Spectrum of Cerebral Venous Thrombosis in Oman

Abstract

Objectives: Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman.

Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes.

Results: A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up.

Conclusion: These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes.

Keywords: Cerebral Thrombosis; Cranial Venous Sinuses; Neurological Manifestations; Oman; Patient Outcome Assessment; Venous Thrombosis.

Figure 1

Imaging of the brain of a 23-year-old woman with puerperal cerebral venous thrombosis showing (A) mixed-density bifrontal venous infarcts on computed tomography, (B) increased involvement of the right hemisphere two days later on magnetic resonance imaging and (C) thrombosis of the anterior two-thirds of the superior sagittal sinus (arrow) and right transverse sinus upon magnetic resonance venography.

Figure 2

Imaging of the brain of a 60-year-old man with recurrent cerebral venous thrombosis showing (A) right parietal patchy haemorrhage, a thrombosed cortical vein in the left parietal region (arrow) and hyperdensity along the superior sagittal sinus (arrowhead) on computed tomography, (B) an increase in the size of the right parietal haematoma upon magnetic resonance imaging the next day and (C) thrombosis of the superior sagittal sinus extending to the transverse and sigmoid sinuses and further into the right internal jugular vein (arrow) upon magnetic resonance venography.

Figure 3

Imaging of the brain of a 41-year-old woman with deep cerebral venous thrombosis showing (A) thrombosis of the superior sagittal sinus (SSS) as well as the left frontal and parietal cortical veins (arrows) on computed tomography, (B) biconvex hyperintensities in the thalamus-basal ganglionic region (arrow) as well as (C) cortical venous infarcts (arrow) upon magnetic resonance imaging the next day and (D) the absence of flow void in the deep venous system as well as the SSS (arrowheads) upon magnetic resonance venography.

Figure 4

Imaging of the brain of a 21-year-old man with thrombosis restricted to the major dural venous sinuses showing (A) empty delta sign in the superior sagittal sinus (SSS) with surrounding contrast (arrow) and (B) thrombosis of the transverse sinus (TrS) (arrow) on computed tomography, (C) normal parenchyma upon magnetic resonance imaging and (D) thrombosis of the SSS and TrS upon magnetic resonance venography (arrowhead).