Abstract
Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that accounts for 0.5–1.0% of all strokes. Clinical presentation, predisposing factors, neuroimaging findings, and outcomes of CVST are extremely diverse, which causes a high index of suspicion in diagnosis. Therefore, early diagnosis of CVST is crucial for prompt treatment to prevent morbidity and mortality. Objective: The purpose of this prospective study is aimed at assessing the clinical characteristics, potential risk factors, and neuro-radiological features along with the topography of venous sinus involved in CVST patients in a tertiary care hospital, Lahore, Pakistan. Material and Methods: Consecutive patients enrolled in this study had a computed tomography (CT) scan, magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) along with a clinical presentation to confirm the diagnosis of CVST. Categorical data were presented as percentages. Continuous variable and categorical data were compared (parenchymal lesions vs. non-parenchymal lesions) using the Student’s t-test and Chi-square test, respectively. Results: A total of 3261 patients with stroke were presented during the study period. Out of all patients, 53 confirmed patients with CVST (1.6%) were recruited; the predominant population was female (84.91%), having a male to female ratio of 1:4. Mean age of the cohort was 28.39 ± 7.19 years. Most frequent symptoms observed were headache (92.45%) followed by vomiting (75.47%), seizures (62.26%), papilledema (54.72%), visual impairment (41.51%), and altered consciousness disturbance (52.83%). The presumed risk factors associated with CVST were puerperium (52.83%), use of oral contraceptives (13.21%), antiphospholipid syndrome (7.55%), elevated serum levels of protein C and S (5.66%), and CNS infection (3.77%). On cranial CT scans, 50 patients (94.33%) showed abnormalities while 32 patients exhibited various parenchymal lesions. Seizures were more frequent in CVST patients with parenchymal lesions compared with subjects lacking parenchymal lesions. Seventy-two sinuses, either single or in combination, were involved in CVST patients, being more common in patients with parenchymal lesions than those without parenchymal lesions. The most frequent locations of CVST were the superior sagittal and transverse sinus. Conclusion: In short, non-contrast CT brain may be used as a first line investigation in suspected cases of CVST. Our study also demonstrates some regional differences in the clinical features, risk factors, and neuroimaging details of CVST as described by some other studies. Therefore, care must be taken while diagnosing and predicting the outcome of the CVST.
Highlights
Cerebral venous sinus thrombosis (CVST), thrombosis of the dural sinus and/or cerebral veins, is a rare form of stroke, accounting for 0.5–1% of all strokes, and often affects the young population [1]
A prospective cross-sectional, single-center study was conducted from January 2017 to December 2019 of all the patients admitted for stroke at the Department of Neurology, King Edward Medical University, Lahore, Pakistan
Patients enrolled in our study had CVST at a much younger age compared to the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT), the largest study of the disease [9], Cerebral Vein Thrombosis International Study (CEVETIS) [18], and Cerebral Venous Sinuses Thrombosis (VENOST) [19], ranging from 39 to 41 years
Summary
Cerebral venous sinus thrombosis (CVST), thrombosis of the dural sinus and/or cerebral veins, is a rare form of stroke, accounting for 0.5–1% of all strokes, and often affects the young population [1]. Another study from India reported that CVST accounted for half of the young stroke cases and 40% of strokes in women [7]. Clinical presentation of CVST is highly variable and symptoms have been found to range from isolated headache to focal neurological symptoms and signs, seizures, and coma [10]. A multicenter study involving Pakistan and the United Arab Emirates demonstrated that headache (81%), focal motor deficits (45%), seizures (39%), and mental status changes (37%) were more frequently presenting features in 109 patients with cerebral venous thrombosis [12]. The involvement of cerebral sinus has been reported in the majority of patients with CVST [13]
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