Cerebral Venous Sinus Thrombosis: An Institutional Experience

Abstract

Introduction: Cerebral venous thrombosis (thrombosis of cerebral veins and sinuses) accounting for 0.5% of all strokes has a variable clinical presentation making early diagnosis difficult. A number of prothrombotic states have been implicated in causation of cerebral venous sinus thrombosis. Anticoagulation with intravenous heparin followed by warfarin for 3-6 months is currently recommended for majority of cases, even in the presence of mild or moderate hemorrhagic transformation. This may need to be continued for longer in some patients who have underlying prothrombotic states. Aim: To study clinical profile and outcome of patients of cerebral venous sinus thrombosis admitted in a tertiary care hospital in northern India. Materials and Methods: The study was carried out in a tertiary care hospital where all patients of cerebral venous thrombosis admitted between 1st January 2005 and 31st December, 2008 (retrospective) and between 1st January 2009 and 30th June 2010 (prospective) were included in the study. The enrolled patients were studied for their demographic profile and complete history was taken. Patients were followed up for minimum period of 6 months and outcome was assessed on basis of morbidity and mortality on follow-up. Results: A total of 46 patients of cerebral venous sinus thrombosis were included in the study. The mean age of the patients was 35.5 years. Out of 25 female patients in the study group, 8 female patients (32%) had puerperium as risk factor and 4 patients (16%) had oral contraceptive use as risk factor. Most common symptom was headache which was present in 41 patients comprising 89.1% of total patients. 39 patients (84.8%) were alive at the end of follow-up and 7 patients died (15.2%). Out of 39 patients who survived, 31 cases (79.4%) had no disability symptoms, 5 patients had mild disability (13%) and 3 patients had moderate disability at six months of follow-up. Conclusion: The recent advances in early diagnosis and prompt management of cerebral venous thrombosis have significantly improved its outcome with markedly decreased morbidity and mortality. The role of endovascular thrombolysis and decompressive craniectomy in the management of severe cerebral venous thrombosis cases remain to be defined. Cerebral venous sinus thrombosis is a clinical entity with a low risk of death and good long-term prognosis in modern era.

Keywords

• anticoagulation
• prothrombotic
• stroke