Clinical Profile, Neuroimaging Features and Aetiology of Cerebral Venous Thrombosis in a Tertiary Care Centre in Southern India

Abstract

Introduction: Cerebral Venous Thrombosis (CVT) refers to thrombus formation within the venous sinuses draining the brain and represents 0.5% to 3% of all stroke types. The clinical presentation and aetiology varies widely among different populations. A systematic study of CVT is lacking from Kerala. Aim: To study the clinical profile, neuroimaging features and the aetiology of CVT presenting to a tertiary care teaching centre in northern Kerala. Materials and Methods: During the one-year study period (June 2015 to June 2016), consecutive cases admitted to the departments of Internal medicine and Neurology, Government Medical College Kozhikode, Kerala, who had CVT on Magnetic Resonance Venography (MRV) were included in the study. A detailed history, physical and neurological examination and aetiological work up was done in all cases. Results: Of the total 35 cases included in the study, 21 (60%) were females and 14 (40%) were males. The mean age of onset was 32.7±15.5 years. The common presenting features were headache in 28 (80%), vomiting 15 (42.9%), generalised seizures 12 (34.3%), visual abnormality 11 (31.43%) and altered sensorium 9 (25.7%). Focal neurological deficits were seen in 10 patients (28.6%). Computed Tomography (CT) brain was done in 27 patients and was abnormal in 24 (88.9%). Superior sagittal sinus 24 (68.6%) and transverse sinus 14 (40%) were the common sinuses involved. The most common aetiology was polycythemia 5 (14.3%) and drugs 5 (14.3%) followed by thrombophilia 4 (11.4%). Conclusion: CVT presents with a wide variety of symptoms and hence diagnosis requires a strong clinical suspicion. Neurogenic fever, previously unreported in CVT, was present in some cases. Superior sagittal sinus was the most common sinus involved. Polycythemia, drugs and inherited thrombophilia were the common risk factors.

Keywords

• idiopathic intracranial hypertension
• neurogenic fever
• stroke
• thunderclap headache