Rare Cause Of Stroke Research Articles

Infective endocarditis and stroke: when does it bleed? A single center retrospective study

BackgroundInfective endocarditis (IE) is a serious condition with a high mortality, represents a rare cause of stroke and an increased risk of intracranial hemorrhage. In this single center study, we characterize stroke patients with IE. We were interested in risk factors for intracranial hemorrhage and outcome of patients with intracranial hemorrhage compared to patients with ischemic stroke.MethodsPatients with IE and symptomatic ischemic stroke or intracranial hemorrhage admitted to our hospital between January 2019 and December 2022 were included in this retrospective study.Results48 patients with IE and ischemic stroke or intracranial hemorrhage were identified. 37 patients were diagnosed with ischemic stroke, 11 patients were diagnosed with intracranial hemorrhage. The intracranial hemorrhage occurred within the first 12 days after admission. We identified Staphylococcus aureus detection and thrombocytopenia as risk factors for hemorrhagic complications. An increased in-hospital mortality in patients with intracranial hemorrhage (63.6% vs. 22%, p = 0.022) was found, whereas patients with ischemic stroke and patients with intracranial hemorrhage do not differ regarding favorable clinical outcome (27% vs. 27.3%, p = 1.0). 27.3% patients with intracranial hemorrhage and 43.2% patients with ischemic stroke underwent cardiac surgery. Overall, 15.7% new ischemic strokes occurred after valve reconstruction, whereas no new intracranial hemorrhage was observed.ConclusionsWe found an increased in-hospital mortality in patients with intracranial hemorrhage. Beside thrombocytopenia, we identified S. aureus detection as a risk factor for intracranial hemorrhage.

Abstract Number ‐ 114: Deep Cerebral Venous Thrombosis requiring Venous Thrombectomy and Intra‐arterial Thrombolysis in Young Pregnant Female

Introduction Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and mortality especially in young women and children (1). Even though, first‐line treatment remains anticoagulation, some patients deteriorate and endovascular treatment is needed. Currently there are no randomized controlled trials comparing the efficacy and safety of intracranial thrombolysis and mechanical thrombectomy to standard‐of‐care anticoagulation therapy (2). We present a case of a pregnant lady with CVST with successful clinical outcomes with venous thrombectomy and intraarterial thrombolysis. Methods Case Report Results 30 year old lady with no past medical history, 7 weeks and 4 days pregnant presented with acute progressive encephalopathy associated with nausea, vomiting and headaches. On admission, she was stuporous, had dysarthria, severe hemiparesis, and hemineglect on the right side. She had COVID‐19 infection and her fetus had subchorionic hematoma by ultrasound. Initial CT brain showed extensive cerebral venous sinus thrombosis (CVST). She was intubated and MRI showed venous infarcts. MR venography revealed acute extensive CVST of superior sagittal sinus, vein of galen, right transverse sinus, right sigmoid sinus, and right jugular vein. IV Heparin drip was initiated. Her follow‐up neurological exam deteriorated despite maximal medical therapy. The decision was made for endovascular recanalization. The cerebral angiogram confirmed the occlusion of deep venous system. Thrombectomy of bilateral internal jugular vein and sigmoid sinus was performed with retrieval of thrombi. Post‐thrombectomy runs demonstrated persistent extensive CVST and decision was made for intra‐arterial thrombolysis. A diagnostic catheter was secured in the right internal carotid artery catheter (ICA). Thombolysis was performed with 4 mg/hr recombinant tissue‐plasminogen activator (rt‐PA). Heparin drip IV was continued. Subsequently, the repeat CT brain showed significant improvement in the CVST and interval development of intraparenchymal hemorrhages and subarachnoid hemorrhages. Heparin and rt‐PA were held. The patient was found to have Factor V Leiden mutation and she was started on Enoxaparin 1mg/kg throughout her pregnancy and 6 weeks postpartum. Clinically she demonstrated significant neurologic improvement and was discharged to home from rehabilitation center. Currently, she is thirty‐ four weeks pregnant and neurologically intact without any deficits. Conclusions Pharmacological and mechanical endovascular interventions can have significantly successful clinical outcomes in deep cerebral venous thrombosis. Controlled studies are required to assess the safety and efficacy of these interventions when compared to standard systemic anticoagulation.

Decompressive hemicraniectomy for patients with malignant cerebral venous sinus thrombosis

Background and objective: 
 Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and may lead to the development of raised intracranial pressure due to edema, infarct or bleed. These patients may require decompressive hemicraniectomy to reduce the raised intracranial pressure. However, the evidence for hemicraniectomy in these patients is scanty. Our objective was to perform a retrospective chart review to describe the clinical characteristics of patients who underwent decompressive hemicraniectomy for malignant CVT and their outcomes.
 Methods:
 We retrospectively analyzed the medical records of patients with CVST who underwent decompressive hemicraniectomy between 2013 and 2020 at Shifa International Hospital. All patients with CVST diagnosed on the basis of clinical and radiographic findings were included in the study. Patients with primary or metastatic brain tumors were excluded from the study.
 Results: 
 A total of 138 patients with CVST presented to our hospital. Twenty-seven (19.6) developed malignant CVST. Of these patients, 10 underwent decompressive hemicraniectomy (7.2% of total). None of the patients died and seven patients (70%) had a modified Rankin scale score of 2 or less at three months.
 Conclusion: 
 Decompressive hemicraniectomy should be considered for patients presenting with malignant CVST who do not respond to medical treatment.

Abstract 8: Outcomes And Recurrence Rates Among Patients With Provoked And Cryptogenic Cerebral Venous Thrombosis: Analysis Of The ACTION CVT Study

Introduction: Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depend on the underlying etiology. This study aims to identify the characteristics and risk of recurrent venous thromboembolism (VTE) in patients with unprovoked CVT (cryptogenic), transient provoked CVT (peripartum, contraception, infection, trauma) and persistent provoked CVT (cancer, hereditary thrombophilias). Methods: We used the ACTION CVT retrospective database which included consecutive CVT patients in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. Baseline characteristics were compared between the groups using Chi square test, T test or Mann-Whitney-U test, followed by multivariable logistic regression. We used interaction analysis to assess the risk of recurrent venous thromboembolism (VTE). Results: A total of 1025 CVT patients were included in this study; 363 (35.4%) had transient provoking factors, 152 (14.8%) had persistent provoking factors, and 510 (49.8%) had cryptogenic CVT. Patients with transiently provoked CVT were younger (P=0.003) and more likely to be women (P<0.001), and patients with cryptogenic CVT were less likely to have a prior VTE (P<0.001). Compared to patients with transient provoked, there was higher risk of recurrent VTE in patients with persistent provoking factors (HR 2.59, 95% CI 1.29-5.22, P=0.008) and numerically higher recurrent VTE risk in cryptogenic CVT (HR 1.85, 95% CI 0.98-3.51, P=0.059). These associations did not vary by age, sex, or history of VTE status (p-interaction > 0.1 for all). Results were similar in sensitivity analyses excluding those with positive Factor V Leiden or Prothrombin gene mutation as well as in analyses excluding patients with positive antiphospholipid antibody test. Conclusions: In this multicenter study, we found that the risk of recurrent VTE after CVT may vary depending on the underlying etiology with higher rates in patients with cryptogenic CVT and those with persistent provoking factors. Longer anticoagulation duration may be needed in such groups compared to CVT with transient provoking factors.

A case of ischemic stroke with hemorrhagic transformation associated with essential thrombocythemia and JAK-2 V617F mutation

BackgroundEssential thrombocythemia (ET) is a rare cause of stroke. The V617F mutation in the Janus kinase 2 (JAK2) gene is one of the most typical mutations in ET and has been shown to be a risk factor for stroke, especially in younger people. However, to date, there have been few reports of intracranial thrombotic and hemorrhagic complications in patients with ET. Herein, we present a case of JAK2 gene mutation-associated ET in a patient who developed both ischemic and hemorrhagic stroke, and discuss potential underlying mechanisms.Case presentationA 45-year-old Chinese male presented to our center with gradually developing weakness of the right limbs for 3 months. A computed tomography scan of the brain showed an area of infarction with hemorrhage in the left subcortical and corona radiata regions. High-resolution magnetic resonance imaging revealed a thrombosis on the surface of the atherosclerotic plaque. Digital subtraction angiography revealed an insect bite-like change in the C1 branch of the left internal carotid artery, which caused up to 50% stenosis. Blood tests showed continued elevation of the platelet and white blood cell counts. After consultation with a hematologist, a bone marrow biopsy was performed, which revealed proliferative bone marrow changes with numerous megakaryocytes and proliferative but mature granulocytes. Further genetic testing revealed a positive JAK2-V617F mutation. Therefore, the diagnosis of ET was confirmed according to the World Health Organization (WHO) 2016 diagnostic criteria. Finally, we decided to administer aspirin and hydroxyurea. The patient remained stroke free and the platelet levels were normal throughout the 1-year follow-up period.ConclusionsJAK2 mutations affect the proliferation and differentiation of blood cells through the JAK, signal transducer and activator of transcription pathway, which leads to changes in platelets and macrophages, and an increase in neutrophil extracellular traps, which may explain the patient’s ischemic and hemorrhagic changes. Further investigation of the underlying mechanisms may change the treatment strategy for such patients in the future.

SUPERIOR SAGITTAL SINUS THROMBOSIS PRESENTING AS DETERIORATING RESIDUAL WEAKNESS

SUPERIOR SAGITTAL SINUS THROMBOSIS PRESENTING AS DETERIORATING RESIDUAL WEAKNESS

Natural history of carotid artery free-floating thrombus—A single center, consecutive cohort analysis

IntroductionCarotid free-floating thrombus (CFFT) is a rare cause of stroke and is thought to be associated with a high risk of recurrent cerebrovascular ischaemic events. The existing data on the natural history and optimal treatment modalities of CFFT is scanty and no clear recommendations exist.ObjectiveA retrospective analysis, single-center cohort of consecutive patients diagnosed with CFFT was conducted, investigating the risk for recurrent cerebrovascular ischaemic events.MethodsWe performed a single-center retrospective analysis including all patients presenting at our tertiary center between January 2005 and December 2020 with symptoms consistent with ischaemic stroke and/or transient ischaemic attack. Digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance angiography (MRA) were used to diagnose CFFT. In all included patients, CFFT was confirmed with a second imaging modality. CFFT was defined on imaging as a defect in contrast filling extending into the carotid lumen. We gathered information on vascular risk factors, diagnosis and follow-up methods, modality of treatment and neurological outcome. A survival analysis was performed, assessing the risk for recurrent cerebrovascular events.ResultsIn total, N = 62 patients presenting with symptomatic CFFT were included. Mean age was 68 years, 69% (43/62) of patients were male, 52% (32/62) current or previous smokers, 76% (47/62) suffered from arterial hypertension, 68% (42/62) from dyslipidaemia, and 31% (19/62) from diabetes mellitus. Overall, 71% (44/62) of patients received any kind of intervention [endovascular or surgical carotid thrombo-endartectomy (CEA)] at any time point during follow-up. Sixteen percent of patients (10/62) received intervention within 48 h after diagnosis of CFFT. The survival analysis and Kaplan-Meier model censoring patients at the time of intervention or last follow-up showed that the risk for any recurrent ischaemic stroke was 19.7% within the first 7 days and 27.4% within 3 months after diagnosis. No patients experienced a new ischaemic stroke beyond 11 days after diagnosis of CFTT (n = 17).ConclusionThe risk of recurrent ischaemic events in patients with CFFT is high, especially in the first week after diagnosis. Prospective studies are needed to further investigate the optimal management of these patients.

Imaging of Cerebral Venous Thrombosis.

Cerebral venous thrombosis is a rare cause of stroke. Imaging is essential for diagnosis. Although digital subtraction angiography is still considered by many to be the gold standard, it no longer plays a significant role in the diagnosis of cerebral venous thrombosis. MRI, which allows for imaging the parenchyma, vessels and clots, and CT are the reference techniques. CT is useful in case of contraindication to MRI. After presenting the radio-anatomy for MRI, we present the different MRI and CT acquisitions, their pitfalls and their limitations in the diagnosis of cerebral venous thrombosis.

Clinical Profile and Short-Term Outcome of Cerebral Venous Thrombosis in a Nepalese Population: A Retrospective Study

Introduction: Cerebral venous thrombosis (CVT) is a rare cause of stroke. The increased awareness among the physicians and the suspiciousness of the myriad of its clinical presentation with increased availability of investigation modules and therapeutic options has led to a decrement of mortality and morbidity. The study intends to assess the clinical etiological profile of patients of CVT and also to assess short-term outcomes and if any factors are associated with it. Methods: It was a hospital-based retrospective, observational cross-sectional study at a tertiary care center in Kathmandu among adult CVT patients from August 2019 to August 2021. Clinical, etiological, and radiological data, the outcome at discharge, and any factors influencing this were assessed where possible. Data were analyzed using SPSS 25 software. Analysis of the descriptive data was performed and independent factors influencing short-term outcome (admission date < 7 days) were analyzed. Results: There were a total of 15 cases included in the study. The study showed female predominance (66.7%. The mean age of the patients was 48.87 years. Four (26.7%) patients had hypertension. The history of oral contraceptive pill (OCP) use was among five (33.33%) females. A significant association was present with direct signs in CT scan (p=0.02), and low erythrocyte sedimentation rate (ESR), p= (0.02). Conclusions: OCP and hypertension are increasingly recognized as independent risk factors for CVT. The presence of direct signs in the CT head and the presence of high ESR have independent predictive value in assessing short-term outcomes.

A Case Report Symptoms Improvement of Cerebral Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke, a life-threatening disorder that occurs in approximately 0,5-1% of all stroke incidents. Various clinical presentations, risk factors, and neuroimaging findings of this disease may cause a delay in the early diagnosis and treatment of CVT. We discuss a case of a 34-year-old female who was admitted to the emergency room (ER) with the onset of a generalized tonic-clonic seizure with a progressive headache in the occipitotemporal region. Based on head CT, there was multiple hyperdense and cerebral venous infarction in the posterior left parietal lobe. D-dimer evaluation, there was an increasing level of D-dimer (>10.000 ng/mL). The patient was treated with the primary therapy heparin. After 15 days of being hospitalized, the patient was discharged without any sequelae.
 Keywords: CVT, heparin, stroke

Effectiveness of the Digging through Thrombus Technique by Using an Aspiration Catheter and Stent Retriever for Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) is a rare cause of stroke, and the first-line treatment is systemic anticoagulation. Patients unresponsive to standard therapy for CVT present with rapid neurological deterioration and require endovascular treatment. We encountered two patients with severe CVT who underwent endovascular treatment. In our cases, the thrombus was too hard and extensive to pass through using currently existing techniques. We performed the “digging through thrombus technique” using an aspiration catheter and stent retriever and achieved rapid sinus recanalization and favorable outcomes.

Loeffler’s endocarditis: A rare cause of stroke resulting in person in the barrel syndrome (P3-10.001)

Loeffler’s endocarditis: A rare cause of stroke resulting in person in the barrel syndrome (P3-10.001)

Acute Ischemic Stroke Caused by Detachment of Cardiac Papillary Fibroelastomas

Cardiac papillary fibroelastomas are associated with a high risk of systemic embolization in spite of benign nature. We report a case of 85-year-old patient with left supraclinoid internal carotid artery occlusion who treated with aspiration thrombectomy. Despite of the absence of residual mass on echocardiography, we could analyze pathologic specimens using retrieved embolus and confirmed cardiac papillary fibroelastoma as a rare cause of stroke.

Clinical profile of cerebral venous thrombosis in a tertiary care center and utility of D-dimer in its diagnosis

Background & Objectives: Cerebral venous thrombosis (CVT) is a rare cause of stroke, occurring commonly in young adults. The variability in the clinical scenario from patient to patient and the lack of specificity of the presenting symptoms of CVT poses a diagnostic challenge. This study aims to analyze the clinical characteristics of patients diagnosed with CVT in comparison to the global profile and explore the diagnostic utility of D-dimer levels as a screening tool in patients with clinical features suspicious of underlying CVT. Methods: This was a hospital-based case-controlled study, included 50 imaging proven patients with CVT and age and sex matched healthy controls. Demographic details were collected, detailed neurological examination done at presentation and d- dimer levels were evaluated. Results: Among our study group a male preponderance was noted (60%) in discordance with the global pattern of CVT. Headache was the most common presenting feature and papilledema was noted in 98% of our patients. Additional clinical signs noted at presentation were nausea and vomiting (78%), seizures (28%), limb weakness (24%) and alteration in sensorium at presentation (14%). Risk factors were alcohol dependency (36%), postpartum period (12%) and anaemia (12%). Additionally the sensitivity of D-dimer was noted to be 90.74% with a specificity of 100% in predicting the disease. Conclusion: Our study differs from the global pattern of CVT in terms of male preponderance, higher detection of papilledema, lesser occurrence of anaemia, and a large proportion of patients with d-dimer positivity. The limitation of the study is the sample size as we cannot extrapolate our results to the population at large. However our data is in concordance with the current concept of CVT, that diagnosis is the key challenge in management.

Moyamoya Disease Associated with Hyperhomocysteinemia: A Rare Cause of Stroke in Sub-Saharan Africa

Introduction: Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive bilateral occlusion of the supraclinoid internal carotid artery (ICA) and its main branches, associated with the development of fine collateral networks, especially adjacent to the site of occlusion in the deep areas of the brain. MMD frequently occurs in East Asian populations, including pediatric and adult patients, and may lead to ischemic or hemorrhagic stroke, headache, epilepsy or transient ischemic attack. The majority is presumed to be of genetic origin and few cases of thrombophilia have been reported in MMD. We report a case of MMD in a young sub-Saharan African woman associated with Hyperhomocysteninemia (HHCys). Observation: A 33-year-old female was seen for aphasia, which had suddenly appeared fourteen days before, and was associated with memory impairment. She mentioned chronic headaches during the 10 previous years, of frontal seat, without migraine criteria. She had no history of hypertension, no obesity, no known dyslipidemia, and there was no family history of stroke. Neurological examination noted Wernicke’s aphasia, with discreet right central facial palsy, associated with memory impairment. The brain MRI revealed semi recent infarct in the left parietal lobe, sequelae in the left temporo-occipital and right frontal with lacunar ischemic lesions, associated with several foci of sub- cortical demyelination. MRA showed stenosis of the supraclinoid carotid arteries and their division branches. In addition, there was a stenosis of the posterior cerebral arteries, with a network of anastomosis at the level of the base of the skull. An investigation of thrombophilia showed hyperhomocysteinemia (HHCys). The diagnosis of moyamoya disease associated with hyperhomocysteinemia was mentioned. She was treated by Aspirin combined to folic acid. After a 3-year setback the patient was asymptomatic. Conclusion: MMD is a rare cause of stroke in sub-Saharan Africa. MRA should be performed whenever possible, as well as investigation for thrombophilia when it’s available. Combined antiplatelet agent with folic acid for ischemic stroke prevention is effective.

Updates in Cerebral Venous Thrombosis.

Purpose of ReviewCerebral venous thrombosis (CVT) is a rare cause of stroke that most commonly affects younger women. Here, we review new literature relevant to the management and prognosis of individuals with CVT and ongoing areas of uncertainty.Recent FindingsDirect-acting oral anticoagulants (DOACs) are being increasingly integrated into routine care but are not yet recommended by guidelines. Recent randomized clinical trials and available case series offer reassuring safety data. Routine use of endovascular therapy is not associated with improved outcomes. The relationship between recanalization and prognosis is uncertain.SummaryThe evidence base for management of CVT continues to improve. Ongoing areas of uncertainty include duration of therapy and whether certain subgroups of patients may benefit from neurointervention or personalized approaches to antithrombotic strategy. The state of knowledge will continue to benefit from large collaborative international efforts, and integration of patient partnerships to identify research priorities.

Dissection of cerebral arteries as a cause of ischemic stroke

Dissection of cerebral arteries is a rare cause of stroke in the general population. The article describes 5 clinical cases of patients with ischemic stroke after dissection, discusses the issues of etiology, diagnosis and treatment tactics. The possibility of using high-tech methods of treatment for this subtype of stroke is emphasized. The diagnostic method of choice is neuroimaging, including cerebral angiography.

Endovascular Therapy Versus Anticoagulation for Treatment of Cerebral Venous Sinus Thrombosis: A Meta-Analysis.

Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that mainly affects the young. Anticoagulation (AC) with heparin is the mainstay of treatment for CVST. Although highly anticipated, endovascular therapy (ET) including local thrombolysis and mechanical thrombectomy has been controversial. To compare the effectiveness and safety of ET with AC for patients with confirmed CVST, we systematically searched PubMed, Embase, and Cochrane Library from the earliest date to February 2020. Data on the total number of patients in each treatment group and the exact number of patients for each outcome were separately extracted from 10 studies with 891 patients.Our Results show that ET has a higher mortality rate compared with AC [odds ratio (OR)=1.95; 95% confidence interval (CI), 1.19-3.18; P=0.008<0.01] and has lower probability of good outcome (OR=0.48; 95% CI, 0.23-1.02; P=0.056). ET leads to a higher risk of complications than AC (OR=5.29; 95% CI, 1.17-23.95; P=0.030<0.05). No difference was found in recurrence rate between 2 treatments (OR=0.85; 95% CI, 0.31-2.35; P=0.761). ET is related to a higher mortality, fewer good outcome and possibly more complications compared with AC. The risks of ET should be weighed in every individualized therapeutic decision.

Massive Cerebral Air Embolism Causing Stroke Secondary to Pulmonary Tuberculosis.

ABSTRACTCerebral air embolism due to pulmonary tuberculosis is an extremely rare cause of stroke. We report an unusual case of a presentation of cerebral air embolism likely due to pulmonary tuberculosis lesions during a severe cough. We discuss the relationship between the pulmonary tuberculosis and the occurrence of the cerebral air embolism. A 55-year-old man with lung tuberculosis suddenly experienced a nontraumatic loss of consciousness after a severe cough. The magnetic resonance imaging confirmed an ischemic stroke due to cerebral air embolism. The thoracic scan revealed tuberculosis with a parenchymatous cavity. Patients with intrapulmonary tuberculosis cavities should be strongly considered for surgical repair and should be warned about the risk of rupture of the cavity in the situation of increasing thoracic pressure.How to cite this article: Bouaggad A, Moussaoui M, Abassi O, Hassen S, Essodegui F. Massive Cerebral Air Embolism Causing Stroke Secondary to Pulmonary Tuberculosis. Indian J Crit Care Med 2021;25(8):942–944.

Structural Imaging Characteristic, Clinical Features and Risk Factors of Cerebral Venous Sinus Thrombosis: A Prospective Cross-Sectional Analysis from a Tertiary Care Hospital in Pakistan.

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.