Symptom Of Cerebral Venous Thrombosis Research Articles

Cerebral venous thrombosis and the eye: the neuro-ophthalmology of cerebral venous blood clot

Introduction: Cerebral venous thrombosis (CVT) is a form of venous thromboembolism which has varied clinical presentation. Ocular clinical features are quite common in CVT and may be the sole presenting feature and often tend to get misdiagnosed. This study was conducted to analyse clinical features especially neuro ophthalmological manifestations in CVT patients. Materials and Methods: In this prospective study 60 patients were enrolled in a study period of 3 years at tertiary care hospital. Follow up visits were performed at 1 month, 3 months, 6 months and 12 months after the initial diagnosis. We analysed the clinical features as well as aetiology of CVT, special focus was on the ocular symptoms and signs. Results: Headache was the most common clinical symptom with 93.33% patients. Among ocular symptoms 43.33 % patients presented with complaint of blurring of vision. Among ophthalmological signs papilledema was reported in 40.0 % patients, cranial nerve involvement in 10.0 % patients, diplopia was seen in 6.66 % patients. In patients with papilledema the intensity reduced as time progressed. Vision loss was seen in 2 patients who had secondary optic atrophy. Conclusion: To avoid misdiagnosis and for the prevention of vision deterioration the ophthalmologist must pay attention to CVT symptoms and signs when patients present with ocular symptoms as the initial manifestation.

Canadian Stroke Best Practice Recommendations, 7th Edition: Cerebral Venous Thrombosis, 2024.

The 7th edition of the Canadian Stroke Best Practice Recommendations (CSBPR) is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners, and intended to drive healthcare excellence, improved outcomes and more integrated health systems. This edition includes a new module on the management of cerebral venous thrombosis (CVT). Cerebral venous thrombosis is defined as thrombosis of the veins of the brain, including the dural venous sinuses and/or cortical or deep veins. Cerebral venous thrombosis is a rare but potentially life-threatening type of stroke, representing 0.5-1.0% of all stroke admissions. The reported rates of CVT are approximately 10-20 per million and appear to be increasing over time. The risk of CVT is higher in women and often associated with oral contraceptive use and with pregnancy and the puerperium. This guideline addresses care for adult individuals who present to the healthcare system with current or recent symptoms of CVT. The recommendations cover the continuum of care from diagnosis and initial clinical assessment of symptomatic CVT, to acute treatment of symptomatic CVT, post-acute management, person-centered care, special considerations in the long-term management of CVT, including pregnancy and considerations related to CVT in special circumstances such as trauma and vaccination. This module also includes supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.

Clinical course and diagnosis of cerebral vein and sinus thrombosis associated with COVID-19 in young and middle-aged patients

Cerebral venous thrombosis (CVT) is a form of cerebrovascular disorders that is difficult to recognize, it is potentially a life threatening condition and requires timely anticoagulant therapy. In the era of the COVID-19 pandemic, there is a steady increase in CVT (4.2% vs. 0.5–1%). At the same time, mortality in patients with CVT on the background of COVID-19 significantly exceeds the mortality in patients with CVT without COVID-19 (45.5% vs. 15%). Objective: to study the clinical course of CVT, to determine the diagnostic value of radiological methods and the significance of genetic risk factors for thrombosis in the development of CVT in young and middle-aged patients against the background of COVID-19. Material and methods. Seven patients were examined: six women (five of them of reproductive age) and one man, aged 26 to 57 years (mean age 37 years). The main clinical and neurological manifestations of CVT, the results of laboratory examination, neuroimaging, and the data of molecular genetic analysis of risk factors for thrombosis were analyzed. Results. The course of COVID-19 was severe in one case, and moderate in the rest of cases. The interval between the onset of COVID-19 symptoms and the development of CVT ranged from 7 to 25 days. In three cases CVT had an acute course and was accompanied by the development of a stroke (in two cases, hemorrhagic stroke was noted, in one case, multifocal ischemic stroke), in other cases, a subacute course of CVT was noted. Genetic risk factors for thrombosis were identified in all patients.Conclusion. The diagnosis of CVT in the era of the COVID-19 pandemic is particularly difficult, since the most common symptom of CVT – headache (90%) – can be regarded as a manifestation of COVID-19. At the same time, timely diagnosis of CVT and immediate initiation of anticoagulant therapy are associated with a relatively favorable prognosis.

Clinical and diagnostic features of course of cerebral venous thrombosis during COVID‑19 pandemic

Relevance. During the COVID‑19 pandemic, there has been an increase in the frequency of cerebral venous thrombosis (CVT) by 30–60 times. At the same time, the development of CVT does not depend on the severity of COVID‑19. Diagnosis of CVT during the COVID‑19 pandemic is particularly difficult, since the most common symptom of CVT, headache, can be regarded as a manifestation of COVID‑19. A wide range of clinical symptoms and low alertness of doctors leads to late diagnosis and verification of CVT.Purpose of the study. To analyze the features of clinical manifestations and neuroimaging signs of CVT against the background of COVID‑19. Patients and methods. We examined 70 young and middle-aged patients with COVID‑19 of varying severity, who underwent inpatient treatment in angio-neurological and re-profiled infectious diseases departments of North-Western State Medical University n. a. I. I. Mechnikov (Saint Petersburg, Russia) at the age of 18 to 59 years (38.5 ± 11.58), of which 49 (70 %) women and 21 (30 %) men.Results. The most common neurological symptom in patients with CVT due to COVID‑19 was diffuse headache. The severity of COVID‑19 and the degree of lung damage did not correlate with the severity of CVT. In 32 (46 %) cases, CVT was accompanied by the development of venous stroke: ischemic – in 13 (19 %) patients, hemorrhagic – in 7 (10 %), ischemic stroke with hemorrhagic impregnation – in 12 (17 %) patients. According to the localization of the thrombus, thrombosis of the left transverse sinus was most often noted – in 39 (57 %) cases.Conclusions. The leading symptom in all patients with CVT was headache, which was not relieved by taking conventional analgesics, which caused clinical alertness of doctors. Early diagnosis of CVT ensured the immediate start of anticoagulant therapy and contributed to positive dynamics in all patients in the form of regression of neurological deficit and improvement in general condition.

Headache at the chronic stage of cerebral venous thrombosis.

Headache is the most frequent symptom of cerebral venous thrombosis (CVT) but there is limited information about the frequency and phenotype of headache, weeks to months after cerebral venous thrombosis (post-cerebral venous thrombosis headache, PCH). To assess the frequency, characteristics and predictors of PCH. In this cross-sectional study, the frequency and characteristics of PCH were assessed in cerebral venous thrombosis survivors. Patients were interviewed between six months and five years after the cerebral venous thrombosis diagnosis. Clinical and imaging characteristics at the time of cerebral venous thrombosis diagnosis, as well as history of headache prior to cerebral venous thrombosis were compared in subjects with (GroupPCH) and without PCH (Groupcontrol). Subjects (n = 100; 82% women) were assessed, on average, at 1.1 ± 1.6 years of follow-up. PCH was present in 59% of the patients, phenotypes of tension-type-like headache were present in 31/59 (52.6%) and of migraine-like headache in 16/59 (27.1%). History of primary headache prior to cerebral venous thrombosis was significantly more common (OR: 6.4; 95% CI: 1.7-36.3) in GroupPCH (33.9%) than in Groupcontrol (7.3%). PCH was present in more than half of the patients. History of prior headache may be a risk factor for PCH. Prospective studies are required to confirm these findings and determine mechanisms, as well as interventions for prevention and treatment of PCH.

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.

Multidetector Computed Tomography Venography versus Magnetic Resonance Venography in Cerebral Venous Thrombosis: A Cross-sectional Study

Introduction: Cerebral Venous Thrombosis (CVT) is a relatively uncommon condition whose presentation is varied. The diagnostic imaging features can be subtle. The correct diagnosis of CVT relies on neuroimaging Non Contrast Computed Tomography (NCCT), CT Venography (CTV), Magnetic Resonance Imaging (MRI), MR Venography (MRV). Aim: To compare 128 slice Multidetector Computed Tomography (MDCT) venography and MRV in CVT, taking MRV as gold standard. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Gandhi Medical College, Secunderabad, Telangana, India, from October 2017 to September 2019. The study constituted of 56 patients, with clinical signs and symptoms of CVT who underwent MDCT venography and MRV. NCCT with MDCT venography was carried out on HITACHI 128 slice CT machine and MR imaging was performed in 1.5 tesla SIEMENS AVANTO systems. Imaging findings analysed on NCCT were hyperdense cord sign, delta sign, and multiple parenchymal hypodense lesions in bilateral parasagittal location, bilateral thalamic hypodensities, and isolated temporal bleed and on CTV signs like empty delta / empty triangle sign. Plain MRI was assessed for involved sinuses with thrombus showing loss of expected flow void with hyperintensity on T1-Weighted (T1W) and blooming on Gradient Recalled Echo (GRE). Parenchymal changes were assessed for presence of cytotoxic oedema, vasogenic oedema and haemorrhagic infarct. MRV was assessed for nonvisualisation of involved sinus or lack of normal flow related enhancement. Results: Among the total 56 study subjects evaluated, 48 were diagnosed to have CVT on both CTV and MRV. On CTV, 147 sinuses were found to be involved, while MRV showed involvement of 142 sinuses. One case was found to be negative for thrombus on CTV but positive on TOF (Time of Flight) MRV. Both CTV and MRV were negative for CVT in seven patients. The sensitivity and specificity of NCCT in diagnosing CVT was found to be 60% and 87% respectively. Conclusion: The parenchymal changes in CVT were better evaluated on MRI. Venous abnormalities were better depicted in MRI as loss of flow voids in T1, T2 and with dark signal on GRE. Haemorrhagic bleeds were easily evaluated on MRI with 100% sensitivity of GRE sequence. CTV was easier to interpret, showed better and faster depiction of sinuses, with thin section reformatted images and showed higher spatial resolution compared to MRV.

Хроническая головная боль как проявление венозного тромбоза дурального синуса

Пациентам с мозговым венозным тромбозом (МВТ) присущ широкий спектр клинических проявлений — от головной боли до комы. Хроническая окклюзия венозных синусов твердой мозговой оболочки приводит к формированию ряда компенсаторных явлений, таких как сосудистая коллатерализация, реканализация организованного тромба, эффективность которых и определяет тяжесть состояния и течение заболевания. Целью нашего исследования стало освещение клинической проблемы диагностирования хронического субкомпенсированного МВТ. С учетом того, что такое течение процесса наблюдается в 20 % случаев, около четверти пациентов, у которых заболевание проявляется головной болью неясной этиологии, остаются незамеченными и с низким качеством жизни. Для анализа течения и прогноза заболевания нашей задачей стало тщательное изучение механизмов адаптации организма при хроническом тромбозе дурального синуса в виде формирования системы венозных коллатералей и реканализации. Однако весомым подводным камнем хронической окклюзии венозных синусов твердой мозговой оболочки при отсутствии соответствующего лечения является то, что гемодинамические компенсаторные явления также определяют и высокий риск развития цереброваскулярных катастроф, которые приводят к летальному исходу или инвалидизации. В представленном нами клиническом случае имел место хронический венозный тромбоз поперечного и сигмовидного синусов, который манифестировал мигренеподобным цефалгическим синдромом с вегетативным компонентом и постепенным нарастанием синдрома внутричерепной гипертензии. Без антикоагулянтной терапии венозный дренаж через коллатеральные пути, отсроченная реканализация тромбированных синусов осуществлялись у пациента неэффективно, что привело к формированию диффузного отека, вторичному повреждению мозговой ткани. После проведения тщательного обследования, установления диагноза, назначения индивидуализированного лечения и длительного наблюдения с коррекцией терапии у пациента имел место регресс симптомов МВТ. Церебральная МР-венография — это важный инструмент в диагностике и прогнозе данного заболевания. Таким образом, пациентам с длительным анамнезом головной боли, которая не поддается лечению и имеет признаки внутричерепной гипертензии, нужно проводить МР-венографию. Тем не менее в случаях геморрагических инсультов неясного генеза, которые не соответствуют артериальным территориям, часто возникает необходимость исследовать состояние вен головного мозга и твердомозговых синусов. С целью индивидуального анализа течения и прогноза заболевания необходимо изучать формирование венозных коллатералей и процессов реканализации тромбов дурального синуса пациента.

Cerebral venous thrombosis in pregnancy: a case report

Cerebral venous thrombosis (CVT) is a rare, multi-symptomatic, and serious complication in pregnancy. CVS constitutes 2% of the causes of strokes in pregnancy. The most common symptoms of cerebral venous thrombosis are: headaches (74%), seizures (50%), limb paresis (38%), disturbed consciousness (45%), visual disturbances (24%). We present our 28-year-old pregnant patient because the dominant symptom was hemi -choreoathetotic movement, which made the daily life very difficult. After the differential diagnostic examinations we recognized cerebral venous thrombosis. After anti-clotting treatment, the symptoms resolved. We would like to point out that such a disorder in pregnant women may also be a symptom of cerebral venous thrombosis.

Delayed onset of fat embolus in the cerebral venous system after breast and hip augmentation: a case report

BackgroundCerebral fat embolism (CFE) is a subtype of fat embolism syndrome which tends to cause ischemic cerebral infarction. Fat embolism in the cerebral venous system have not been reported. We hereby present a rare case of fat embolus formed in the cerebral venous system 10 days after cosmetic surgery, and describe our management of this patient.Case presentationA 26-year-old woman with the disturbance of consciousness and recurrent convulsions of the right upper extremity over a 21-h period was admitted to our hospital. The patient was initially diagnosed with haemorrhagic infarction, and cerebral venous thrombosis (CVT) was suspected based on computed tomography (CT). A diagnosis of CFE was confirmed based on surgical findings. Breast and hip augmentation performed 10 days ago was considered the underlying cause. Drug-induced hypothermia, low molecular weight heparin, atorvastatin, dexamethasone, piperacillin/tazobactam, valproic acid, and mannitol were applied. On hospital day 30, she was discharged with a Montreal Cognitive Assessment score of 25.ConclusionsFat embolism can occur in the cerebral venous system, and may mimic CVT symptoms rather than CFE symptoms. Early identification of the nature of the embolus is essential. The use of heparin may prevent secondary thrombus formation, and accelerate fat embolus decomposition.

Headache Attributed to Vaccination Against COVID-19 (Coronavirus SARS-CoV-2) with the ChAdOx1 nCoV-19 (AZD1222) Vaccine: A Multicenter Observational Cohort Study.

IntroductionThe most frequently reported neurological adverse event of ChAdOx1 nCoV-19 (AZD1222) vaccine is headache in 57.5%. Several cases of cerebral venous thrombosis (CVT) have developed after vaccination. Headache is the leading symptom of CVT. For the differential diagnosis of headaches attributed to this vaccine and headaches attributed to CVT, it is of central clinical importance whether and, if so, how the phenotypes and course of these headaches can be differentiated. The study aims to examine in detail the phenotype of headache attributed to this vaccine.MethodsData on the clinical features and corresponding variables were recorded using a standardized online questionnaire in this multicenter observational cohort study. The primary outcomes of this study are the clinical features of headaches after vaccination.FindingsA total of 2464 participants reported headaches after vaccination with the ChAdOx1 nCoV-19 (AZD1222) vaccine. On average, headaches occurred 14.5 ± 21.6 h after vaccination and lasted 16.3 ± 30.4 h. A bilateral location was described by 75.8% of participants. This is most often found on the forehead (40.0%) and temples (31.4%); 50.4% reported a pressing and 37.7% a dull pain character. Headache intensity was most often severe (38.7%), moderate (35.2%), or very severe (15.5%). Accompanying symptoms were most commonly fatigue (44.8%), chills (36.1%), exhaustion (34.9%), and fever (30.4%).ConclusionHeadaches attributed to COVID-19 vaccination with the ChAdOx1 nCoV-19 (AZD1222) vaccine demonstrate an extensive and characteristic complex of symptoms. The findings have several important clinical implications for the differentiation of post-vaccinal headache and other primary as well as secondary headaches.

Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis.

Background and purposeSevere acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection predisposes patients to arterial and venous thrombosis. This study aimed to systematically review the available evidence in the literature for cerebral venous thrombosis (CVT) in association with coronavirus disease‐2019 (COVID‐19).MethodsWe searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases to identify cases of COVID‐19–associated CVT. The search period spanned 1 January 2020 to 1 December 2020, and the review protocol (PROSPERO‐CRD42020214327) followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Identified studies were evaluated for bias using the Newcastle‐Ottawa scale. A proportion meta‐analysis was performed to estimate the frequency of CVT among hospitalized COVID‐19 patients.ResultsWe identified 57 cases from 28 reports. Study quality was mostly classified as low. CVT symptoms developed after respiratory disease in 90%, and the mean interval was 13 days. CVT involved multiple sites in 67% of individuals, the deep venous system was affected in 37%, and parenchymal hemorrhage was found in 42%. Predisposing factors for CVT beyond SARS‐CoV‐2 infection were present in 31%. In‐hospital mortality was 40%. Using data from 34,331 patients, the estimated frequency of CVT among patients hospitalized for SARS‐CoV‐2 infection was 0.08% (95% confidence interval [CI]: 0.01–0.5). In an inpatient setting, CVT accounted for 4.2% of cerebrovascular disorders in individuals with COVID‐19 (cohort of 406 patients, 95% CI: 1.47–11.39).ConclusionsCerebral venous thrombosis in the context of SARS‐CoV‐2 infection is a rare, although there seems to be an increased relative risk. High suspicion is necessary, because the diagnosis of this potentially life‐threatening condition in COVID‐19 patients can be challenging. Evidence is still scarce on the pathophysiology and potential prevention of COVID‐19–associated CVT.

Headache in cerebral venous thrombosis.

Headache has been consistently reported as the most common symptom of cerebral venous thrombosis and as the most frequent presenting feature. It is often the heralding symptom, preceding other manifestations of the disease by days or even weeks. This aspect highlights the importance of recognizing headache due to cerebral venous thrombosis, as early recognition of the disease can lead to a rapid diagnosis with appropriate imaging techniques and as early treatment with heparin can dramatically change the course of the disease and alter the prognosis. Unfortunately, although common, the headache has no specific features, and the clinical presentation of CVT is highly variable, making the correct diagnosis in the emergency setting a challenging task for clinicians, even in the case of highly specialized ones such as neurologists. In this review, we will briefly summarize the epidemiology and physiopathology of CVT, and then we will discuss in more details the causes, features, and course of headache, focusing on its relevance for differential diagnosis and on red flags that should suggest the possibility of CVT as the cause of the headache.

Subdural hematoma as a manifestation of cerebral venous thrombosis. Case report

Cerebral venous thrombosis (CVT) is a common complication in pregnant, postpartum and eclampsia patients in a developing country, more common with another pathology prothrombotic profile. Commonly, acute non-traumatic subdural hematomas are rare in young patients without haematological disorders. We reported a case of acute subdural hematoma (ASH) in a patient with cerebral venous thrombosis. A 34-year-old postpartum woman who present seizure in a postpartum period, was studied in the ICU of our hospital. She is under sedation and CT cranial study to show hyperdensity in the superior longitudinal sinus and the left transverse sinus with diffuse subcortical cortical hypodensity in both parietal and occipital lobes and delta sign. All date according a CVT. In addition, a subdural hematoma is appreciate in the left temporal region. The management was non-surgical and a subsequent CT cranial scan showed resolution of the hematoma. Subsequently prothrombotics studies ruled out a hematological problem. The patient was discharged asymptomatic and with anticoagulant treatment. Patients with CVT are frequently in our environment but it does not exist a large number of studies from the neurological point of view. Neurological manifestations are varied and infrequent in a general neurological approach. Our case illustrates that subdural hematomas can be a symptom of cerebral venous thrombosis.

Short insight of pediatric cerebral venous thrombosis and the safety of intra-arterial heparin flushing as a new therapeutic method

Introduction. The incidence rate of Cerebral Venous Thrombosis (CVT) in children has been increased quite significantly due to the availability of advanced imaging technology and the trends of increasing awareness about health-related problem. Systemic anticoagulant was mainstay treatment for CVT. The author proposed a method of heparin deliveries through existing Digital Subtraction Angiography (DSA) procedure called Intra-arterial Heparin Flushing (IAHF). The safety of this procedure in children was still few known and reported. The purpose of this study is to provide insights on CVT and the potential complication of IAHF as the primary therapeutic modality.Methods. This was a descriptive longitudinal study involving all patients with age 0-18 years diagnosed with Cerebral Venous Thrombosis whom admitted in RSPAD Gatot Soebroto from 2016 to 2018 through MRI examination and will undergo IAHF Procedure as the primary treatment. All subject had signed informed consent regarding the nature of the study. The descriptive data were presented in tables and narratives.Results. The study found that the highest age group found in this study was between 6-12 years old (46,6%) with male-predominant (70,6%). The origins of the patients were mostly from Indonesia (88%) and several from Vietnam (12%). The most common symptoms of CVT in this study was the speech/communication problem (12%). The most common complication after IAHF procedure was wound swelling at the puncture site (2,6%).Conclusion. CVT predominantly affect male aged 6-12 years old with speech problem was the most common symptoms. IAHF procedure shown minimal side effects in pediatric with CVT.

Subarachnoid hemorrhage complicated with cerebral venous thrombosis in pregnancy: A case report

The conditions most commonly associated with cerebral venous thrombosis are the ones characterized by hormonal changes, which include pregnancy, puerperium, and oral contraceptive use. The classical signs and symptoms of cerebral venous thrombosis include headache, papilledema, convulsions, focal deficits, coma, and death. Cerebral venous thrombosis particularly affects superior sagittal or lateral sinus, but also sinuses to which cortical deep veins open. Cerebral venous thrombosis can cause serious neurological syndromes, but thanks to the introduction and widespread use of cerebral angiography, computerized brain tomography, and cranial magnetic resonance imaging, it can be diagnosed in a timely manner. In this case report we report a 22-year-old woman with unknown pregnancy status who was subsequently diagnosed to have pregnancy and cerebral venous thrombosis and subarachnoid hemorrhage after presenting to emergency room with severe headache followed by altered consciousness.

A clinical study of cerebral venous thrombosis

Background: Cerebral venous thrombosis (CVT) is an uncommon form of stroke, usually affecting young population. Clinical features of CVT are diverse, and for this reason, high degree of clinical suspect is mandatory to diagnose the conditions. The objectives of the study were to analyse the commonest clinical modes of presentation, possible etiologies, and to evaluate clinical outcome.Methods: This study was prospective, clinical study was conducted on 40 patients during the period of September 2010 to September 2011 in the Department of Emergency, Institute of Internal medicine at Government General Hospital (GGH), Chennai. All the patients included in the study were subjected to neuroimaging techniques like Computed tomography (CT), magnetic resonance imaging (MRI) along with magnetic resonance venography (MRV) according to guidelines and standard protocol.Results: Majority of the patients involved in the study were in the age group of 15-35 years contributing to 75%. Male: female ratio was 1.5: 1. Headache was the most common presenting symptom seen in 36 (87.5%) cases followed by convulsions in 32 (80%) patients. Altered sensorium was observed in 26 (65%), focal deficits in 22 (55%), and 18 (45%) had fever. Two of them had ear discharge and another with diarrhea. Cranial nerve involvement in 35% and pappiledema was noted in 20% of patients. Out of 40, 17 (42.5%) patients were anemic. Eighteen (18) patients who were suspected of meningitis underwent CSF analysis. Abnormality was seen in 10 patients with pleocytosis being the maximum. On CT scan, haemorrhagic infarct was seen in 22 (55%) cases followed by edema in 8 (20%) and 10% showed normal CT picture. On MRI scan, superior sagittal sinus thrombosis was observed in 24 (60%) patients followed by transverse sinus in 20 (50%) patients. Etiology factor were identified in 25 (62.5%) of patients and in 15 (37.5%) cases risk factors could not be identified. The mortality rate in the study was 20%.Conclusions: The clinical symptoms of CVT are not specific, as a result of chances of misdiagnosis tends to be more. CT scan and MRI along with MRV can improve the precision of CVT diagnosis.

EHMTI-0254. One- year follow up study of clinical characteristics of headache and its profile in a case series of cerebral venous sinus thrombosis

Headache is the most frequent presenting symptom of cerebral venous thrombosis (CVT), most commonly associated with other manifestations.

Headaches in pregnancy

Key content Headaches in pregnancy and the postnatal period are common and usually benign but can herald intracranial catastrophe. Assessment of headache in pregnancy is an essential skill for obstetricians and general practitioners. Pregnancy can alter migraine aura and may trigger attacks of aura without a headache. Headache may be the only symptom of cerebral venous thrombosis. If cerebral venous thrombosis is suspected, expert opinion should be sought and urgent brain imaging considered. Neurological conditions were the third most common cause of death and ahead of sepsis in the Confidential Enquiries into Maternal Deaths in the United Kingdom 2006–2008 report (when considering direct and indirect causes). Learning objectives To revise the ‘red flag’ features and the differential diagnosis of headache in pregnancy. To recognise when referral to a neurologist and urgent brain imaging is indicated. To review the management of common causes of headache in pregnancy. Ethical issues Should obstetricians ever manage a neurological problem in pregnancy without neurological advice?

Clinical features and underlying causes of cerebral venous thrombosis in Japanese patients

The clinical symptoms, causative factors, and prognosis in Japanese patients with cerebral venous thrombosis have not been adequately characterized. The present study describes these features in patients in Japan. Twenty-two patients with cerebral venous thrombosis were retrospectively identified. Diagnosis was confirmed by either digital subtraction angiography, magnetic resonance venography, or contrast-enhanced computed tomography. Demographic data and clinical and radiological features were recorded and analyzed for each patient. Prognosis was evaluated by the modified Rankin scale (mRS) at the time of hospital discharge. The most frequent symptom of cerebral venous thrombosis was headache (59.1 %). Causative factors included congenital thrombophilia (31.8 %), acquired thrombophilia (27.3 %), and iron-deficiency anemia (13.6 %). Of seven patients with congenital thrombophilia, four had mutations in the protein S gene, two had mutations in the protein C gene, and one had mutations in the antithrombin gene. All patients were alive at discharge from hospital. Nineteen of the 22 patients (86.4 %) recovered completely or exhibited only mild residual symptoms (mRS 0-2). However, three patients (13.6 %) had a poor prognosis (mRS 3-5). Cerebral venous thrombosis in Japanese patients is frequently associated with congenital thrombophilia and protein S gene mutation.