Clinicoepidemiological profile of cerebral venous thrombosis in Algarve, Portugal: A retrospective observational study

ABSTRACT Background: Cerebral venous thrombosis (CVT) is a very uncommon disorder with a wide variety of clinical manifestations. There are few studies describing the clinical and epidemiological profile of CVT in peripheral or rural areas. Over the last decades, the frequency in which this disease is diagnosed has increased due to greater awareness and availability of noninvasive diagnostic techniques. Materials and Methods: A hospital-based retrospective case review of adult (≥15 years) patients with CVT between 2001 and 2012 is described. 31 patients with confirmed imagiological diagnosis of CVT were included. Statistical Analysis Used: Statistical analysis was performed using R version 2.15.2. Incidence rate was computed as number of new cases by time. Confidence interval (CI) was set at 95% and P < 0.05 was considered significant. Results: The average annual incidence was 0.84 (CI: 0.58–1.18) to 0.73 (CI: 0.5–1.02) per 100 000 cases for adult population. There were 23 (74%) women and 8 (26%) men. Predominant initial manifestations were headache, followed by altered mental status and seizures. Median diagnostic delay from onset of illness was 8 days. All patients were treated with unfractionated heparin or low-molecular heparin followed by warfarin. Complete recovery occurred in the majority of cases 22 (78.6%) but two patients died during hospitalization. Conclusions: Albeit with some particularities, the epidemiology and clinical manifestations we found are comparable to what has been reported in western studies.

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Cerebral venous thrombosis and Covid 19: Literature review

Journal of Neurology & Stroke ◽

10.15406/jnsk.2021.11.00457 ◽

2021 ◽

Vol 11 (2) ◽

pp. 57-68

Author(s):

Carlos Alexandre Martins Zicarelli ◽

Jonathan Vinicius Martins ◽

Wesley Vieira Doni ◽

Rafael Rodrigues Pinheiro dos Santos ◽

Ana Carla Mondek Rampazzo ◽

...

Keyword(s):

Literature Review ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Rare Complication ◽

Clinical Manifestations ◽

Risk Of Death ◽

Cranial Sinus Thrombosis ◽

Stent Retrievers ◽

Low Incidence

Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.

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A case series of cerebral venous thrombosis as the first manifestation of homocystinuria

European Stroke Journal ◽

10.1177/23969873211059479 ◽

2021 ◽

pp. 239698732110594

Author(s):

Antonio Ochoa-Ferraro ◽

Subadra Wanninayake ◽

Charlotte Dawson ◽

Adam Gerrard ◽

Mary Anne Preece ◽

...

Keyword(s):

Venous Thrombosis ◽

Effective Treatment ◽

Cerebral Venous Thrombosis ◽

Thrombotic Event ◽

Case Series ◽

Autosomal Recessive Disorder ◽

Retrospective Case ◽

Tertiary Referral Centre ◽

Physician Awareness ◽

The Mean

Background Cerebral venous thrombosis (CVT) is an important cause of stroke particularly in younger patients and potentially fatal if diagnosis is delayed. The presentation of symptoms is highly variable and consequently the diagnosis and underlying cause is often delayed or overlooked. Homocystinuria, a rare autosomal recessive disorder is an identified risk factor for CVT. Purpose A timely diagnosis and treatment of the underlying cause of CVT could result in improved outcome and prevent further events. This case series describes the clinical course of six adults presented with unprovoked CVT, in whom the diagnosis of underlying homocystinuria was delayed with adverse consequences. We aim to highlight the importance of recognising homocystinuria as an underlying cause of CVT and offer a practical approach to the diagnosis and management. Methods This is a retrospective case series of a cohort of 30 consecutive patients seen in a UK tertiary referral centre. Result Six out of 30 patients presented with CVT prior to homocystinuria diagnosis. The mean and range of age at the time of the first CVT episode was 22.6 (range 11–31) years. The mean ±SD age at diagnosis of homocystinuria as the underlying cause was 26 ± 4.2 years. The time between first CVT and diagnosis of homocystinuria ranged from 1.6 to 11 years resulting in a delay to introduction of effective treatment and, in some cases, a further large vessels thrombotic event. Conclusion Physician awareness of homocystinuria as an underlying cause for an unprovoked CVT will facilitate timely introduction of effective treatment to prevent a further event.

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Cerebral venous thrombosis: a practical guide

Practical Neurology ◽

10.1136/practneurol-2019-002415 ◽

2020 ◽

Vol 20 (5) ◽

pp. 356-367 ◽

Cited By ~ 1

Author(s):

Leonardo Ulivi ◽

Martina Squitieri ◽

Hannah Cohen ◽

Peter Cowley ◽

David J Werring

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Current Knowledge ◽

Clinical Manifestations ◽

Stroke Care ◽

Future Research ◽

Supporting Evidence ◽

Permanent Disability ◽

Decompressive Craniotomy ◽

Relative Rarity

All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from ‘conventional’ stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although CVT can result in death or permanent disability, it generally has a favourable prognosis if diagnosed and treated early. Neurologists involved in stroke care therefore also need to be aware of the treatments for CVT (with varying degrees of supporting evidence): the mainstay is prompt anticoagulation but patients who deteriorate despite treatment can be considered for endovascular procedures (endovascular thrombolysis or thrombectomy) or neurosurgery (decompressive craniotomy). This review summarises current knowledge on the risk factors, diagnosis, treatment and prognosis of CVT in adults, and highlights some areas for future research.

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Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report

Journal of Neurosurgery Spine ◽

10.3171/2017.10.spine17806 ◽

2018 ◽

Vol 28 (6) ◽

pp. 669-678 ◽

Cited By ~ 3

Author(s):

Avital Perry ◽

Christopher S. Graffeo ◽

Waleed Brinjikji ◽

William R. Copeland ◽

Alejandro A. Rabinstein ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Intracranial Hypotension ◽

Primary Repair ◽

Rare Complication ◽

External Ventricular Drain ◽

Spontaneous Intracranial Hypotension ◽

Mass Effect ◽

Complete Recovery ◽

Csf Leak

Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia. CT venography confirmed CVT, and therapeutic heparin was initiated. He suffered a generalized seizure due to left parietal hemorrhage, which subsequently expanded. He developed signs of mass effect and herniation, heparin was discontinued, and he was taken to the operating room for clot evacuation and external ventricular drain placement. Intraoperatively, the dura was deflated, suggesting underlying SIH. Ventral T-1 CSF leak was identified, which failed multiple epidural blood patches and required primary repair. The patient ultimately made a complete recovery. Systematic review identified 29 publications describing 36 cases of SIH-associated CVT. Among 31 patients for whom long-term neurological outcome was reported, 25 (81%) recovered completely. Underlying coagulopathy/risk factors were identified in 11 patients (31%). CVT is a rare and potentially lethal sequela occurring in 2% of SIH cases. Awareness of the condition is poor, risking morbid complications. Evaluation and treatment should be directed toward identification and treatment of occult CSF leaks. Encouragingly, good neurological outcomes can be achieved through vigilant multidisciplinary neurosurgical and neurocritical care.

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Early clinical manifestations in patients with cerebral venous thrombosis

Journal of the Neurological Sciences ◽

10.1016/j.jns.2013.07.724 ◽

2013 ◽

Vol 333 ◽

pp. e176

Author(s):

I. Macavei ◽

O. Costache ◽

C. Popa ◽

A. Treaba ◽

A. Macavei ◽

...

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Manifestations

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Gender Differences in Risk Factor Profile and Clinical Characteristics in 89 Consecutive Cases of Cerebral Venous Thrombosis

Journal of Clinical Medicine ◽

10.3390/jcm10071382 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1382

Author(s):

Zoltan Bajko ◽

Anca Motataianu ◽

Adina Stoian ◽

Laura Barcutean ◽

Sebastian Andone ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Manifestations ◽

Important Variable ◽

Term Outcome ◽

Hematological Disorders ◽

Risk Factor Profile ◽

Male Patients

Gender has been shown to be an important variable in cerebral venous thrombosis (CVT) risk and significantly influences its clinical manifestations and outcome. The aim of our study was to investigate the gender-specific risk factor profile and clinical picture of this rare cerebrovascular disorder. Materials and methods: We retrospectively reviewed the medical records of 89 consecutive cases of CVT at a tertiary neurology clinic in Târgu Mures, Romania, between June 2009 and January 2021 to analyze the gender-related differences in etiology, clinical presentation, and outcome. Results: Women comprised 62.5% of the cohort. Females were significantly younger than males (37.3 years versus 48.8 years, respectively, p = 0.001), and the main risk factors were hormone related in 37.9% of the cases, followed by primary thrombophilia (34.4%), smoking (25.8%), obesity (17.2%), infections (17.2%), mechanical factors (17.2%), cancer (8.6%), systemic autoimmune disorders (8.6%), and hematological disorders (8.6%). In male patients, the main risk factors were smoking (41.9%), primary thrombophilia (29%), infections (22.6%), heavy alcohol consumption (16.1%), and venous thromboembolism in the medical history (12.9%). Frequency of headache was higher in females than in males (75.9% versus 67.7%), whereas frequency of coma (6.5% in males versus 1.7% in females) and dizziness (19.4% in males versus 10.3% in females) was higher in males. CVT onset was acute in 41.4% of females and 38.7% of males. The Rankin score at discharge was significantly lower in females compared with males (0.6 versus 1.6), reflecting a more favorable short-term outcome. Mortality was 6.4% in males and 1.7% in females. Conclusions: CVT is a multifactorial disorder that has a broad spectrum of risk factors with important gender-related differences in clinical manifestation and prognosis. Female patients, especially those with hormone-related risk factors, have a more favorable outcome than male patients.

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Thrombosis and bleeding outcomes in the treatment of cerebral venous thrombosis in cancer

Thrombosis Journal ◽

10.1186/s12959-021-00292-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Nadia I Abelhad ◽

Wei Qiao ◽

Naveen Garg ◽

Cristhiam M. Rojas-Hernandez

Keyword(s):

Venous Thrombosis ◽

Cancer Patients ◽

Major Bleeding ◽

Cerebral Venous Thrombosis ◽

Adult Population ◽

Therapeutic Index ◽

Propagation Rate ◽

Outcome Data ◽

Bleeding Complications ◽

Stepdown Procedure

Abstract Background There is a need for clinical outcome data of cerebral venous thrombosis (CVT) in cancer patients. We examined the recanalization, thrombosis recurrence and major bleeding during CVT treatment in a cancer exclusive adult population. Methods We performed a retrospective review of cancer associated CVT identified through an institutional data warehouse. The primary endpoint was radiological and comprised the evaluation of thrombus recanalization at 12 months. Secondary endpoints were clinical and included rates of bleeding complications and recurrence of CVT. Variables were compared across subgroups of study outcomes. The backward stepdown procedure was used to identify variables for the final logistic model regarding thrombosis and bleeding outcomes. Results The population included forty-five patients, slightly predominant of male adults (55.6%) with a median age of 54.5 years. Solid malignancies comprised 64.4% of cases. A total of 31 cases were treated with anticoagulation. CVT recanalization was documented in almost 60% of cases. The cerebral venous thrombosis recurrence or propagation rate at 12 months was 15.6%. Major bleeding complications were observed in 15 patients. Conclusions Our findings are suggestive of a narrow therapeutic index of anticoagulation in cancer-CVT. Careful monitoring of anticoagulation effect and bleeding complications are of utmost clinical relevance in cancer patients. Further larger and controlled studies are needed to confirm our observations.

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Cerebral venous thrombosis

Neurology Bulletin ◽

10.17816/nb89672 ◽

2003 ◽

Vol XXXV (1-2) ◽

pp. 52-57

Author(s):

E. I. Bogdanov ◽

A. T. Zabbarova

Keyword(s):

Early Diagnosis ◽

Venous Thrombosis ◽

19Th Century ◽

Cerebral Venous Thrombosis ◽

Clinical Manifestations ◽

Effective Therapy ◽

Neurological Symptoms ◽

Early 19Th Century ◽

Autopsy Data

Classical descriptions of cerebral venous thrombosis (CVT) have been known since the early 19th century and are based on autopsy data. Focal neurological symptoms, seizures, and coma were considered typical clinical manifestations of CVT. Progress in the development of neuroimaging technology has contributed to the expansion of ideas about the etiology, pathogenesis, spectrum of clinical manifestations and the course of this disease. Currently, the most urgent are the problems of early diagnosis and effective therapy of CVT.

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Unilateral Postoperative Deep Cerebral Venous Thrombosis with Complete Recovery: A Report of 2 Cases

Pediatric Neurosurgery ◽

10.1159/000452803 ◽

2017 ◽

Vol 52 (3) ◽

pp. 205-210 ◽

Cited By ~ 3

Author(s):

Mony Benifla ◽

Suzzanne Laughlin ◽

Zulma S. Tovar-Spinoza ◽

James T. Rutka ◽

Peter B. Dirks

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Complete Recovery ◽

Deep Cerebral Venous Thrombosis

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Risk factors and clinical manifestations of cerebral venous thrombosis in patients admitted to Zahedan city hospitals during 2011-2017

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i3.19184 ◽

2018 ◽

Vol 9 (3) ◽

pp. 6-9 ◽

Cited By ~ 1

Author(s):

Hamed Amirifard ◽

Alireza Khosravi ◽

Hoseinali Akbarian

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Clinical Symptoms ◽

Post Partum ◽

Oral Contraceptive Pill ◽

Clinical Manifestations ◽

City Hospital ◽

Blood Clots ◽

Prevalent Symptom

Background: In Cerebral venous thrombosis (CVT), blood clots are create in the veins and, blood clots may form in the veins or sinuses. In 78% of cases this problem occurred in people lower than 50 years and in women more than men. The annual prevalence of CVT in Iran was 12.3 per one million which was 2.5 times more than world prevalence.Aims and Objective: The aim of this study was to investigate the Risk factors and clinical manifestations of cerebral venous thrombosis in patients admitted to Zahedan city hospitals. Methods and Materials: This retrospective descriptive study was done on 50 patients with CVT which hospitalized in the Zahedan city hospital. Necessary information such as clinical symptoms, risk factors and demographic data extracted from patients file and analyzed by statistical methods in SPSS.16.Results: In this study, 68% of patients were female and 32% were male. The most prevalent season was summer age group 34-43 years constituting about 28 % of the cases. The prevalent season was summer with 38 % cases and headache was the most prevalent symptom (66%). The most prevalent risk factor was infection comprising 30 % of the total patients.Conclusion: Results showed higher prevalence of CVT in women than in men which could be due to the positive relation between prevalence of this disease and risk factors such as oral contraceptive pill (OCP), pregnancy and post-partum period. Also, in this study the most prevalent symptom was headache and the most prevalent season was summer, which could be due to dehydration of patients. The validity of the current study could be further substantiated with study in the similar pattern with more sample size.Asian Journal of Medical Sciences Vol.9(2) 2018 6-9

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