Epileptic Seizures Related to Cerebral Venous Sinus Thrombosis: Clinicoradiological Findings and Cases of Delayed Diagnosis.

Abstract

Summary Objectives: We aimed to describe clinicoradiological findings and determine some causes of misdiagnosis or delay in diagnosis of patients with epileptic seizures and status epilepticus related to cerebral venous sinus thrombosis. Methods: Nine patients with seizures or status epilepticus associated with cerebral venous sinus thrombosis, admitted to the intensive care unit between November 2012 and November 2013, were included in the study. Full neurological and ophthalmological examinations, electroencephalography, computerized tomography, magnetic resonance imaging and magnetic resonance venography were performed on all of the patients. Also, previous history of neuropsychiatric disorders, initial findings of cerebral venous sinus thrombosis, specialties, where they were initially directed, and treatment interventions were recorded. Results: The main initial clinical symptom was headache in all patients. All patients had a sub-acute progression of disease. Five patients had convulsive, one had non-convulsive status epilepticus. Six patients had presenting seizures (i.e., seizures occurred before confirmation of diagnosis). The superior sagittal sinus was affected in all cases, except in patients 5 and 6. Initial diagnoses in some patients were eclampsia, dissociative disorder, subarachnoid hemorrhage, migraine, and psychotic disorder. Conclusion: Different clinical presentations of cerebral venous sinus thrombosis and the need for differential diagnosis with respect to similar neuropsychiatric diseases often cause the delay of early diagnosis and treatment of cerebral venous sinus thrombosis, and thus lead to