Abstract T P168: Headache and Cerebral Venous Thrombosis

Abstract

Background and purpose: Headache is the most frequent presenting symptom of cerebral venous thrombosis (CVT), but many aspects of its profile are unknown because large scale studies are scarce. We aimed to analyze the headache characteristics in the largest cohort of Hispanic Mestizo patients with CVT. Methods: Since 1986 a systematic CVT registry has been carried out in 2 tertiary referral Neurological centers in Mexico City. Herein we examine the headache profile and the association of demographic, clinical and neuroimaging factors with the occurrence of headache in 408 consecutive patients. Results: Among 408 patients (82% women) included in this registry, headache occurred in 346 (85%; 86% in women, 79% in men, p NS), being the first neurological manifestation in 309 (76%). Headache onset was acute in 46%, of gradual onset in 51%, and a sudden explosive onset like thunderclap occurred in 3%. A diffuse headache pattern occurred in 56%, bifrontal in 22%, unilateral in 15%, and suboccipital in 8%. It was of pulsatile quality in 73%, and oppressive in 24.3%, and it was mostly deemed as severe (49%) or moderate (47%) in intensity, described as progressive in 19%, and with nausea or vomiting in 52% patients. Headache was the only neurological symptom in 58 patients (14%): as part of an isolated intracranial syndrome in 52 (13%) and as the sole manifestation of CVT in 6 (1.5%). Headache was followed by other neurological symptoms in 70%, appearing within 48 hours of headache onset in 33%, within 3-6 days in 34%, within 7-10 days in 16%, and after 10 days in 18%. CVT diagnosis was significantly delayed in patients with headache, as compared with other neurological presentations (delay >15 days: 30% vs. 8%, respectively; p<0.05). There were not differences in anatomical topography of CVT in patients presenting with headache, as compared with other neurological features. Conclusions: There is no identifiable, uniform, recognizable pattern of headache in CVT and often precedes the development of other neurological deficits for days or even weeks delaying the diagnosis of CVT. Interestingly, neither the presence nor the quality of headache is associated with the topography or extension of CTV.