Cerebral vein and dural sinus thrombosis: an evaluation of 30 cases

Abstract

Background and objectives: cerebral vein and dural sinus thrombosis (CVT) present a variety of non-specific clinical signs, but, due to the development of neuroimaging techniques, especially magnetic resonance imaging, their identification has increased in recent years, due to the development of neuroimaging techniques, especially of magnetic resonance imaging. The aim of our study was to identify causes and risk factors, to describe the demographic, clinical, laboratory and neuroimaging data, and to evaluate the treatment and outcome of patients with C.V.T., comparing our experience with international literature. Patients and methods: we included 30 patients (pts) with CVT, between January 1998 and September 2010. The diagnosis was based in all cases on neuroimaging features. The pts were examined at admission and after three months, using the mRS scores. Results: mean age was 37.2 years (SD 8.6), sex ratio: male/female was 1/2. 80% of women were fertile. The main clinical manifestations were headache: 22 pts (73.3%), and papilledema: 16 pts (53.3%). The most frequent neurological syndrome at onset was intracranial hypertension with subacute evolution. CT showed direct signs of dural sinuses thrombosis: (dense triangle sign in 3 pts, delta sign in 7 cases); in 12 pts, we identified a venous cerebral infarct (indirect sign of dural sinuses thrombosis). MRI identified thrombosis of SSS in 21 pts, transverse sinus in 12 cases, cavernous sinus in 3 pts, cerebral edema in 18 pts. In 12 cases, we identified a venous cerebral infarct. 7 out of 30 MRI had a normal CT. DSA revealed isolated cortical veins occlusion, without sinus occlusion in 2 cases (CT, MRI, and MR-A were normal). Risk factors were identified in 22 pts (73.3%); congenital thrombophilia being the most common (9 pts). All pts received anticoagulant therapy. After 90 days from admission, complete resolution of symptoms was seen in 14 cases, minimal neurological deficits in 7 pts, and the death rate was 16.7% (5 pts). Conclusions: CVT appear to be underdiagnosed in our region, due to low percentage of admissions for benign intracranial hypertension. CVT was common in women of fertile age, but oral contraceptive was not an important risk factor. The outcome was favorable with adequate therapy.

Keywords

• cerebral venous thrombosis
• dural sinuses
• anticoagulant therapy