Abstract
Gender has been shown to be an important variable in cerebral venous thrombosis (CVT) risk and significantly influences its clinical manifestations and outcome. The aim of our study was to investigate the gender-specific risk factor profile and clinical picture of this rare cerebrovascular disorder. Materials and methods: We retrospectively reviewed the medical records of 89 consecutive cases of CVT at a tertiary neurology clinic in Târgu Mures, Romania, between June 2009 and January 2021 to analyze the gender-related differences in etiology, clinical presentation, and outcome. Results: Women comprised 62.5% of the cohort. Females were significantly younger than males (37.3 years versus 48.8 years, respectively, p = 0.001), and the main risk factors were hormone related in 37.9% of the cases, followed by primary thrombophilia (34.4%), smoking (25.8%), obesity (17.2%), infections (17.2%), mechanical factors (17.2%), cancer (8.6%), systemic autoimmune disorders (8.6%), and hematological disorders (8.6%). In male patients, the main risk factors were smoking (41.9%), primary thrombophilia (29%), infections (22.6%), heavy alcohol consumption (16.1%), and venous thromboembolism in the medical history (12.9%). Frequency of headache was higher in females than in males (75.9% versus 67.7%), whereas frequency of coma (6.5% in males versus 1.7% in females) and dizziness (19.4% in males versus 10.3% in females) was higher in males. CVT onset was acute in 41.4% of females and 38.7% of males. The Rankin score at discharge was significantly lower in females compared with males (0.6 versus 1.6), reflecting a more favorable short-term outcome. Mortality was 6.4% in males and 1.7% in females. Conclusions: CVT is a multifactorial disorder that has a broad spectrum of risk factors with important gender-related differences in clinical manifestation and prognosis. Female patients, especially those with hormone-related risk factors, have a more favorable outcome than male patients.
Highlights
Cerebral venous thrombosis (CVT) is a rare but important subtype of stroke comprising 0.5–1% of all stroke cases and, because of protean and non-specific clinical presentation, represents a diagnostic challenge, requiring a high level of clinical awareness for early diagnosis [7]
CVT was diagnosed on the basis of either computed tomography venous angiography or magnetic resonance venography, in addition to native and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI)
The main differences in the risk factor profile are attributable to the gender-related risk factors such as oral contraceptive medication use and pregnancy/puerperium
Summary
Gender is an important variable in cerebrovascular and cardiovascular diseases, which is reflected in major differences in the rate and evolution of stroke, myocardial infarction, and venous thromboembolism [1]. The mechanism by which gender functions as an important disease modifier in vascular pathology is not fully elucidated, but there is evidence that sex influences even platelet function and coagulation factor activity [2,3,4,5,6]. CVT predominantly affects young adults, with an important female predominance. This uneven gender distribution is mainly attributable to hormone-related risk factors such as oral contraceptive medication, pregnancy, and puerperium and hormone replacement therapy [7,8,9]. The percentage of affected female patients prior to 1981 was
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