Abstract
Headache is the most frequent presenting symptom of cerebral venous thrombosis (CVT), most commonly associated with other manifestations. It has been described as its only clinical presentation in 15 % of patients. There is no typical pattern of headache in CVT. The objective of this study was to study the characteristics of headache as the sole manifestation of CVT. From a prospective study of 30 consecutive patients diagnosed with CVT over 18 months, we selected those who presented with headache only: they had a normal neurological examination, no papilloedema and no blood or any parenchymal lesion on CT scan. All were submitted to a systematic etiological workup and a structured questionnaire about the characteristics of headache was provided. Headache was the sole manifestation of CVT in 12 patients; it was diffuse or bilateral in the majority. Seven patients referred worsening with sleep/lying down, Valsalva maneuvers or straining. There was no association between the characteristics of headache and extension of CVT. Time from onset to diagnosis was significantly delayed in these patients presenting only with headache. In our series, 40 % of patients presented only with headache. There was no uniform pattern of headache apart from being bilateral. There was a significant delay of diagnosis in these patients. Some characteristics of headache should raise the suspicion of CVT: recent persistent headache, thunderclap headache or pain worsening with straining, sleep/lying down or Valsalva maneuvers even in the absence of papilloedema or focal signs.
Highlights
Introduction and aimsCerebral venous thrombosis (CVT) presents with a wide spectrum of manifestations
From a prospective study of 30 consecutive patients diagnosed with cerebral venous thrombosis (CVT) over 18 months, we selected those who presented with headache only: they had a normal neurological examination, no papilloedema and no blood or any parenchymal lesion on computed tomography (CT) scan
There was no uniform pattern of headache apart from being bilateral
Summary
Introduction and aimsCerebral venous thrombosis (CVT) presents with a wide spectrum of manifestations. The most common presenting symptom is headache, frequently associated with other symptoms and signs, namely seizures, focal neurological deficits, papilloedema and impaired consciousness [1]. The clinical picture is determined by the age of patient, site of CVT and the presence or absence of parenchymal lesions [2]. As the only presentation of CVT, has been described but it is rare [1, 3, 4]. In these circumstances, usually computed tomography (CT) scan and/or cerebrospinal fluid (CSF) examination disclose conditions that explain the headache, such as subarachnoid hemorrhage (SAH), parenchymal lesions or meningitis (this last one frequently related to an infections cause of CVT). A typical pattern of headache has not been yet identified [5]
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