Cerebral Venous Sinus Thrombosis: A Diagnostic Challenge

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Chumpol Anamnart

Abstract

Abstract


Background: Cerebral venous sinus thrombosis (CVST) is an unusual cause of stroke, which accounts for less than 1% of all cases of stroke. The diagnosis is generally delayed due to a wide spectrum of clinical symptoms. Delay in the diagnosis and treatment of CVST usually results in death.


Objective: To identify the factors that may predict a delay in the diagnosis, morbidity and mortality outcomes in patients with CVST.


Materials and methods: A retrospective review of all cases of CVST diagnosed at the Prapokklao Hospital, Chanthaburi Province, Thailand between January 2013 and December 2017.


Result: Thirty-nine cases of CVST were identified. There were 24 (61.5%) female and 15 (38.5%) male patients with a median age of 37 years. The duration of the time that the patients were presented to the hospital until CVST was diagnosed was less than 24 hours for 12 cases, 24-48 hours for 13 cases, and more than 48 hours for 14 cases. The correct diagnosis rate at admission was only 23%. The only one factor that predicted a delay in the diagnosis was a Glasgow coma score, which was less than 12 at admission. The most common risk factor in female patients was oral contraceptive pill consumption. For most of the male patients, the risk factors could not be identified (8/15 cases). The morbidity rate was 20.5% and mortality rate was 10.3%, which showed no difference between the three groups.


Conclusion: The diagnosis of CVST should be considered in women with headache and any other neurological symptoms, especially for those females who have taken oral contraceptive pills and had unexplained intracerebral hemorrhage.


Key words: cerebral venous sinus thrombosis; headache; oral contraceptive pill

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