DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172981

Clinical features, predisposing factors and radiological study of cerebral venous sinus thrombosis: experience from a tertiary care center in Southern India

Aneesh T., Hemamalini Gururaj, Arpitha J. S., Anusha Rao, Vaishnavi Chakravarthy, Abhiman Shetty

Abstract


Background: Cerebral venous thrombosis (CVT) is a less common cause of stroke with a wide range of clinical presentations, predisposing factors, radiological features and outcomes. A high index of suspicion is absolutely essential to diagnose cerebral venous thrombosis. In this article, we have reviewed the clinical spectrum and radiological profile of patients with cerebral venous thrombosis and attempted to identify the specific predisposing factors for developing cerebral venous thrombosis particularly in this region of India.

Methods: 116 patients hospitalized from January 2015 to March 2017 with a final diagnosis of Cerebral Venous Thrombosis which was confirmed by imaging (MRI/MRV or CT angiography) were included. Patients who were initially diagnosed as CVT but imaging were not suggestive of the same were excluded.

Results: The mean age of the study population was 35.21 years, with most patients aged between 21-30 years. 18.1% of the study population were puerperal women, much lower than earlier series. 54.54% of the men had a significant history of alcohol consumption and 10.34% of the non-puerperal women revealed a history of consuming oral contraceptive pills. Among men, seizures were the most common presenting symptom followed by headache. Women presented with headache followed by vomiting. Superior sagittal sinus, transverse sinus, cortical veins and sigmoid sinus involvement were quite common in comparison to the other sinuses.

Conclusions: Accurate and prompt diagnosis of CVT is crucial because timely and appropriate therapy can reverse the disease process and significantly reduce the risk of acute complications and long-term sequelae. In this article, we have reviewed the epidemiology, causative factors, clinical features and as well as radiological pattern of CVT from an Indian perspective. Over the last decade, a relatively high incidence of CVT in fairly young individuals warrants further evaluation towards genetic predisposition for pro-thrombotic states particularly in this region of India.


Keywords


Alcohol, CVT, Intracranial thrombosis, Neuroimaging

Full Text:

PDF

References


Ribes MF. Des recherches faites sur la phlebite. Rev Med Franc Etrang. 1825;3:5-41.

Ray BS, Dunbar HS, Dotter CT. Dural sinus venography as an aid to diagnosis in intracranial disease. J Neurosurg. 1951;8:23-37.

Nagaraja D, Taly AB. Puerperal venous sinus thrombosis in India. In: Sinha KK ed. Progress in clinical neurosciences, Ranchi, NSI, Publications. 1989;5:165-77.

Srinivasan K. Cerebral venous and arterial thrombosis in pregnancy and puerperium: a study of 135 patients. Angiol. 1983;34(11):731-46.

Dash D, Prasad K, Joseph L. Cerebral venous thrombosis: An Indian perspective. Neurol India. 2015;63:318-28.

Stephan Moll, Beth Waldron. Cerebral and Sinus Vein Thrombosis, 2014 Available at http://circ.ahajournals.org/content/circulationaha/130/8/e68.full.pdf. Circulation.

Yakovlev SB, Bocharov AV, Mikeladze K, Gasparian SS, Serova NK, Shakhnovich AR. Endovascular Treatment of Acute Thrombosis of Cerebral Veins and Sinuses. Neuroradiol J. 2014; 27(4 ):471-8.

Sasidharan PK. Cerebral Vein Thrombosis Misdiagnosed and Mismanaged. Thrombosis. 2012;2012:1-11.

Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis. Stroke. 2004;35(3):664-70.

Parikh PM, Sukthankar RU, Parikh A, Pipalia DH, Sidhva SJ, Ramakanten R, et al. Cerebral venous thrombosis. J Assoc Physicians India. 1987;35:349-51.

Narayan D, Kaul S, Ravishankar K, Suryaprabha T, Bandaru VC, Mridula KR, et al. Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: Insights from Nizam′s Institute Venous Stroke Registry, Hyderabad (India). Neurol India. 2012; 60:154-9.

Pai N, Ghosh K, Shetty S. Hereditary thrombophilia in cerebral venous thrombosis: A study from India. Blood Coagul Fibrinolysis. 2013;24:540-3.

Rathi M, Stephen S, Santanam R, Arjundas D, Ayyar SSK, Kumar S. CVT in young adults; study from tertiary care teaching hospital in Chennai, India. Int J Inf Res Rev. 2016;03(01);1782-4.

Gorelick PB. Alcohol and stroke. Stroke. 1987;18:268-71.

Ameri A, Bousser MG. Cerebral venous thrombosis. Neurol Clin. 1992;10:87-111.

Daif A, Awada A, Al-Rajeh S, Abduljabbar M, Al Tahan AR, Obeid T, et al. Cerebral venous thrombosis in adults. A study of 40 cases from Saudi Arabia. Stroke. 1995;26:1193-5.