptoms suggestive of CVST and contrast CT/MRV presentations (Bano et al., 2021): (1) presented with the clinical symptoms of CVST, including headache, focal neurological deficits, and cranial hypertension (diagnosed by the pressure detection of cerebrospinal fluid through lumbar puncture); (2) contrast cranial computed tomography (CT) scan showed a “delta sign”; (3) magnetic resonance imaging (MRI) or MR venography (MRV) demonstrated the cerebral sinus or venous occlusion (MRI and MRV were conducted by experienced radiologists who were not aware of the clinical symptoms and signs of patients to exclude the diagnosis deviation). The inclusion criteria include the following: (1) age ≥ 18 years; (2) discharge diagnosis of CVST (by using ICD 9 codes); (3) the time duration of patients with CVST in plateau areas (altitude ≥ 4000 m) was at least 1 months.…”

“…CVST has a variety of predisposing factors, age of onset, clinical manifestations, and radiological presentations. The most common risk factors of CVST include genetic/acquired prothrombotic conditions, infections, malignancy, pregnancy, oral contraceptives, and so on (Bano et al., 2021). In recent years, a relationship between high‐altitude exposure and CVST has been established, as a result of the documentation of CVST at high altitude has raised obviously owing to the availability of better neuroimaging facilities, such as MRI and MRV (Devasagayam et al., 2016; Khattar et al., 2019).…”

Sinus venous thrombosis as a complication of COVID-19-associated hypercoagulability

“…We should be told if either patient was regularly taking hormones. Missing is an extensive history for other risk factors for SVT, such as smoking, antiphospholipid syndrome, thrombophilia (elevated protein-S or protein-C), or inflammatory bowel disease [ 10 ].…”