Skip to main content

Advertisement

SpringerLink
Log in

Cerebral venous thrombosis: a retrospective unicentric analysis of clinical and neuroimaging characteristics

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Thrombosis of dural sinuses and/or cerebral veins (CVT) is an uncommon form of stroke, usually affecting young individuals. It has a variable clinical presentation ranging from mild cases presenting only headaches, to severe cases featuring encephalopathy, coma or status epilepticus. A retrospective cross-sectional study of patients treated in the outpatient department and in-hospital during the period from 2014 to 2020 at the Neurology Clinic—University Clinical Centre of Serbia was conducted. Forty-nine patients (24 men; 25 women) were included in the study. Twenty-three patients (46.9%) suffered a subacute form of CVT (48 h—4 weeks), 19 (38.8%) presented with an acute form (< 48 h) and 7 (14.3%) with a chronic form (> 4 weeks). Around 75% of patients reported headaches during disease course. Focal neurological deficit (FND) was observed in 27 (55.1%) patients. Patients who did not report headaches (22.4%) presented with more severe symptoms (seizures and coma). More than 70% of patients had no radiologically evident brain parenchymal lesion. The most frequent locations of CVT were transverse sinus (79.6%), sigmoid sinus (44.9%) and superior sagittal sinus (36.7%). Thrombosis of more than one sinus/vein occurred in 33 (67.3%) patients. Hereditary thrombophilia was observed in 9 (18.4%) patients, 11 (22.4%) patients had some type of infection and 20% of women reported OCT usage. As much as 25% of cases remained without evident risk factors. The most common symptom in our cohort was acute unilateral throbbing headache of high intensity, while patients without headaches had more severe symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell C, Cucchiara B, Cushman M, deVeber G, Ferro JMTF (2011) Diagnosis and management of cerebral venous thrombosis a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:1158–1192

  2. Ferro JM, Aguiar de Sousa D. Cerebral venous thrombosis: an update. Curr Neurol Neurosci Rep 2019;19. https://doi.org/10.1007/s11910-019-0988-x.

  3. Danwang C, Mazou TN, Tochie JN, Tankeu R, Bigna JJ (2018) Global epidemiology and patterns of cerebral venous thrombosis: a systematic review and meta-analysis protocol. BMJ Open 8:1993–1999. https://doi.org/10.1136/bmjopen-2017-019939

    Article  Google Scholar 

  4. Devasagayam S, Wyatt B, Leyden J, Kleinig T (2016) Cerebral venous sinus thrombosis incidence is higher than previously thought: a retrospective population-based study. Stroke 47:2180–2182. https://doi.org/10.1161/STROKEAHA.116.013617

    Article  PubMed  Google Scholar 

  5. Silvis SM, De Sousa DA, Ferro JM, Coutinho JM (2017) Cerebral venous thrombosis. Nat Rev Neurol 13:555–565. https://doi.org/10.1038/nrneurol.2017.104

    Article  PubMed  Google Scholar 

  6. Canhão P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F (2005) Causes and predictors of death in cerebral venous thrombosis. Stroke 36:1720–1725. https://doi.org/10.1161/01.STR.0000173152.84438.1c

    Article  PubMed  Google Scholar 

  7. Stam J (2005) Thrombosis of the cerebral veins and sinuses. N Engl J Med 352:1791–1798

    Article  CAS  Google Scholar 

  8. Capecchi M, Abbattista M, Martinelli I (2018) Cerebral venous sinus thrombosis. J Thromb Haemost 16:1918–1931. https://doi.org/10.1111/jth.14210

    Article  CAS  PubMed  Google Scholar 

  9. Zuurbier SM, Arnold M, Middeldorp S, Broeg-Morvay A, Silvis SM, Heldner MR et al (2016) Risk of cerebral venous thrombosis in obese women. JAMA Neurol 73:579–584. https://doi.org/10.1001/jamaneurol.2016.0001

    Article  PubMed  Google Scholar 

  10. Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E (2020) Cerebral venous thrombosis: a comprehensive review. Eur Neurol 83:369–379. https://doi.org/10.1159/000509802

    Article  PubMed  Google Scholar 

  11. Kristoffersen ES, Harper CE, Vetvik KG. Cerebral venous thrombosis – epidemiology, diagnosis and treatment. Tidsskr Den Nor Legeforening 2018;138. https://doi.org/10.1016/s0992-5945(15)72049-0.

  12. Stack CA, Cole JW. Cerebral venous thrombosis: a clinical overview. Ischemic Stroke of Brain, InTech; 2018, p. 21–44. https://doi.org/10.5772/intechopen.79049.

  13. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F (2004) Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke 35:664–670. https://doi.org/10.1161/01.STR.0000117571.76197.26

    Article  PubMed  Google Scholar 

  14. Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F et al (2017) European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology. Eur Stroke J 2:195–221. https://doi.org/10.1177/2396987317719364

    Article  PubMed  PubMed Central  Google Scholar 

  15. Aliprandi A, Borelli P, Polonia V, Salmaggi A (2020) Headache in cerebral venous thrombosis. Neurol Sci 41:401–406. https://doi.org/10.1007/s10072-020-04784-w

    Article  PubMed  Google Scholar 

  16. Luo Y, Tian X, Wang X. Diagnosis and treatment of cerebral venous thrombosis: a review. Front Aging Neurosci 2018;10. https://doi.org/10.3389/fnagi.2018.00002.

  17. Ben Sassi S, Touati N, Baccouche H, Drissi C, Ben Romdhane N, Hentati F (2017) Cerebral venous thrombosis: a Tunisian monocenter study on 160 patients. Clin Appl Thromb 23:1005–9. https://doi.org/10.1177/1076029616665168

    Article  Google Scholar 

  18. Duman T, Uluduz D, Midi I, Bektas H, Kablan Y, Goksel BK et al (2017) A multicenter study of 1144 patients with cerebral venous thrombosis: the VENOST study. J Stroke Cerebrovasc Dis 26:1848–1857. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.04.020

    Article  PubMed  Google Scholar 

  19. Khan MWA, Zeeshan HM, Iqbal S. Clinical profile and prognosis of cerebral venous sinus thrombosis. Cureus 2020;12. https://doi.org/10.7759/cureus.12221.

  20. Alami B, Boujraf S, Quenum L, Oudrhiri A, Alaoui Lamrani MY, Haloua M et al (2019) Cerebral venous thrombosis: clinical and radiological features, about 62 cases. JMV-Journal Med Vasc 44:387–399. https://doi.org/10.1016/J.JDMV.2019.09.011

    Article  CAS  Google Scholar 

  21. Gazioglu S, Eyuboglu I, Yildirim A, Aydin CO, Alioglu Z (2017) Cerebral venous sinus thrombosis: clinical features, long-term outcome and recanalization. J Clin Neurosci 45:248–251. https://doi.org/10.1016/j.jocn.2017.07.028

    Article  PubMed  Google Scholar 

  22. Zuurbier SM, Middeldorp S, Stam J, Coutinho JM (2016) Sex differences in cerebral venous thrombosis: a systematic analysis of a shift over time. Int J Stroke 11:164–170. https://doi.org/10.1177/1747493015620708

    Article  PubMed  Google Scholar 

  23. Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F (2005) Cerebral vein and dural sinus thrombosis in elderly patients. Stroke 36:1927–1932. https://doi.org/10.1161/01.STR.0000177894.05495.54

    Article  PubMed  Google Scholar 

  24. Nasr DM, Brinjikji W, Cloft HJ, Saposnik G, Rabinstein AA (2013) Mortality in cerebral venous thrombosis: results from the national inpatient sample database. Cerebrovasc Dis 35:40–44. https://doi.org/10.1159/000343653

    Article  CAS  PubMed  Google Scholar 

  25. De Sousa DA, Neto LL, Canhão P, Ferro JM (2018) Recanalization in cerebral venous thrombosis a systematic review and meta-analysis. Stroke 49:1828–1835. https://doi.org/10.1161/STROKEAHA.118.022129

    Article  Google Scholar 

  26. Qureshi A, Perera A (2017) Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: a systematic review and meta-analysis. Ann Med Surg 17:22–26. https://doi.org/10.1016/j.amsu.2017.03.016

    Article  Google Scholar 

  27. Uluduz D, Midi I, Duman T, Yayla V, Karahan AY, Afsar N et al (2020) Epileptic seizures in cerebral venous sinus thrombosis: subgroup analysis of VENOST study. Seizure 78:113–117. https://doi.org/10.1016/j.seizure.2020.02.017

    Article  PubMed  Google Scholar 

  28. Lindgren E, Silvis SM, Hiltunen S, Heldner MR, Serrano F, de Scisco M et al (2020) Acute symptomatic seizures in cerebral venous thrombosis. Neurology 95:e1706–e1715. https://doi.org/10.1212/WNL.0000000000010577

    Article  CAS  PubMed  Google Scholar 

  29. Botta R, Donirpathi S, Yadav R, Kulkarni G, Kumar M, Nagaraja D (2017) Headache patterns in cerebral venous sinus thrombosis. J Neurosci Rural Pract 8:72–77. https://doi.org/10.4103/jnrp.jnrp_339_16

    Article  Google Scholar 

  30. Singh RJ, Saini J, Varadharajan S, Kulkarni GB, Veerendrakumar M (2018) Headache in cerebral venous sinus thrombosis revisited: exploring the role of vascular congestion and cortical vein thrombosis. Cephalalgia 38:503–510. https://doi.org/10.1177/0333102417698707

    Article  PubMed  Google Scholar 

  31. Diamanti S, Longoni M, Agostoni EC (2019) Leading symptoms in cerebrovascular diseases: what about headache? Neurol Sci. https://doi.org/10.1007/s10072-019-03793-8

    Article  PubMed  Google Scholar 

  32. Olesen J (2018) Headache Classification Committee of the International Headache Society (IHS) The international classification of headache disorders, 3rd edition. Cephalalgia 38:1–211. https://doi.org/10.1177/0333102417738202

    Article  Google Scholar 

  33. Konakondla S, Schirmer CM, Li F, Geng X, Ding Y (2017) New developments in the pathophysiology, workup, and diagnosis of dural venous sinus thrombosis (DVST) and a systematic review of endovascular treatments. Aging Dis 8:136–48. https://doi.org/10.14336/AD.2016.0915

    Article  PubMed  PubMed Central  Google Scholar 

  34. Uzar E, Ekici F, Acar A, Yucel Y, Bakir S, Tekbas G et al (2012) Cerebral venous sinus thrombosis: an analyses of 47 patients. Eur Rev Med Pharmacol Sci 16:1499–1505

    CAS  PubMed  Google Scholar 

  35. Behrouzi R, Punter M (2018) Diagnosis and management of cerebral venous and dural sinus thrombosis. Clin Med (Lond) 18:75–79. https://doi.org/10.3109/9781841848075.023

    Article  Google Scholar 

  36. Jalili M, Ghourchian S, Shahidi GA, Rohani M, Rezvani M, Zamani B (2013) A study of factors associated with cerebral venous thrombosis. Neurol Sci 34:321–326. https://doi.org/10.1007/s10072-012-0997-x

    Article  PubMed  Google Scholar 

  37. United Nations. Department of Economic and Social Affairs. Population Division. Contraceptive use by method 2019 : data booklet. 2019.

  38. De Stefano V, Chiusolo P, Paciaroni K, Leone G (1998) Epidemiology of factor V leiden: clinical implications. Semin Thromb Hemost 24:367–379. https://doi.org/10.1055/s-2007-996025

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Jovan Petrović, Jasna Zidverc-Trajković, Dejana Jovanović & Milija Mijajlović

  2. Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia

    Tamara Švabić, Jasna Zidverc-Trajković, Predrag Stanarčević, Dejana Jovanović & Milija Mijajlović

Authors
  1. Jovan Petrović
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamara Švabić
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jasna Zidverc-Trajković
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Predrag Stanarčević
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dejana Jovanović
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Milija Mijajlović
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Milija Mijajlović.

Ethics declarations

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of the Medical Faculty University of Belgrade who determined that our study did not need ethical approval.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Petrović, J., Švabić, T., Zidverc-Trajković, J. et al. Cerebral venous thrombosis: a retrospective unicentric analysis of clinical and neuroimaging characteristics. Neurol Sci 43, 1839–1847 (2022). https://doi.org/10.1007/s10072-021-05514-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-021-05514-6

Keywords

Search

Navigation