Cerebral venous thrombosis--clinical presentations

Abstract

Cerebral venous thrombosis (CVT) is an under diagnosed condition for acute or slowly progressive neurological deficit. CVT is less frequent than arterial thrombosis. CVT has a wide spectrum of signs and symptoms, which may evolve suddenly or over the weeks. It is clinically challenging and mimics many neurological conditions such as, meningitis, encephalopathy, benign intracranial hypertension, and stroke. With increasing awareness, CVT cases are now being diagnosed more frequently. Newer imaging procedures have led to easier recognition of venous sinus thrombosis, offering the opportunity for early therapeutic measures. It may be difficult to diagnose it on clinical grounds alone. Headache is the most frequent symptom in patients with CVT, present in about 80% of cases. Most common pattern of presentation is with a benign intracranial hypertension-like syndrome. The prognosis of CVT is worse in elderly subjects. The shorter the history the more likely is the presence of focal signs. Sixth cranial nerve palsy usually manifests as false localizing sign. Subarachnoid haemorrhage (SAH) has been described, as the presenting event with CVT. Patients may have seizures that can be recurrent. Cranial nerve syndromes are seen with venous sinus thrombosis. Psychiatric disturbances are sometimes the presenting symptoms. CVT, an important cause of stroke in puerperium, is frequently observed in India. We have seen 6 patients of CVT out of 490 stroke registry. Of these 6, four were females and two were males. The mean age among females was 27.75 years and among males was 41.5 years. Of the 4 females two were postpartum; one was on oral contraceptive and in one Antiphospholipid antibodies (APLA) were positive. Amongst two males one had hyperhomocysteinemia and one had hyperlipidemia.