Dwijal Patel1, Hetal Patel2, Smita Trivedi3
In 1825, Ribes, a French physician, described the foremost detailed explanation of Cerebral Venous Sinus Thrombosis (CVST). Infective causes, thrombophilic abnormalities, oral contraceptives, antithrombin III, protein C and protein S defects, antiphospholipid syndrome, high plasma concentrations of homocysteine, low plasma folate level are common causes of CVT. The prognosis after CVT during pregnancy and puerperium is probably better than after CVT from other causes. During the past decade, increased awareness of the diagnosis improved neuroimaging techniques and more effective treatment have improved the prognosis.
MATERIALS AND METHODS
32 patients admitted to SSG Hospital from November 2012 to November 2013 with a confirmed diagnosis of cerebral venous thrombosis by imaging of brain (MR Veno) were included. Meticulous history, clinical examination and laboratory investigations were carried out in all cases. Haemorrhagic thromboembolic stroke and metabolic encephalopathy were excluded from study.
The puerperal CVT group consisted of 17 women (53.125%) and the non-puerperal group consisted of 25 patients (78.125%) of which 10 were women and 15 were men. The present study showed 42.875% of patients presented within 10 days. Headache was the most common symptom in the present study accounting for 85% of patients. In the present study, 50% of cases had seizures, 31.25% of patients had focal deficit, 53.125% of patients had altered level of consciousness and 25% of patients had papilloedema. The most common finding in the present study is haemorrhagic infarction present in 59.375% of cases. The transverse sinus is most commonly involved accounting for 65.625% followed by sigmoid sinus with 59.375% and superior sagittal sinus with 56.25%. In our study, all the 32 patients were treated with anticoagulants. All patients were subjected to LMWH and then switched on to warfarin therapy maintaining the INR value 1.5 to 2 times normal. Patients were followed at 15 days interval and values of INR reviewed. Patients of hyperhomocysteinaemia were given folic acid and vitamin B12. In the present study, mortality is 12.5%.
CVT diagnosed with MR venogram presenting within 10 days with symptoms of headache, seizures, focal deficit, altered level of consciousness with MRI findings of haemorrhagic transformation commonly involving transverse sinus were key findings of our study. About 80 percent of all patients now have a good neurologic outcome