Improvement in the Prognosis of Cerebral Venous Sinus Thrombosis over a 22-Year Period

AbstractBackground: Cerebral venous thrombosis is a rare cause of stroke, with a number of well-defined risk factors. However, there exist few studies that describe trends in the prognosis of this disease over time. Methods: A retrospective study was performed on patients diagnosed with cerebral venous thrombosis at the University of Alberta Hospital during two time periods: 1988-1998 (21 patients) and 1999-2009 (40 patients). Signs and symptoms, risk factors, imaging findings, etiologies, treatment modalities, and status at discharge were examined. Results: Headache, nausea and vomiting, focal motor deficit, and seizure were the most common signs and symptoms, and active hormonal contraception was the most commonly identified risk factor between the two cohorts. Hematoma and hyperdense sinuses were the most commonly identified CT findings between groups. Thrombophilia and the use of hormonal contraception were the most frequently identified etiologies between the two cohorts. Treatment was similar, with the majority of patients in both cohorts receiving unfractionated heparin as first-line therapy. Patients in the 1999-2009 cohort were significantly less likely to have a severe deficit or be dead at discharge (odds ratio [OR]=0.178; 95% confidence interval [CI95%]=0.051, 0.625) and were more likely to have a favorable modified Rankin Scale score of 0 or 1 at discharge (OR=7.98; CI95%=1.79, 35.71). Conclusions: Our data indicate a reduction in severe residual symptoms at discharge and improved functional status at discharge for patients presenting with cerebral venous thrombosis from 1999 to 2009, as compared with 1988-1998.

Download Full-text

Cerebral Venous Sinus Thrombosis (CVST) in a Middle-Aged Female with Clustering of Risk Factors

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/605 ◽

2021 ◽

Vol 10 (34) ◽

pp. 2960-2963

Author(s):

Maria Prothasis ◽

Yash Gupte ◽

Sourya Acharya ◽

Samarth Shukla ◽

Neema Acharya

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Factor V ◽

Venous Sinus Thrombosis

Thrombosis of cerebral venous channel is a known complication of hypercoagulable states. Hyperhomocysteinaemia is a known hypercoagulable state. Obesity is a modern-day global epidemic. Disorders such as myocardial infarction (MI), stroke, and venous thromboembolism are on the rising trend and its increased morbidity and mortality is being associated with obesity. To date, however, the knowledge about the association between obesity and adult cerebral venous thrombosis (CVT) is sparse. We report a 44-year-old young morbidly obese metabolically unhealthy female who presented with headache, nausea, vomiting and giddiness. On evaluation, magnetic resonance venogram showed cerebral venous sinus thrombosis. On investigations, she had concomitant hyperhomocysteinaemia and metabolic syndrome. Cerebral venous sinus thrombosis causing stroke in young adults is uncommon with various conditions precipitating it.1,2,3 Severe headache (70 - 90 %), focal lateralized signs (25 % - 75 %), seizures (30 – 40 %) as well as behavioural symptoms such as delirium, amnesia, and disturbances in consciousness are the various associated clinical symptoms. The known inherited hypercoagulable risk factors that cause CVST are gain of function mutations in the genes encoding factor V (factor V Leiden) and prothrombin, Protein C, S and antithrombin III deficiency. Hyperhomocysteinaemia, is a known risk factor for causing venous thrombosis of the lower limbs. However, till date there is no data available showing its role in causing cerebral venous thrombosis. The interaction between genetic and acquired determinants result in high plasma levels of total homocysteine (tHcy).4,5,6 Vitamins such as folic acid, pyridoxine, and cobalamin are involved in the metabolic pathways of homocysteine and its deficiencies represent the acquired determinants. Venous thromboembolism (VTE) comprises of deep vein thrombosis of the leg and pulmonary embolism and obesity is now being recognised as one of the risk factors causing it. The risk of VTE is approximately increased to 2-fold in an individual with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 30 or more compared with a normal BMI (< 25), and higher BMIs increase more risk with approximately 3 times higher risk in individuals with a BMI greater than 40.7, 8,9 Again obesity as a risk factor for CVST is less known.

Download Full-text

Scrub typhus with cerebral venous sinus thrombosis: a rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-241401 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241401

Author(s):

Sayonee Das ◽

Sidhartha Chattopadhyay ◽

Kausik Munsi ◽

Sagar Basu

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Scrub Typhus ◽

Sinus Thrombosis ◽

Hormonal Contraception ◽

Neurological Involvement ◽

Rare Presentation ◽

Specific Test ◽

Satisfactory Outcome ◽

The Brain

This is a rare presentation of scrub typhus with cerebral venous thrombosis. A 32-year-old woman presented with signs of raised intracranial tension. Examination revealed maculopapular skin rashes and an ‘eschar’ over the right thigh. Nuchal rigidity and bilateral papilloedema were found. Scrub typhus was diagnosed by the presence of IgM antibody in serum. CT scan of the brain showed cerebral oedema. MRI of the brain was normal. Magnetic resonance venography of the brain showed thrombosis of several venous sinuses. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with raised protein level. Other causes of prothrombotic states were ruled out by doing specific test results. There was no history of hormonal contraception and prolonged bed rest. A case of scrub typhus complicated with meningoencephalitis and cerebral venous thrombosis was diagnosed. She responded to treatment with doxycycline, anticoagulants, antipyrectics and intravenous saline. Early identification of such atypical neurological involvement in scrub typhus was helpful in satisfactory outcome.

Download Full-text

Risk factors and diagnosis of cerebral venous thrombosis: Data from a cohort of 45 Romanian patients

Acta Medica Marisiensis ◽

10.2478/amma-2014-0044 ◽

2014 ◽

Vol 60 (5) ◽

pp. 207-214

Author(s):

Rodica Bălaşa ◽

M Daboczi ◽

Oana Costache ◽

Smaranda Maier ◽

Z Bajko ◽

...

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Brain Imaging ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Demographic Data ◽

Brain Mri ◽

Clinical Aspects ◽

Initial Symptom ◽

Clinical Criteria

Abstract Cerebral venous thrombosis (CVT) represents 1% of the total stroke pathology but is a real challenge both regarding the diagnosis and the treatment. Objective: Evaluate different etiological, demographical, clinical, imaging and therapeutic aspects of CVT. Material: Prospective study during 4 years. From the total 3658 patients hospitalized with acute stroke, 45 (1.23%) had CVT. For each patient, were recorded: demographic data, symptom of onset, type of onset, daily habits, medical history, neurological examination, brain imaging (CT and MRI with venography). Statistical analysis: data are presented as mean and SD and Student t test was applied. Results: Mean age was 44.07± 23,12 years; female: male ratio 2.21:1. The most frequent type of onset was acute (77.78%). Headache was found in 80% of cases as initial symptom, followed by neurological focal deficits. As risk factors, thrombophilia was found most often (59.5%), followed by local infections. No risk factors were found in 17.8% of cases. The brain imaging was positive in 29 patients. In 16 cases, the imaging workout was negative and the diagnosis consisted of clinical criteria, risk factors, response to heparin treatment. Conclusions: CVT is a rare pathology that affects mainly young women and that needs a complex diagnostic evaluation. The patient prototype diagnosed with CVT in our region: female of 44 years old, with an intense acute headache, with MRI showing direct signs of transverse sinus thrombosis, with a thrombophilic state and good response to anticoagulants. Brain MRI is the imaging investigation required but clinical aspects play a decisive role.

Download Full-text

Mutation in the Prothrombin Gene G20210A as a Cause of Cerebral Venous Thrombosis

Case Reports in Medicine ◽

10.1155/2012/828050 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Jorge A. Arroyave ◽

Jairo Quiñones

Keyword(s):

Venous Thrombosis ◽

Sinus Thrombosis ◽

Gene Mutations ◽

Signs And Symptoms ◽

Cerebral Venous Sinus Thrombosis ◽

Prothrombin G20210a ◽

Coding Region ◽

Blood Disorders ◽

Prothrombin Gene ◽

Superior Longitudinal Sinus

Introduction. Cerebral venous sinus thrombosis (CVST) is a rare form of cerebrovascular disease, which may manifest clinically by a wide variety of signs and symptoms. It has been associated with multiple risk factors including genetic or acquired blood disorders, infections, and trauma.Case Report. Man of 17 years who presented with 10 days of intense global headache with nausea and vomiting and subsequent onset of mild hemiparesis and hypoesthesia in right hemibody. Studies show venous thrombosis of the superior longitudinal sinus. It was identified a gene mutation in prothrombin G20210A as a probable cause of the thrombosis.Conclusions. Substitution of guanine for adenine at nucleotide 20210 in the coding region of the prothrombin gene is the second most common primary thrombophilia. Multiple cases of CVST have been associated with this mutation. In the presence of CVST must be considered the primary studies for thrombophilia gene mutations, including prothrombin G20210A.

Download Full-text

Cerebral venous thrombosis related to the use of combined oral contraceptives

10.5327/1516-3180.514 ◽

2021 ◽

Author(s):

Amanda Mendes Clemente Vilella ◽

Letícia Luísa Mattos

Keyword(s):

Venous Thrombosis ◽

Oral Contraceptives ◽

Cerebral Venous Thrombosis ◽

Polycystic Ovary ◽

Sinus Thrombosis ◽

Rare Condition ◽

Signs And Symptoms ◽

Reproductive Age ◽

Combined Oral Contraceptives ◽

Menstrual Dysfunction

Background: Cerebral venous thrombosis (CVT) is a rare condition (less than 1% of stroke). It occurs in the younger population (less than 50 years old), 3 times more common in women, especially those of reproductive age. Objectives and methodology: Narrative review to correlate CVT with the use of combined oral contraceptives (ACO). The following databases were used: Pubmed, Scielo and Medline. Results: A systematic review had 11 studies included showing that the use of OAC increases the chances of developing CVST (central venous sinus thrombosis). Among the 9 studies that reported odds ratios, the combined probability of developing CVST in women of reproductive age who use OAC was 7.59 times the probability of developing CVST compared to those who do not take oral contraceptives (OR = 7.59, 95 CI % 3.82-15.09). A retrospective study of 37 female adolescents was diagnosed with CVT, 22 (59%) of whom used OAC and the remaining 15 had other etiological factors. The data indicate that adolescents using OAC to treat hirsutism, menstrual dysfunction or polycystic ovary syndrome may also have some risk factors for thrombosis, such as hereditary coagulopathy. The coexistence of these diseases mentioned with the use of OCA can increase the risk of CVT. Conclusions: The two main studies analyzed concluded the association between the use of ACO and cases of CVT in women. It’s necessary to be attentive to suggestive signs and symptoms in this population, as they are common to other pathologies, making the diagnosis of CVT difficult.

Download Full-text

Clinical Profile And Risk Factors of Cerebral Venous Sinus Thrombosis (CVST) in Sudan

10.21203/rs.3.rs-640264/v1 ◽

2021 ◽

Author(s):

Etedal Ahmed A Ibrahim ◽

Rofiedah Eisa Hassan Mohamed ◽

Khabab Abbasher Hussien Mohamed Ahmed ◽

Mohammed Eltahier Abdalla Omer

Keyword(s):

Risk Factors ◽

Sinus Thrombosis ◽

Wide Spectrum ◽

Treatment Options ◽

Signs And Symptoms ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Clinical Profile ◽

Cross Sectional ◽

Venous Sinus Thrombosis

Abstract Background Cerebral venous sinus thrombosis (CVST) is relatively uncommon cause of stroke mainly affects young ladies, with a wide spectrum of symptoms severity and prognosis. In this study we aim to study the clinical profile and Risk Factors of CVST among Sudanese patients in Khartoum state hospitals. Methods This is an observational cross-sectional multi-center hospital based study which covered 37 participants, in three major hospitals in khartoum, with radiologically confirmed Cerebral Venous Sinus Thrombosis (CVST) Results 37 patients were included in this study, The mean age of patients was 38.5 ± 13.4 years, with minimum age of 23 years and maximum of 75 years, the largest group (n = 18, 48.6%) were in the range between “26–35” years, regarding gender distribution (n = 8; 21.6%) were males and the majority of patients were female (n = 29; 78.4%), the commonest presenting feature was headache (n = 35; 94.6%), followed by blurring of vision (n = 25; 67.6%), while seizures is a presenting symptom in nearly half of the patients (n = 17; 45.9%), on examination papilloedema was present in 83.8%. In this study 13.8% were pregnant, 31.0% were postpartum, OCPS user account for 27.%, and No risk factor present in 32.4%. regarding the involved sinus Sagittal Venous Sinus and the transverse sinus were the most affected sinuses. Regarding treatment options: “low molecular weight heparin followed with warfarin” was found in 81.1%, followed with heparin only 10.8%, while the new agents NOACs comprised only 8.1%. Conclusion The study concluded that Cerebral Venous Sinus Thrombosis is mainly a disease of child-bearing women, although significant proportions of men were affected. Cerebral Venous Sinus Thrombosis presents in a wide variety of signs and symptoms.

Download Full-text

Chronic headache as a clinical manifestation of cerebral venous sinus thrombosis

INTERNATIONAL NEUROLOGICAL JOURNAL ◽

10.22141/2224-0713.17.1.2021.226919 ◽

2021 ◽

Vol 17 (1) ◽

pp. 50-54

Author(s):

O. Sayko ◽

A. Bohdan ◽

J. Malankevich

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Secondary Brain Injury ◽

Venous Sinus Thrombosis ◽

Dural Sinuses ◽

Cerebral Mri ◽

Compensation Mechanisms

Patients with cerebral venous thrombosis (CVT) pre-sent with a range of symptoms, which varies widely from headache to coma. Chronic occlusion of venous dural sinuses leads to the initiation of compensation processes, such as vascular collatera-lization, recanalization of the organized thrombus. Consequently, their efficacy determines disease course and severity. The purpose of our study was to highlight the clinical challenges while managing a patient with subcompensated CVT. Taking into account the fact that mild severity is observed in 20 % of cases, eventually, about a quarter of patients presenting with the headache of unclear etio-logy becomes unnoticed and results in low quality of life. To analyze the disease outcome and prognosis, we accurately studied compensation mechanisms, which occur in a patient due to cerebral venous sinus thrombosis, notably venous collateral circulation and thrombus recanalization. However, the most important “pitfall” of chronic dural sinuses occlusion, when not appropriately treated, is the fact that hemodynamic compensation also leads to a high risk of cerebrovascular events, which may lead to death or disabi-lity. The patient with cerebral venous thrombosis of the transverse and sigmoid sinuses manifested migraine-like headache with a vegetative issue and signs of increased intracranial pressure. Due to the absence of anticoagulant therapy, venous drainage through collateral pathways and recanalization of thrombosed sinuses were insufficient to maintain a cerebral blood supply, resulting in diffuse cerebral edema, secondary brain injury. After an accurate survey, diagnostic procedures, prescribing of individualized treatment, and long-term follow-up with correction of therapy the patient experienced regression of CVT symptoms. Cerebral MRI venography is an important tool for the diagnosis and prediction of the prognosis of this condition. Thus, patients with a long history of untreatable headache and signs of intracranial hypertension should undergo this procedure. To consider intracranial vascular events and outcomes, the venous hemodynamics should be evaluated. Moreover, it is often necessary to examine cerebral veins and sinuses, when hemorrhagic stroke does not correspond to cerebral arterial territories and has unclear etiology.

Download Full-text

Cerebral Venous Sinus Thrombosis and Covid-19: an Integrative Review

10.5327/1516-3180.519 ◽

2021 ◽

Author(s):

Maria Theresa de Alencar Ramsdorf ◽

Camilla Haddad Oliveira ◽

Gabriela Mayumi Uehara ◽

Inaê de Oliveira Aquino ◽

Kamilla Menezes e Souza ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

English Studies ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Glycoprotein I ◽

Pubmed Database ◽

Virus Interaction

Background: Although the majority of those infected by COVID-19 develop an asymptomatic or mild condition, there are those who evolve to a critical condition, such as Cerebral Venous Thrombosis (CVT), which deserves attention, as it is a neurovascular emergency. Objectives: The objective of the abstract is to analyze CVT as a complication of COVID-19. Design and setting: This is an integrative literature review, conducted in the Pubmed database. Methods: The descriptor “cerebral venous thrombosis covid” was used. The inclusion criteria were English studies published in 2020. The exclusion criteria were the non- relevance of the information to the theme. In all, 7 articles were selected. Results: It was observed that most patients were middle-aged men diagnosed with CVT after 7 days of Covid-19 discharge. CVT may be associated with endotheliitis caused by the virus interaction with the Angiotensin Converting Enzyme receptor, also with an abnormal proliferation of cytokines, and both of them favor vasoconstriction and hypercoagulopathy. It has been proposed that the disease may induce a prothrombotic state by the elevated levels of circulating fibrinogen, D-dimer, and pro-thrombotic microparticles. Furthermore, increasing levels of antiphospholipid antibodies detected in patients with COVID-19, such as anti-cardiolopin IgA, anti-β2-glycoprotein I IgA and IgG may precipitate hypercoagulability and vascular infarctions. Conclusion: This review shows the influence of the post-COVID on the occurrence of TVC. However, the studies are still incipient and have not systematically described other previous prothrombotic conditions that may be additive factors.

Download Full-text

Case Reports of Pregnancy-Related Cerebral Venous Thrombosis in the Neurology Department of the Emergency Clinical Hospital in Constanta

Life ◽

10.3390/life12010090 ◽

2022 ◽

Vol 12 (1) ◽

pp. 90

Author(s):

Any Docu Axelerad ◽

Lavinia Alexandra Zlotea ◽

Carmen Adella Sirbu ◽

Alina Zorina Stroe ◽

Silviu Docu Axelerad ◽

...

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Young Patients ◽

Clinical Manifestations ◽

Special Treatment ◽

Lateral Sinus ◽

Cortical Vein ◽

Cortical Vein Thrombosis

Cerebral venous thrombosis accounts for 0.5–1% of all cerebrovascular events and is one type of stroke that affects the veins and cerebral sinuses. Females are more affected than males, as they may have risk factors, such as pregnancy, first period after pregnancy, treatment with oral contraceptives treatment with hormonal replacement, or hereditary thrombophilia. This neurological pathology may endanger a patient’s life. However, it must be suspected in its acute phase, when it presents with variable clinical characteristics, so that special treatment can be initiated to achieve a favorable outcome with partial or complete functional recovery. The case study describes the data and the treatment of two patients with confirmed cerebral venous thrombosis with various localizations and associated risk factors, who were admitted to the neurology department of the Sf. Apostol Andrei Emergency Hospital in Constanta. The first patient was 40 years old and affected by sigmoid sinus and right lateral sinus thrombosis, inferior sagittal sinus, and right sinus thrombosis, associated with right temporal subacute cortical and subcortical hemorrhage, which appeared following a voluntary abortion. The second case was a patient aged 25 who was affected by left parietal cortical vein thrombosis, associated with ipsilateral superior parietal subcortical venous infarction, which appeared following labor. The data are strictly observational and offer a perspective on clinical manifestations and clinical and paraclinical investigations, including the treatment of young patients who had been diagnosed with cerebral venous thrombosis and admitted to the neurology department.

Download Full-text

Cerebral venous sinus thrombosis

Galen Medical Journal ◽

10.31661/gmj.v5is1.594 ◽

2016 ◽

Vol 5 ◽

pp. 48-61

Author(s):

Golnaz Yadollahikhales ◽

Afshin Borhani-Haghighi ◽

Anahid Safari ◽

Mohammad Wasay ◽

Randall C.Edgell

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Contraceptive Pills ◽

Contrast Enhanced ◽

Clinical Presentations ◽

Threatening Condition ◽

Life Threatening ◽

Magnetic Resonance Imaging Mri

Cerebral venous thrombosis (CVT) is occlusion of dural sinuses and/or cortical veins due to clot formation. It is a potentially life-threatening condition that requires rapid diagnosis and urgent treatment.Cerebral venous thrombosis is more common in females and young people. Pregnancy, postpartum state, contraceptive pills, infection, malignancy, hyper-coagulable state, rheumatological disorders, trauma are among the major etiologies of cerebral venous thrombosis. Headache, focal neurologic deficits and seizure were the most common clinical presentations. Different techniques of unenhanced and contrast enhanced brain computerized tomography(CT scan) and ,magnetic resonance imaging(MRI) are the most helpful ancillary investigations for diagnosis of Cerebral venous thrombosis.Specific treatment of the underlying cause of cerebral venous thrombosis should be considered as the mainstay of the treatment. Anticoagulation with heparin or low molecular weight heparinoids is the most accepted treatment. In acute phase, medical or surgical management to decrease intracranial pressure (ICP) is also recommended. If the patient's clinical condition aggravates despite adequate anticoagulation, thrombolysis or mechanical thrombectomy can be an additive option.

Download Full-text