A clinical study of cerebral venous thrombosis

Authors

  • Priyadarsini Bose Department of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, India
  • Jacinth Preethi Joshua Department of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, India
  • Murali Thandavarayan Department of Pediatrics, ICH and HC, Egmore, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20173663

Keywords:

Cerebral venous sinus thrombosis, CT scan, MRI, MRV

Abstract

 Background: Cerebral venous thrombosis (CVT) is an uncommon form of stroke, usually affecting young population. Clinical features of CVT are diverse, and for this reason, high degree of clinical suspect is mandatory to diagnose the conditions. The objectives of the study were to analyse the commonest clinical modes of presentation, possible etiologies, and to evaluate clinical outcome.

Methods: This study was prospective, clinical study was conducted on 40 patients during the period of September 2010 to September 2011 in the Department of Emergency, Institute of Internal medicine at Government General Hospital (GGH), Chennai. All the patients included in the study were subjected to neuroimaging techniques like Computed tomography (CT), magnetic resonance imaging (MRI) along with magnetic resonance venography (MRV) according to guidelines and standard protocol.

Results: Majority of the patients involved in the study were in the age group of 15-35 years contributing to 75%. Male: female ratio was 1.5: 1. Headache was the most common presenting symptom seen in 36 (87.5%) cases followed by convulsions in 32 (80%) patients. Altered sensorium was observed in 26 (65%), focal deficits in 22 (55%), and 18 (45%) had fever. Two of them had ear discharge and another with diarrhea. Cranial nerve involvement in 35% and pappiledema was noted in 20% of patients. Out of 40, 17 (42.5%) patients were anemic. Eighteen (18) patients who were suspected of meningitis underwent CSF analysis. Abnormality was seen in 10 patients with pleocytosis being the maximum. On CT scan, haemorrhagic infarct was seen in 22 (55%) cases followed by edema in 8 (20%) and 10% showed normal CT picture. On MRI scan, superior sagittal sinus thrombosis was observed in 24 (60%) patients followed by transverse sinus in 20 (50%) patients. Etiology factor were identified in 25 (62.5%) of patients and in 15 (37.5%) cases risk factors could not be identified. The mortality rate in the study was 20%.

Conclusions: The clinical symptoms of CVT are not specific, as a result of chances of misdiagnosis tends to be more. CT scan and MRI along with MRV can improve the precision of CVT diagnosis.

Metrics

Metrics Loading ...

References

Patil VC, Choraria K, Desai N, Agrawal S. Clinical profile and outcome of cerebral venous sinus thrombosis at tertiary care center. J Neurosci Rural Pract. 2014;5(3):218-24.

Cross JN, Castro PO, Bennel Wb. Cerebral strokes associated with pregnancy an puerperium. Br Med J Clin Res. 1968;3:214-8.

Newman LC, Lipton RB. Emergency department of evaluation of headache. Neurol clin. 1998;16:285-303.

Sohoni CA. Acute cerebral venous sinus thrombosis: A rare complication of binge drinking. J Sci Soc. 2014;41(3):192-4.

Bousser MG, Chiras J, Bones J, Castaigne P. Cerebral venous thrombosis. A review of 38 cases. Stroke. 1985;16:199-213.

Bousser MG. Cerebral venous thrombosis: Diagnosis and management. J Neurol. 2000;247:252-8.

Prakash C, Bansal BC. Cerebral Venous Thrombosis. J Indian Acad Clin Med. 2004;5(1):56-61.

Canhão P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F. Causes and predictors of death in cerebral venous thrombosis. Stroke. 2005;36:1720-5.

Deschiens M, Conard J, Horellou M, Ameri A, Preter M, Chedu F. Coagulation studies, factor V Leiden and anticardiolipin antibodies 90 in 40 cases of Cerebral venous sinus thrombosis. Stroke. 1996;27:1724-30.

Daif A, Awada A, Al-Rajeh S, Abdul Jabbar M, Al Tahan Ar, Obeid T, et al. Cerebral venous thrombosis in adults: A study of 40 cases from Saudi Arabia. Stroke. 1995;26:1193-5.

Stolz E, Kemkes-Matthes B, Hahn M. Screening for thrombophilic risk factors among 25 German patients with CVT. Acta Neural Scand. 2000;102:31-6.

Nagaraj D, Haridas T, Taly AB, Veerendrakumar M, Subbukrishna DK. Puerperal cerebral venous thrombosis: therapeutic benefit of low dose heparin. Neurol India. 1999;47:43-6.

Neki NS. Clinical profile of cortical vein thrombosis - A two years experience. Annals Indn Acad Neurol. 2004;7:450.

Nagarajan E, Shankar V. Characteristics of cerebral venous thrombosis in a South Indian Rural Hospital. Int J Med Health Sci. 2013;2:298-304.

Kumar S, Alexander M, Gnanamuthu C. Clinical presentation and outcome of postpartum cerebral venous thrombosis. Annals Indn Acad Neurol. 2004;7:448-9.

Nagaraja D, Noone ML, Bharatkumar VP, Christopher R. Homocysteine, folate and vitamin B (12) in puerperal cerebral venous thrombosis. J Neurol Sci. 2008;272(1-2):43-7.

Einhaupl K, Villringer A, Meister W, Mehraein S, Garner C, Pellkofer M, et al. Heparin treatment in venous sinus thrombosis. Lancet. 1991;338:59-600.

Cipri S, Gangeni A, Campolo C, Cafarelli F, Gambardella G. High dose heparin plus warfarin administration in non-traumatic dural sinus thrombosis- a clinical and neurological study. J Neurosurgical Sci. 1998;42(1):23-32.

Nagaraja D, Tlly AB, Hardas VT, Veerendrakumar M, Subbakrishna DK. Heparin in haemorrhagic infarction in CVT. J Ass Phy Ind. 1998;46:706-7.

Aaron S, Alexander M, Maya T, Mathew V, Goel M, Nair SC, et al. Underlying prothrombotic states in pregnancy associated cerebral venous thrombosis. Neurol India. 2010;58:555-9.

Downloads

Published

2017-09-22

How to Cite

Bose, P., Joshua, J. P., & Thandavarayan, M. (2017). A clinical study of cerebral venous thrombosis. International Journal of Advances in Medicine, 4(5), 1236–1240. https://doi.org/10.18203/2349-3933.ijam20173663

Issue

Section

Original Research Articles