Clinical and radiologic features of cerebral venous sinus thrombosis associated with iron deficiency anemia

Abstract

Objective To investigate the clinical and imaging features of patients with cerebral venous sinus thrombosis (CVST) associated with iron deficiency anemia (IDA) and to analyze its possible pathogenesis. Methods Eighteen patients with CVST associated with IDA, consecutively admitted to our hospital from January 2006 to June 2018, were chosen in our study. Their clinical presentations, laboratory and neuroimaging features, treatments and prognoses were retrospectively analyzed. Results (1) Mean hemoglobin concentration was (81.6±16.0) g/L (53 g/L-112 g/L), with mild anemia in 5 patients (27.8%), moderate anemia in 11 patients (61.1%) and severe anemia in 2 patients (11.1%); mean platelet count was (371.9±202.5)×109/L ([64-825]×109/L). (2) The clinical symptoms were highly variable: all the 18 patients had headache (5 with isolated headache); 14 patients were combined with other neurological symptoms, including focal neurological deficits (n=11, 61.1%), disturbance of consciousness (n=5, 27.8%), and epilepsy (n=2, 11.1%). (3) MR imaging showed that 14 patients (77.8%) were with venous infarction, in which 10 (55.6%) had hemorrhagic transformation; MR venography showed that 16 patients (88.9%) were with more than one cerebral venous thrombosis, and the most common sites were transverse sinus (n=16, 88.9%), followed by sigmoid sinus (n=13, 72.2%), and superior sagittal sinus (n=9, 50.0%). (4) All 18 patients accepted anticoagulant therapy; one died at the acute phase, and 17 were with good prognosis after 3-6 months of follow-up. Conclusion CVST associated with IDA is common in young and middle-aged women with moderate and severe anemia; the common symptoms include headache and focal neurological deficits; the common imaging features include multiple venous sinus involvement with venous infarction and hemorrhagic transformation; good prognosis can be obtained after anticoagulant therapy. Key words: Cerebral venous sinus thrombosis; Iron deficiency anemia; Polyplastocytosis; Hypercoagulative state; Anticoagulant therapy