Clinical and radiological study profile of cerebral venous sinus thrombosis at a tertiary care center in Pakistan

Purpose: A prospective, observational study was done at the country leading tertiary care hospital to evaluate etiologies, clinical features, diagnosis, and prognosis of cerebral venous sinus thrombosis (CVST) in the Pakistani population. Methods: 34 patients with clinical and MRI features suggestive of CVST were evaluated. Modified Rankin Score (mRS) was assessed of all patients at presentation. Results: The mean age of presentation was 30.69 years with female predominance (n = 28). Headache was most common presenting symptoms (97%, n = 33) followed by seizure (59%, n = 20), hemiparesis (56%; n = 19), altered sensorium (47%; n = 16), vomiting (21%; n-7) and cranial nerve involvement (18%; n = 6). 72% of patients (n = 23) had thrombosis of superior sagittal sinus, 53% of patients (n = 17) had thrombosis of the transverse sinus, 25% patients (n = 8) of patients had sigmoid sinus thrombosis, 16 % patients (n = 8) had straight sinus thrombosis. The most common cause for provoked CVST was found to be pregnancy/puerperium in 53% (n = 18 patients), followed by previous CVST/DVT in 12% (n = 4), and then OCP and parainfectious causes which were 3% (n = 1) for each and elevated factor VIII and protein deficiency were found in 7 patients. MRS between 3 and 5 was assessed in most patients on presentation (n = 23). Conclusion: CVST is an under-recognized cause of stroke in the young population, especially in the puerperium period. Clinical presentation is highly variable, and correction with magnetic resonance imaging with venography is the current diagnostic modality of choice. Aggressive management with anticoagulants is safe with excellent clinical outcomes.