Clinical Profile, Risk Factors and Outcomes in Patients with Cerebral Venous Sinus Thrombosis: A Study from Western India.

AIM: Study of cause and clinical profile of venous sinus thrombosis in Western India. SETTINGS AND
DESIGN: A retrospective study was conducted to ascertain the clinical profile, etiology, and follow up of patients with venous sinus thrombosis. METHODS AND MATERIAL: Hospital database of patients suffering from venous sinus thrombosis from two tertiary care hospitals in West India were studied. A telephonic follow up was taken for assessment of outcome. Inclusion criteria were a) Age more than 15 years of age b) clinically symptomatic patients c) Diagnosis confirmed by Magnetic resonance Venography (MRV) or CT Venography (CT Venography) Exclusion criteria: Patients with infarct in arterial territory, hypertensive hemorrhage, metabolic encephalopathy and eclampsia were excluded from the study. STATISTICAL ANALYSIS USED: Descriptive statistic was performed as frequency, mean and standard deviation or percentages. Difference in continuous variables was evaluated by using independent t-test while chi-square test was performed in categorical variables. Statistical P<0.05 was considered statistically significant.
RESULTS: We conducted a retrospective study of patients with venous sinus thrombosis in Rajasthan in western India. Out of 71 patients in our study group the mean age of presentation was 36.64 years. 42 patients were male (59.2%) and 29 were female (40.8%). Only 9 patients (12.6%) had pregnancy or puerperium related venous sinus thrombosis. The most common presenting feature was headache 47/71(66.2), followed by seizures 33 (46.5%), paresis 20/71 (28.16%) and coma 15/71(21.1%). MRI Brain recorded infarcts in 32/71 patients and predominant hemorrhage was recorded in 34/71. 4 cases were associated with malignancy (one CNS, one outside CNS and 2 hematological). Raised homocysteine level was found in 26/35 (74.3%) patients in whom they were measured. 9 patients had moderately elevated homocysteine levels (15-30), another 9 had intermediate values (31-64) and 5 patients had elevated homocysteine level >65. Hyperhomocysteinemia was the commonest causative factor and was far more common in men (21/25) than in women (5/10). (p value 0.019). 24 out of 71 patients were found to be anemic (33.8%). Anemia was far more common in women than in men. (p value .002). Protein C level was found abnormal in 5/27 patients, Protein S in 6/27 patients and Anti thrombin III in 1/23 patient studied respectively. History of oral contraceptive intake was recorded in only a minority of women with venous sinus thrombosis 7(24.1%) compared to the western data where most of the venous sinus thrombosis are related to the contraceptive pills.
CONCLUSION: The clinical presentation of venous sinus thrombosis in tertiary care centers is changing outside the traditional peurperium / pregnancy related venous sinus thrombosis. Common risk factors include hyperhomocysteinemia, anemia, coagulopathy, pregnancy related, vasculitis, malignancy and oral contraceptive usage. Male involvement was far more common than females and was usually associated with a higher level of homocysteine. © Journal of the Association of Physicians of India 2011.