Cerebral Venous Thrombosis: Risk Factors, Possible Etiologies and Outcome

Abstract
Background: CVT represented 1% of all strokes. The most frequent risk factors associated conditions for CVT are genetic prothrombotic conditions, antiphospholipid syndrome and other acquired prothrombotic diseases, including cancer, oral contraceptives, puerperium and pregnancy, infections and trauma.
Aim of the Work: Is to study possible etiologies, risk factors, clinical presentations, radiological features and out-come of cerebral venous thrombosis during child bearing period.
Patients and Methods: This study was conducted in the Neuropsychiatric Department Tanta University Hospital on 82 patients with CVT, aged from 15-45 years. They were classified into female and male groups plus 20 control group matched with age. All patients were subjected to full history taking, neurologic examination including evaluation by Glas-gow coma scale (GCS) and National Institute of Health Stroke Scale (NIHSS), laboratory investigations, neuroimaging including: CT, MRI, MRV were done and follow-up by Mod-ified Rankin Scale (MRS) after 3 months.
Results: OCP was the most common risk factor followed by postpartum state. Single risk factor was presented in 48.8% and multiple risk factors were presented in 22%. Headache was the most common presenting symptoms followed by GTCS and motor deficit. Headache, GTCS, motor deficit and encephalopathy were more in females while papilledema, focal seizures, sensory deficit and aphasia were more in males. Hypercoagulable state was the most common etiology followed by antiphospholipid syndrome and SLE. Hypercoagulable state was most common in both sex, while sepsis and Behcet were significantly more common in males. Superior sagittal sinus (SSS) was the most common affected sinus followed by transverse and sigmoid sinuses. Single affected sinus was in 65.9%, while multiple affected sinuses was in 31.7% of patients. 12 patients (14.6%) were died. The most common cause of death was herniation followed by uncontrolled seizures. Factors associated with poor outcome were GCS less than 10 and NIHSS more than 14.
Conclusion: Headache is the most common presenting symptoms followed by motor deficit. D-dimer is positive in 76%. Hypercoagulable state is the most common etiology followed by antiphospholipid syndrome and SLE. SSS is the most common affected sinus then transverse sinus and sigmoid one. Female sex, GCS less than 10, NIHSS more than 14 and patients presented by headache have poor outcome.