Clinical Presentation, Neuroimaging Findings, and Predictors of Brain Parenchymal Lesions in Cerebral Vein and Dural Sinus Thrombosis: A Retrospective Study

Abstract

Introduction: Cerebral venous sinus thrombosis (CVST) is an unusual cause of stroke with potentially serious consequences. This study was designed to investigate the clinical and neuroimaging features in patients with CVST and to analyze the predictors of brain parenchymal lesions.

Materials and methods: A retrospective study of 181 patients with CVST was conducted in a tertiary care hospital.

Results: Of 181 patients (age range 14-96 years, mean age: 34.64 ± 14.66 years), 121 were female (66.9%). Most of the patients were in their third decade of life. Headache (47.51%) was the most common clinical presentation followed by seizures (24.31%). Transverse sinus (TS) (77.9%) was the most common site of venous sinus thrombosis. Brain parenchymal lesions were present in 63%, and each patient had subarachnoid and intraventricular hemorrhage. Hemorrhagic venous infarct was the most common brain parenchymal lesion (37.57%). Frontal region (25.4%) was the most common site of brain parenchymal lesions followed by frontoparietal region (21.9%). Women were more likely to have brain parenchymal lesions (72.4%, P = 0.034). Headache was the most common clinical presentation in patients without brain parenchymal lesions while seizures with brain parenchymal lesions. Straight sinus thrombosis was more likely to be associated with brain parenchymal lesions (P = 0.009).

Conclusion: CVST presents in young and more commonly in females. TS was the most common site of venous sinus thrombosis. Female gender, seizures, altered sensorium and focal neurological deficit at presentation, and straight sinus thrombosis were more likely associated with the presence of brain parenchymal lesions.

Keywords: Magnetic resonance venography; straight sinus; superior sagittal sinus; transverse sinus.

Figure 1

Distribution of cortical venous sinus thrombosis patients according to age (decade years)

Figure 2

A 34-year-old female with seizure had (a) Hyperdensity of straight sinus (thick arrow) and superior sagittal sinus (arrowhead) and subarachnoid hemorrhage of the left parietal region (long arrow) on noncontrast computed tomography head. (b) Thrombus at superior sagittal sinus (short arrow) and subarachnoid hemorrhage of the left parietal region (thick arrows) on fluid-attenuated inversion recovery. (c) Magnetic resonance venography showed thrombosis of superior sagittal sinus (long arrows), straight sinus (arrowhead) and (d) Left transverse sinus and sigmoid sinus (long arrows). (e) A 23-year-old female (postpartum) with altered sensorium had thrombosis of deep venous system (thick arrows) and bilateral transverse sinus (short arrows) on magnetic resonance venography, and (f) nonhemorrhagic venous infarcts of bilateral thalami and basal ganglia on fluid-attenuated inversion recovery sequence