Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 5974  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (702 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

  In this Article
 »  Abstract
 » Introduction
 »  Materials and Me...
 » Results
 » Discussion
 » Conclusion
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    PDF Downloaded634    
    Comments [Add]    
    Cited by others 51    

Recommend this journal


Table of Contents    
Year : 2012  |  Volume : 60  |  Issue : 2  |  Page : 154-159

Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: Insights from Nizam's Institute Venous Stroke Registry, Hyderabad (India)

1 Department of Neurology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, India
2 Department of Neurology, City Neurocenter, Vijayawada, India
3 Department of Clinical Research, Yashoda Superspeciality Hospital, Hyderabad, India

Date of Submission11-Dec-2011
Date of Decision03-Jan-2012
Date of Acceptance04-Mar-2012
Date of Web Publication19-May-2012

Correspondence Address:
Subhash Kaul
Department of Neurology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500082
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.96388

Rights and Permissions

 » Abstract 

Background: With the widespread use of neuroimaging and hematological workup, many of the previously held concepts about cerebral sinus venous thrombosis (CSVT) are changing. Objective: The objective of this study was to investigate the risk factors, clinical profile, and outcome of the fully investigated cases of CSVT from a major university referral hospital in South India. Materials and Methods: Consecutive patients of CSVT confirmed by definite neuroimaging criteria and fully investigated for prothrombotic states, between June 2002 and September 2010, were prospectively studied in the Venous Stroke Registry of Nizam's Institute of Medical Sciences, Hyderabad, South India. Results: Of the 428 patients, 230 (53.7%) were men and the mean age was 31.3 years (range 8-65 years). Seizures were noted in 126 (29.4%) patients, stroke like presentation was found in 122 (28.5%) patients, and benign intracranial hypertension like presentation was found in 78 (18.2%) patients. Common risk factors were anemia in 79 (18.4%), hyperhomocysteinemia in 78 (18.2%), alcoholism in 67 (15.6%), oral contraceptive pill intake in 49 (11.4%), postpartum state in 42 (9.8%), anticardiolipin antibodies in 31 (7.2%), and protein S deficiency in 53 (12.3%) patients. Good outcome at 90 days (modified Rankin Scale £ 2) was observed in 273 (71.2%) of 383 patients available for follow-up. In-house mortality was noted in 33 (7.7%) and recurrence in 22 (5.1%) patients. Conclusions: Compared to the previous studies, prevalence of CSVT was higher in men. Anemia, hyperhomocysteinemia, alcoholism, oral contraceptive use, and postpartum state were the most common risk factors. Overall prognosis was good, but a small percentage of patients died or showed recurrence.

Keywords: Cerebral sinus venous thrombosis, India, outcome, risk factors

How to cite this article:
Narayan D, Kaul S, Ravishankar K, Suryaprabha T, Bandaru VS, Mridula K R, Jabeen S A, Alladi S, Meena A K, Borgohain R. Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: Insights from Nizam's Institute Venous Stroke Registry, Hyderabad (India). Neurol India 2012;60:154-9

How to cite this URL:
Narayan D, Kaul S, Ravishankar K, Suryaprabha T, Bandaru VS, Mridula K R, Jabeen S A, Alladi S, Meena A K, Borgohain R. Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: Insights from Nizam's Institute Venous Stroke Registry, Hyderabad (India). Neurol India [serial online] 2012 [cited 2023 Jun 9];60:154-9. Available from:

 » Introduction Top

Cerebral sinus venous thrombosis (CSVT) is a common cause of stroke in India. With the widespread use of magnetic resonance imaging (MRI), many more cases of CSVT are being diagnosed than before. It is important to be aware of the varied clinical presentation and course of CSVT, as most of these patients have an excellent outcome if treated early and appropriately. Previous studies from India on CSVT were done before the widespread availability of MRI and procoagulant workup. [1],[2],[3] The aim of the present study was to investigate the risk factors, clinical presentation, course, the response to treatment, and follow-up in patients of CSVT in a prospective manner. This is probably the largest single centre series on this subject to date from the Indian subcontinent.

 » Materials and Methods Top

This study was conducted on the patients diagnosed as CSVT between June 2002 and September 2010 in the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, South India. Patients from all the strata of society were either referred or came by themselves to this hospital. The disease pattern seen in this major university hospital is representative of Andhra Pradesh, a province in South India. All the patients suspected to have CSVT were subjected to thorough clinical evaluation by neurologists. The clinical diagnosis was confirmed by at least one of the following radiological investigations: brain computer tomography (CT) scan, brain MRI (1.5 T) scan [T1-, T2-weighted axials, T1-weighted sagittal sequences, and MR Venography (MRV)] and digital subtraction angiography (DSA) done on Universal Angiogram System (Axiom Artis FA; Platinum Siemens Medical System, Erlangan, Germany). In some cases, more than one radiological investigation was done. The diagnosis of CSVT was based on appropriate clinical setting supported by radiological evidence in the form of partial or complete absence of filling of one or more dural sinuses or thrombosis of cortical veins. All the confirmed cases of CSVT were investigated with complete blood count, erythrocyte sedimentation rate (ESR), blood urea, sugars, serum creatinine, Human Immunodeficiency Virus (HIV), collagen profile like antinuclear antibody (ANA), antiphospholipid antibodies, prothrombin time, activated partial thromboplastin time, procoagulant states like protein C, protein S, antithrombin III (AT III), and serum homocysteine, with an aim to detect the underlying etiology. Hyperhomocysteinemia was defined as serum homocysteine >15 mg/100 ml in those below 60 years, [4] and >20 mg/100 ml in those above 60 years. [5] Anemia was defined as hemoglobin level <13 g/dl in males and <12 g/dl in females. [6]

Patients were treated with adjusted dose intravenous unfractionated heparin with an approximate dose of 1000 units/h, with the target activated partial thromboplastin time (APTT) of 2-2.5 times the control, or subcutaneous low molecular weight heparin (LMWH) in approximate dose of 0.1 mg/10 kg body weight for a duration of 10 days, intrasinus urokinase, or decompression craniotomy, as per the judgment of the attending doctor. All patients were treated with oral anticoagulation therapy with a target International Normalized Ratio (INR) of 2-3 for a period of 6 months after which it was continued indefinitely in patients with persistent hypercoagulable states. Detailed information about the patients was recorded which included: demographic data, type and duration of symptoms, time since the onset of symptoms elapsed at presentation: acute (<48 h), subacute (48 h to <30 days), and chronic (>30 days), Glasgow Coma Scale (GCS) score at admission, imaging modalities used, location and size of parenchymal lesions, location of thrombus, blood investigations, treatment given, and the response to treatment. Follow-up visits were performed at 6, 9, 12 months, and every 6 months thereafter by direct interview. For all patients, the condition recorded at the time of last follow-up was taken as the final follow-up. The data recorded during follow-up were disability according to modified Rankin Scale (mRS), death, recurrent symptomatic sinus thrombosis, seizures, severe visual loss, and the ongoing treatment. Outcome was assessed using mRS comprising complete recovery (mRS 0-1), partial recovery but independent (mRS = 2), dependent (mRS 3-5), and death (mRS 6).

Statistical analysis

Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 16.0 window software (SPSS Inc Chicago, Illinois (IL) 60606 USA). Continuous variables were presented in titer of mean and ± SD. Categorical variables were expressed as proportions and chi square test was used to study the association in proportions. We estimated odds ratio (OR) and the resulting 95% CI for the matched good and poor outcome pairs. Multiple logistic regression was performed before and after adjustment for potential confounders. All tests were two sided and P value equal to or less than 0.05 was considered statistically significant.

 » Results Top

A total of 428 patients (men 230, women 198; 1.17:1) were included in this study. The age range was 8-65 years (mean 31.3 years). Mean duration of symptoms before admission was 16.1 days. Presentation was acute in 61 (14.2%), subacute in 312 (72.8%), and chronic in 53 (12.3%) patients. Headache, vomiting, and seizures were the most common clinical features found in 378 (88.3%), 298 (69.6%), and 171 (39.9%) patients, respectively [Table 1].
Table 1: Demographic and clinical features

Click here to view

In terms of clinical syndromes, stroke like presentation was observed in 122 (28.5%), presentation as isolated seizures in 126 (29.4%), benign intracranial hypertension (BIH) like presentation in 78 (18.2%), presentation as encephalopathy in 108 (25.2%), and presentation as psychosis was observed in 8 (1.8%) patients. Normal neurological examination was found in 31 (7.2%) patients. Common risk factors identified were anemia in 79 (18.4%), hyperhomocysteinemia in 78 (18.2%), alcoholism in 67 (15.6%), oral contraceptive pill (OCP) intake in 49 (11.4%), postpartum state in 42 (9.8%), anticardiolipin antibodies in 31 (7.2%), and protein S deficiency in 53 (12.3%) patients. Multiple risk factors (two or more) were seen in 78 (18.2%) patients. No risk factor could be identified in 69 (16.1%) patients [Table 2].
Table 2: Risk factors

Click here to view

CT scan brain was done in 293 patients and the findings included: hemorrhagic infarction in 172 (58.7%), empty delta sign in 56 (19.1%), and cord sign in 9 (3%) patients [Table 3]. MRI was done in 392 patients and CSVT diagnosis was made by hemorrhagic infarct in 179 (45.6%), hyperdense sinuses in 145 (36.9%), empty delta sign in 80 (20.4%), and cord sign in 13 (3.3%) patients. In MRV done in 412 patients, superficial venous system was involved in 403 (97.8%) and deep venous system in 24 (5.8%) patients [Figure 1]a, b, [Figure 2]a, b and [Figure 3]a, b.
Figure 1: CT Brain showing hyperdense superior sagittal sinus with bilateral haemorrhagic infarcts in high parietal regions

Click here to view
Figure 2: T1 weighted MRI brain sagittal image showing thrombus in superior saggital sinus

Click here to view
Figure 3: (a-b) MRV phase contrast showing left transverse and superior sagittal sinus thrombosis

Click here to view
Table 3: CT and MRI characteristics

Click here to view

Three hundred and ninety-six (92.5%) patients received unfractionated heparin for 7 days overlapping with oral anticoagulants for 3 days which was continued for a minimum period of 6 months. LMWH was given in 41 (9.5%) of our patients, who had massive hemorrhagic infarcts with midline shift. Six patients (1.4%) not showing a satisfactory response to unfractionated heparin were administered intrasinus urokinase under catheter guidance via the transfemoral route. Decompression craniotomy was done in 16 (3.7%) patients who had midline shift and mass effect.

Information on outcome at discharge was available for all patients. Mean hospital stay was 16.1 days. In-hospital mortality was noted in 33 (7.7%) patients. Death in all cases was caused by raised intracranial pressure leading to cerebral herniation in the acute phase and also due to underlying complications like septicemia. At 90 days information on 416/428 patients (97%)was available. Two hundred and twenty-six (52.8%) patients became normal (mRS: 0-1), 47 (10.9%) patients became functionally independent (mRS = 2), and 110 (25.7%) remained dependent (mRS ³3-5) at the end of 3 months [Table 4].
Table 4: Difference between good outcome and poor outcome with various risk factors at 90 days

Click here to view

The independent predictors of poor outcome were fever (OR: 10.3, 95% CI: 2.3-38.9), deep venous thrombosis (OR: 9.9, 95% CI: 3.5-40.8), seizures (OR: 6.9, 95% CI: 3.8-12.4), focal neurological deficit (OR: 6.1, 95% CI: 3.2-11.6), and unconsciousness (OR: 3.4, 95% CI: 1.8-8.4) [Table 5].
Table 5: Predictors of poor outcome at 90 days

Click here to view

Follow-up ranging from 6 months to 5 years was available for 258 patients (60.2%), with a mean follow-up of 33 months. Chronic headache was the most common complication on follow-up seen in 18 (4.2%) patients. Other complications were recurrent seizures in 6 (1.1%), chronic intracranial hypertension in 4 (0.9%), deep venous thrombosis in lower limbs in 4 (0.9%), pulmonary thromboembolism in 2 (0.4%), and arterial thrombosis in 3 (0.7%) patients.

Recurrence of CSVT was seen in 22 patients (5.1%). All the recurrences occurred after 6 months and occurred up to 4.5 years after the initial episode. Risk factors for recurrence were persistent alcohol intake in 3 (13.6%), persistent OCP usage in 5 (2.7%), anemia in 3 (13.6%), hyperhomocysteinemia in 7 (31.8%), retroviral disease in 2 (9%), protein C deficiency in 1 (4.5%), abortion in 1 (4.5%), pregnancy in 1 (4.5%) and unknown in 4 (18.1%) patients. After adjustment of variables by multiple regression analysis, hyperhomocysteinemia (OR: 3.7, 95% CI: 1.5-9.0) and OCP usage (OR: 2.6, 95% CI: 1.0-7.0) were found to be independent risk factors for recurrence. The sinuses involved in the recurrent CSVT cases were Superior sagittal sinous (SSS) in 15/22 (68%), Straight Sinus (SS) in 7/22 (33%), and multiple sinuses in 14/22 (66%).

 » Discussion Top

Previous studies from India have shown CSVT to be highly prevalent and generally associated with postpartum state. [7],[8],[9],[10] Most of these studies were done before the widespread use of modern neuroimaging [1],[2],[3],[7],[10] and had limitations of having small numbers and incomplete investigations. [1],[3],[7],[8],[9],[10] The largest international multicentric trial of CSVT in 2004 included very few patients from Asia and Africa. [11] With the greater availability of MRI, CSVT is being increasingly diagnosed in both genders and at an early stage in India. Many new risk factors are being identified due to more complete workup. Due to the large sample size, uniform risk factor workup, and regular follow-up, the observations from the present study are most up-to-date and valid. In the present study, CSVT was found more frequently in men. Previous studies found 60-79% of CSVT patients to be women [7],[10],[12] and reported it as the commonest cause of stroke in young women in India. [13] The main reason for this was believed to be high prevalence of postpartum hypercoagulable state, precipitated by dehydration and consumption of high fat food in the developing countries during peripartum period. [12] The high frequency of CSVT in men in this study is probably due to rising consumption of alcohol by men, improvement in obstetric care, and higher level of clinical suspicion and detection of CSVT at an early stage.

The mean age in the present study was 31.3 years. However, it is not uncommon in children. Pediatric population constituted 9.4% of the study population, and the most common risk factor was anemia and infections like otitis media. Other studies showed various risk factors like infection, dehydration, renal failure, trauma, cancer, and hematological disorders, alone or in combination. [14],[15],[16],[17] Main clinical features in children in this study were headache and seizures. Other studies have shown that toddlers frequently present with seizures and focal signs, whereas older children present with headache and altered sensorium. [14] The elderly (>60 years) constituted only five patients (1.2%) among whom two were alcoholics and others had no identifiable risk factors. Most common presenting features in the present study were headache, vomiting, and seizures, as was shown in the previous studies. [11],[18],[19],[20] Papilledema was the most frequent sign. Like the previous studies, we encountered four distinct clinical syndromes, i.e. stroke like presentation, encephalopathy, seizures, and BIH like presentation. We did not encounter any case of puerperal psychosis as described in previous studies, probably due to better postpartum care. Non-puerperal psychiatric manifestations were seen in 8 (1.9%) patients out of whom 3 (0.7%) were using OCP and 5 (1.2%) consumed alcohol. Alcoholism and hyperhomocysteinemia were the main risk factors in men. Alcohol contributes to thrombosis by dehydration, hypercoagulability, and reactive thrombocytosis. [21] Overall, 42 (9.8%) patients were postpartum, which was equal to that reported in most western studies [22],[23] and less than 31-86% as reported from a few Asian studies. [24],[25] Less cases of postpartum CSVT in this study probably represent better women healthcare. While postpartum state, anemia, and OCP use were the most common risk factors in women, newly identified risk factors like protein C, protein S, AT III, and antiphospolipid antibodies (APLA) were also detected more frequently in them than in men. These abnormalities were also detected in some women of postpartum and OCP induced CSVT. It is possible that the presence of these procoagulant states triggers the thrombotic state during such exposure due to their additive effects. Rare etiologies in the present study included acute lymphoid leukemia on l-asparginase therapy, [26] drug-induced protein S deficiency, HIV infection, nephrotic syndrome, Coombs positive hemolytic anemia, carcinoma tongue, and chicken pox. Multiple risk factors were seen in 72 (17.9%) patients. Both arterial and venous thrombosis was seen in six patients, the etiology of which was anti-cardiolipin antibodies syndrome in one patient and the etiology of rest of the cases was unknown. Presence of empty delta sign and cord sign on CT scan brain suggests the diagnosis of CSVT, but these were found only in 56 (11.2%) and 9 (3%) patients, respectively. MRI was found to be better than CT in identification of these findings. As reported by others, we found MRV to be the most effective noninvasive technique to confirm the diagnosis. [27] However, DSA was required for 20 (4.9%) patients to confirm the diagnosis in this study and remains the gold standard for establishing the diagnosis of CSVT. [28] Superior sagittal sinus was the most frequent sinus involved. However, other sinuses can also be involved alone or in combination. Most of the patients were treated with unfractionated heparin. Six patients (1.4%) who did not respond to heparin were treated with intrasinus urokinase, as has been done elsewhere. [29] Successful recanalization with improvement of symptoms was achieved in all cases except one who subsequently died. Decompressive craniotomy was done in 15 (4%) patients of whom 2 patients expired while others had good outcome. Others have had a similar experience. [30] The predictors of good outcome were high GCS at presentation and superficial venous system involvement. Poor outcome was seen in patients with fever, low GCS at presentation, deep venous system involvement, and focal deficits. Association of CSVT and deep venous thrombosis in lower limbs was seen in 14 (3.4%) patients. The etiology of these patients was hyperhomocysteinemia in four, puerperium in two, protein C deficiency in one, malignancy in one, and unknown in six patients.

In majority of the patients, outcome was good and the patients were functionally independent (73.8%) at 3 months in contrast to arterial stroke where more patients remain dependent and bed bound. However, despite a good outcome, we did have an in-house mortality rate of 7.7%. Death was mainly caused by raised intracranial pressure leading to cerebral herniation in the acute phase, along with complications like septicemia.

Recurrence of CSVT was noted in 22 (5.4%) patients after being asymptomatic for a period of at least 6 months and occurred as late as 4.5 years after the initial event. This emphasizes the need for regular and prolonged follow-up in the patients of CSVT.

 » Conclusion Top

CSVT is an important and treatable cause of stroke affecting both the genders almost equally. Headache associated with raised intracranial pressure and seizures are the common presenting features. Risk factors like anemia, hyperhomocysteinemia, OCP use, alcoholism, and procoagulant state are being increasingly identified, while conventional risk factors like postpartum state are decreasing.

 » References Top

1.Lath R, Kumar S, Reddy R, Boola GR, Ray A, Prabhakar S, et al. Decompressive surgery for severe cerebral venous sinus thrombosis. Neurol India 2010;58:392-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Nagaraja D, Sarma GR. Treatment of cerebral sinus/venous thrombosis. Neurol India 2002;50:114-6.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Kalita J, Bandal V, Misra UK, Phadke RV. Cerebral venous sinus thrombosis in a tertiary care setting in India. QJM 2006;99:491-2.  Back to cited text no. 3
4.Ueland PM, Refsum H, Stabler SP, Malinow R, Andersson A, Allen RH. Total homocysteine in plasma or serum: Methods and clinical applications. Clin Chem 1993;39:1764-79  Back to cited text no. 4
5.Clarke R, Woodhouse P, Ulvik A, Frost C, Sherliker P, Refsum H, et al. Varibility and determinats of total homocysteine concentrations in plasma in an elderly population. Clin Chem 1998;44:102-7.  Back to cited text no. 5
6.Malhotra P, Kumar S, Kumar R, Varma S. Prevalence of anemia in adults rural population of North India. J Assoc Physicians India 2004;52:18-20.  Back to cited text no. 6
7.Nagpal RD. Dural sinus and cerebral venous thrombosis. Neurosurg Rev 1983;6:155-60.  Back to cited text no. 7
8.Srinivasan K, Natarajan M. Cerebral venous and arterial thrombosis in pregnancy and puerperium. Neurol India 1974;22:131-40.  Back to cited text no. 8
9.Srinivasan K, Natarajan M. Cerebral venous and sinus thrombosis in pregnancy and puerperium. A study of 135 patients. Angiology 1983;34:731-46.  Back to cited text no. 9
10.Nagaraja D, Taly AB. Cerebral venous thrombosis. J Assoc Physicians India 1987;35:876.  Back to cited text no. 10
11.Ferro JM, Correia M, Ponter C, For ISCVT investigators. Prognosis of cerebral venous and dural sinus thrombosis, Results of ISCVT. Stroke 2004;35:664-70.  Back to cited text no. 11
12.Chopra JS, Banerjee AK. Primary intracranial sinovenous occlusions in youth and pregnancy. In:Toole JF, editor.Handbook of clinical neurology, vascular disease part II.Vao.54 North Holland: Elsevier;1989.p.425-52.  Back to cited text no. 12
13.Bansal BC, Gupta RR, Prakash C. Stroke during pregnancy and puerperium in young females below the age of 40 years as a result of cerebral venous / sinus thrombosis. Jpn Heart J 1980;21:171-83.  Back to cited text no. 13
14.Carvalho KS, Bodensteiner JB, Connolly PJ, Garg BP. Cerebral venous thrombosis in children. J Child Neurol 2000;16:574-80.  Back to cited text no. 14
15.Barron TF, Gusnard DA, Zimmerman RA, Clancy RR. Cerebral venous thrombosis in neonates and children. Pediatr Neurol 1992;8:112-6.  Back to cited text no. 15
16.Heller C, Heinecke A, Junker R, Knofler R, Kosch A, Kurnik K, et al. Cerebral venous thrombosis in children: A multifactorial origin. Circulation 2003;108:1362-7.  Back to cited text no. 16 Veber G, Andrew M. And the Canadian Pediatric Ischemic Stroke Study Group. The epidemiology and outcome of sinovenous thrombosis in pediatric patients. N Engl J Med 2001;345:417-23.  Back to cited text no. 17 Bruijin SF, de Haan RT, Stam T. For cerebral venous sinus thrombosis study group. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. J Neurol Neurosurg Psychiatry 2001;70:105-8.  Back to cited text no. 18
19.Preter M, Tzourio CH, Ameri A, Bousser MG. Long term prognosis in cerebral venous thrombosis: A follow up of 77 patients. Stroke 1996:27;243-6.  Back to cited text no. 19
20.EinHaupl KM, Villringer A, Meister W, Mehracin S, Garner C, Pellkofer M, et al. Heprin treatment in sinus venous thrombosis. Lancet 1993;38:597-600.  Back to cited text no. 20
21.Mehta SR, Muthukrishnan J, Varadarajulu R, Gupta A. Cerebral Venous sinus thrombosis: A great masquerader. Medical Journal Armed Forces India Med J Armed Forces India 2004;60:299-301.  Back to cited text no. 21
22.Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol 2007;6:162-70.  Back to cited text no. 22
23.Deschiens MA, Conard J, Horellou MH, Ameri A, Preter M, Chedru F, et al. Coagulation studies, Factor V Leiden, and anticardiolipin antibodies in 40 cases of cerebral venous thrombosis. Stroke 1996;27:1724-30.  Back to cited text no. 23
24.Khealani BA, Wasay M, Saadah M, Sultana E, Mustafa S, Shohab Khan F, et al. Cerebral venous thrombosis A descriptive multicenter study of patients in Pakistan and Middle East. Stroke 2008;39:2707-11.  Back to cited text no. 24
25.Nagaraja DD, Haraidas TT, Taly AB, Veerendra Kumar MM, Subbu Krishna DK. Puerperal cerebral venous thrombosis. Therapeutic benefits of low dose Heparin. Neurol India 1999;47:43-6.  Back to cited text no. 25
[PUBMED]  Medknow Journal  
26.Feinberg WM, Swenson MR. Cerebrovascular complications of C aspergenase therapy. Neurology 1988;38:127-33.  Back to cited text no. 26
27.Anderson CM, Edelman RR, Turski PA. Magnetic resonance venography. Vol. 1. Raven, Philadelphia: Lippincott; 1993. pp. 289.  Back to cited text no. 27
28.Krayenbuhl H. Cerebral venous thrombosis. The diagnostic value of cerebral angiography Schweiz Arach Neuro Neurocli Psychiat 1954;74:261-87.  Back to cited text no. 28
29.Smith TP, Higahida R, Barnwell S, Halbach VV, Dowd CF, Fraser KW, et al. Treatment of dural sinus thrombosis by urokinase injection. Am J Neuroridol 1994;15:801-7.  Back to cited text no. 29
30.Stefini R, Latsonico N, Cornalic, Rasulo F, Bollati A. Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: Report of three cases. Neurosurgery 1999;45:626-30.  Back to cited text no. 30


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

This article has been cited by
1 Age of onset of cerebral venous thrombosis: the BEAST study
Redoy Ranjan, Gie Ken-Dror, Ida Martinelli, Elvira Grandone, Sini Hiltunen, Erik Lindgren, Maurizio Margaglione, Veronique Le Cam Duchez, Aude Bagan Triquenot, Marialuisa Zedde, Michelangelo Mancuso, Ynte M Ruigrok, Brad Worrall, Jennifer J Majersik, Jukka Putaala, Elena Haapaniemi, Susanna M Zuurbier, Matthijs C Brouwer, Serena M Passamonti, Maria Abbattista, Paolo Bucciarelli, Robin Lemmens, Emanuela Pappalardo, Paolo Costa, Marina Colombi, Diana Aguiar de Sousa, Sofia Rodrigues, Patrícia Canhao, Aleksander Tkach, Rosa Santacroce, Giovanni Favuzzi, Antonio Arauz, Donatella Colaizzo, Kostas Spengos, Amanda Hodge, Reina Ditta, Thang S Han, Alessandro Pezzini, Jonathan M Coutinho, Vincent Thijs, Katarina Jood, Turgut Tatlisumak, José M Ferro, Pankaj Sharma
European Stroke Journal. 2023; : 2396987322
[Pubmed] | [DOI]
2 Case of Pediatric Urticaria Pigmentosa
Sevkiye Aydogdu, Ibrahim Halil Aydogdu
The Journal of Pediatric Academy. 2023; 4(1): 42
[Pubmed] | [DOI]
Sandeep Kumar G, Rakesh Reddy P, Venkateswarlu N, Nikhita Kailas
[Pubmed] | [DOI]
Pratibha Prasad
[Pubmed] | [DOI]
5 A study of the prognostic significance of platelet distribution width, mean platelet volume, and plateletcrit in cerebral venous sinus thrombosis
Komal Usha Madineni, S. V. Naveen Prasad, Vengamma Bhuma
Journal of Neurosciences in Rural Practice. 2022; 0: 1
[Pubmed] | [DOI]
6 Cerebral venous thrombosis in Latin America: A critical review of risk factors, clinical and radiological characteristics
Gabriel Marinheiro dos Santos-Bezerra, Yasmin da Silveira Cavalcante, Paulo Roberto Matos-Neto, Joaquim Francisco Cavalcante-Neto, Keven Ferreira da Ponte, Diana Aguiar de Sousa, Paulo Roberto Lacerda Leal, Espártaco Moraes Lima Ribeiro
Frontiers in Neurology. 2022; 13
[Pubmed] | [DOI]
7 The Distribution of Lifestyle Risk Factors Among Patients with Stroke in the Indian Setting: Systematic Review and Meta-Analysis
Biji P. Varkey, Jaison Joseph, Abin Varghese, Suresh K. Sharma, Elezebeth Mathews, Manju Dhandapani, Venkata Lakshmi Narasimha, Radha Kuttan, Saleena Shah, Surekha Dabla, Sivashanmugam Dhandapani
Annals of Neurosciences. 2022; : 0972753122
[Pubmed] | [DOI]
8 Prevalence of Inherited Procoagulant States in Cerebral Venous Thrombosis and its Correlation with Severity and Outcome
Shaman Gill, Pawan Dhull, Madhukar Bhardwaj
Journal of Neurosciences in Rural Practice. 2022;
[Pubmed] | [DOI]
9 A Study of the Prognostic Significance of Platelet Distribution Width, Mean Platelet Volume, and Plateletcrit in Cerebral Venous Sinus Thrombosis
K. Usha Chowdary Madineni, Naveen Prasad Siddam Venkata, Vengamma Bhuma
Journal of Neurosciences in Rural Practice. 2022;
[Pubmed] | [DOI]
10 Body Iron Store and its Association with Risk of First Episode of Spontaneous Lower Extremity Deep Vein Thrombosis/ Pulmonary Embolism: A Case-Control Study
Ritwik Dey, Kolar Vishwanath Vinod, Prashant Shankarrao Adole
Indian Journal of Hematology and Blood Transfusion. 2022;
[Pubmed] | [DOI]
11 Clinical profile and risk factors of cerebral venous sinus thrombosis (CVST) in Sudan: A multicenter cross-sectional study
Etedal Ahmed A. Ibrahim, Rofiedah Eisa Hassan Mohamed, Khabab Abbasher Hussien Mohamed Ahmed, Mazin S. Haroun, Yassin Abdelrahim Abdalla, Mohammed Eltahier Abdalla Omer, Mohammed Mahmmoud Fadelallah Eljack
Annals of Medicine and Surgery. 2022; : 104891
[Pubmed] | [DOI]
12 Effect of recanalization on clinical outcomes in patients with cerebral venous thrombosis – An ambispective study
Naga Karthik Vanukuri, Radhakrishna Pedapati, Sundar Shanmugam, Philo Hazeena, Rajeswaran Rangasami, Shankar Venkatasubramanian
European Journal of Radiology. 2022; 153: 110385
[Pubmed] | [DOI]
13 Clinical and radiological study profile of cerebral venous sinus thrombosis at a tertiary care center in Pakistan
Muhammad Hassan, Naveed Ullah Khan, Haris Majid Rajput, Waleed Shahzad, Taimoor Hassan, Hafiza Faiza Mushtaq, Mazhar Badshah
Brain Hemorrhages. 2022;
[Pubmed] | [DOI]
14 Does gender difference matter in cerebral venous thrombosis?
Jayantee Kalita, Usha K. Misra, Varun K. Singh, Sunil Kumar, Neeraj Jain
Journal of Clinical Neuroscience. 2022; 102: 114
[Pubmed] | [DOI]
15 Comprehensive Thrombophilia Evaluation in Cerebral Venous Thrombosis: A Single Center Cross Sectional Study
Rajiv Kumar, Pulikottil Wilson Vinny, Vishnu G. Nair, Rajesh Jakku
Indian Journal of Hematology and Blood Transfusion. 2021;
[Pubmed] | [DOI]
16 Glasgow Coma Scale = 12 at Admission is a Predictor of Poor Functional Outcome (mRS 2–6) at One Year in Patients with Cerebral Venous Thrombosis
Salil Gupta, Rahul Soni, Pawan Dhull, Manoj Somasekharan, Amit Sreen
Journal of Stroke and Cerebrovascular Diseases. 2021; 30(7): 105811
[Pubmed] | [DOI]
17 Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar – Senegal
N.M. Gaye, R. Diagne, A.M. Diop, M. Ka, A.P. Senghor, A.B. Mbodji, K.A. Mbaye, S.S. Mbacké, S.A.A. Fall, M. Fall, O. Cissé, N.S. Diagne, M.S. Diop-Sène, A.M. Basse-Faye, A.D. Sow, M.M. Sarr, L.B. Seck, K. Touré, M. Ndiaye, A.G. Diop
Revue Neurologique. 2021; 177(6): 670
[Pubmed] | [DOI]
18 Cerebral Venous Thrombosis Associated with COVID-19 Infection: An Observational, Multicenter Study
Sajid Hameed, Mohammad Wasay, Bashir A. Soomro, Ossama Mansour, Foad Abd-allah, Tianming Tu, Raja Farhat, Naila Shahbaz, Husnain Hashim, Wasim Alamgir, Athar Iqbal, Maria Khan
Cerebrovascular Diseases Extra. 2021; 11(2): 55
[Pubmed] | [DOI]
19 Predictors of Caregiver Burden of Moderate and Severe Stroke Survivors: A Cross-Sectional Study from South India
Usha M. Khanapur, Jacob John, Arun Mathai Mani, Sanjith Aaron
Journal of Stroke Medicine. 2021; 4(1): 34
[Pubmed] | [DOI]
20 Structural Imaging Characteristic, Clinical Features and Risk Factors of Cerebral Venous Sinus Thrombosis: A Prospective Cross-Sectional Analysis from a Tertiary Care Hospital in Pakistan
Safia Bano, Muhammad Farooq, Sarwat Nazir, Ayesha Aslam, Adnan Tariq, Muhammad Javed, Habib Rehman, Ahsan Numan
Diagnostics. 2021; 11(6): 958
[Pubmed] | [DOI]
21 Cerebral Venous Thrombosis: Clinical, Radiological, Biological, and Etiological Characteristics of a French Prospective Cohort (FPCCVT)—Comparison With ISCVT Cohort
Aude Triquenot Bagan, Isabelle Crassard, Ludovic Drouet, Marianne Barbieux-Guillot, Raphaël Marlu, Emmanuelle Robinet-Borgomino, Pierre-Emmanuel Morange, Valérie Wolff, Lelia Grunebaum, Frédéric Klapczynski, Elisabeth André-Kerneis, Fernando Pico, Brigitte Martin-Bastenaire, Emmanuel Ellie, Fanny Menard, François Rouanet, Geneviève Freyburger, Gaëlle Godenèche, Hong-An Allano, Thierry Moulin, Guillaume Mourey, Laurent Derex, Micheline Berruyer, Gwénaëlle Runavot, Catherine Trichet, Fausto Viader, Agnès Le Querrec, Thomas Tarek Husein, Sophie Cluet-Dennetiere, Francisco Macian-Montoro, Magali Donnard, Benoît Guillon, Catherine Ternisien, Mathieu Zuber, Sophie Laplanche, Philippe Tassan, Jean-Yves Peeltier, Sandrine Canaple, Bertrand Roussel, Nicolas Gaillard, Emilie Scavazza, Véronique Le Cam Duchez
Frontiers in Neurology. 2021; 12
[Pubmed] | [DOI]
22 Posterior Reversible Encephalopathy Syndrome Is the Common Cause of New-Onset Seizures in the Peripartum Period: A Tertiary Hospital-Based Study in South India
Jagarlapudi MK Murthy, Shyam K Jaiswal, Keshava Anand Gaade
Journal of Epilepsy Research. 2021; 11(1): 49
[Pubmed] | [DOI]
23 Serebral venöz trombozlu hastalarda manyetik rezonans görüntüleme skoru ile Glasgow koma skoru arasindaki iliskinin arastirilmasi
Sakarya Medical Journal. 2020;
[Pubmed] | [DOI]
24 Radiological evaluation in patients with clinical suspicion of cerebral venous sinus thrombosis presenting with nontraumatic headache - a retrospective observational study with a validation cohort
Håkan Almqvist, Michael Mazya, Alberto Falk Delgado, Anna Falk Delgado
BMC Medical Imaging. 2020; 20(1)
[Pubmed] | [DOI]
25 Cerebral venous thrombosis in Argentina: clinical presentation, predisposing factors, outcomes and  literature review
Matías Alet, Celina Ciardi, Alberto Alemán, Lucrecia Bandeo, Pablo Bonardo, Clarisa Cea, Juan Cirio, Jerónimo Cossio, María Cuculic, María Martha Esnaola, Fernando García-Pérez, Federico Giner, Maia Gómez-Schneider, Cristian Isaac, Sandra Lepera, Carlos Martínez, Román Martínez-Lorenzín, Mariana Montes, Gabriela Orzuza, Gabriel Persi, Guillermo Povedano, Virginia Pujol-Lereis, Julieta Quiroga-Narváez, Marina Romano, Rodrigo Sabio, Juan Viglione, María Cristina Zurrú, Gustavo Saposnik
Journal of Stroke and Cerebrovascular Diseases. 2020; 29(10): 105145
[Pubmed] | [DOI]
26 Clinico-radiological profile of CVT patients and its correlation with D-dimer
Abhishek Pathak, Rameshwar Nath Chaurasia, Varun Kumar Singh, Upasana Shukla, Deepika Joshi, Vijaya Nath Mishra
Journal of Clinical Neuroscience. 2020; 78: 139
[Pubmed] | [DOI]
27 Comparative Analysis of CT and MRI in Emergency Assessment of Stroke: A Review
Digvijay Singh, Chanchal Kaushik
Journal of Multidisciplinary Research in Healthcare. 2019; 5(2): 57
[Pubmed] | [DOI]
28 Cerebral venous sinus thrombosis complicated by seizures: a retrospective analysis of 69 cases
Du-juan Sha,Jian Qian,Shuang-shuang Gu,Lu-na Wang,Fang Wang,Yun Xu
Journal of Thrombosis and Thrombolysis. 2018; 45(1): 186
[Pubmed] | [DOI]
29 Profile of 26 HIV Seropositive individuals with Cerebral Venous Thrombosis
Netravathi M.,Jaychandran R.,M. Bhat,R. Christopher,Satishchandra P.
Journal of the Neurological Sciences. 2017; 378: 69
[Pubmed] | [DOI]
30 Cerebral venous sinus thrombosis in pregnancy and puerperium: A pooled, systematic review
Ahmed I. Kashkoush,Henry Ma,Nitin Agarwal,David Panczykowski,Daniel Tonetti,Gregory M. Weiner,William Ares,Cynthia Kenmuir,Ashutosh Jadhav,Tudor Jovin,Brian T. Jankowitz,Bradley A. Gross
Journal of Clinical Neuroscience. 2017; 39: 9
[Pubmed] | [DOI]
31 An Examination of Stroke Risk and Burden in South Asians
Vineeta Singh,Shyam Prabhakaran,Seemant Chaturvedi,Aneesh Singhal,Jeyaraj Pandian
Journal of Stroke and Cerebrovascular Diseases. 2017; 26(10): 2145
[Pubmed] | [DOI]
32 A study of clinical, radiological and etiological profile of cerebral venous sinus thrombosis at a tertiary care center
R.K. Anadure,Vinny Wilson,Samaresh Sahu,Anuj Singhal,Satish Kota
Medical Journal Armed Forces India. 2017;
[Pubmed] | [DOI]
33 Cerebral Venous Thrombosis: A Tunisian Monocenter Study on 160 Patients
Samia Ben Sassi,Nahla Touati,Hela Baccouche,Cyrine Drissi,Neila Ben Romdhane,Fayçal Hentati
Clinical and Applied Thrombosis/Hemostasis. 2017; 23(8): 1005
[Pubmed] | [DOI]
34 European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology
José M Ferro,Marie-Germaine Bousser,Patrícia Canhão,Jonathan M Coutinho,Isabelle Crassard,Francesco Dentali,Matteo di Minno,Alberto Maino,Ida Martinelli,Florian Masuhr,Diana Aguiar de Sousa,Jan Stam
European Stroke Journal. 2017; 2(3): 195
[Pubmed] | [DOI]
35 Stroke profile and outcome between urban and rural regions of Northwest India: Data from Ludhiana population-based stroke registry
Paramdeep Kaur,Shweta J Verma,Gagandeep Singh,Rajinder Bansal,Birinder S Paul,Monika Singla,Shavinder Singh,Clarence J Samuel,Meenakshi Sharma,Jeyaraj D Pandian
European Stroke Journal. 2017; 2(4): 377
[Pubmed] | [DOI]
Dwijal Patel, Hetal Patel, Smita Trivedi
Journal of Evidence Based Medicine and Healthcare. 2017; 4(62): 3752
[Pubmed] | [DOI]
37 European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology
J. M. Ferro,M.-G. Bousser,P. Canhão,J. M. Coutinho,I. Crassard,F. Dentali,M. di Minno,A. Maino,I. Martinelli,F. Masuhr,D. Aguiar de Sousa,J. Stam
European Journal of Neurology. 2017; 24(10): 1203
[Pubmed] | [DOI]
38 Outcome of a cohort of severe cerebral venous thrombosis in intensive care
Benjamin Soyer,Marco Rusca,Anne-Claire Lukaszewicz,Isabelle Crassard,Jean-Pierre Guichard,Damien Bresson,Joaquim Mateo,Didier Payen
Annals of Intensive Care. 2016; 6(1)
[Pubmed] | [DOI]
39 Cerebral Venous Thrombosis in the Absence of Headache
Jonathan M. Coutinho, Jan Stam, Patricia Canhão, Fernando Barinagarrementeria, Marie-Germaine Bousser, José M. Ferro
Stroke. 2015; 46(1): 245
[Pubmed] | [DOI]
40 Association Between Anemia and Cerebral Venous Thrombosis
Jonathan M. Coutinho, Susanna M. Zuurbier, Aafke E. Gaartman, Arienne A. Dikstaal, Jan Stam, Saskia Middeldorp, Suzanne C. Cannegieter
Stroke. 2015; 46(10): 2735
[Pubmed] | [DOI]
41 Cerebral venous thrombosis in a Caribbean population
C. Bodez,A. Landais
Revue Neurologique. 2015;
[Pubmed] | [DOI]
42 Hydrocephalus in cerebral venous thrombosis
Susanna M. Zuurbier,René van den Berg,Dirk Troost,Charles B. Majoie,Jan Stam,Jonathan M. Coutinho
Journal of Neurology. 2015; 262(4): 931
[Pubmed] | [DOI]
43 Hyperhomocysteinemia and methylenetetrahydrofolate reductase C677T polymorphism in cerebral veno-sinus thrombosis
Bharatkumar, V.P., Nagaraja, D., Christopher, R.
Clinical and Applied Thrombosis/Hemostasis. 2014; 20(1): 78-83
44 Cerebral Venous Thrombosis: Clinical Features, Risk Factors, and Long-term Outcome in a Tunisian Cohort
Youssef Sidhom,Malek Mansour,Mariem Messelmani,Hajer Derbali,Nejiba Fekih-Mrissa,Jamel Zaouali,Ridha Mrissa
Journal of Stroke and Cerebrovascular Diseases. 2014;
[Pubmed] | [DOI]
45 Cerebral Venous Sinus Thrombosis With Ophthalmic Manifestations in 18-Year-Olds on Oral Contraceptives
Jeffrey J. Tan,Ameer Hassoun,Valerie I. Elmalem
Clinical Pediatrics. 2014; 53(9): 826
[Pubmed] | [DOI]
46 Hyperhomocysteinemia and Methylenetetrahydrofolate Reductase C677T Polymorphism in Cerebral Veno-sinus Thrombosis
Venkata Pinnelli Bharatkumar,Dindagur Nagaraja,Rita Christopher
Clinical and Applied Thrombosis/Hemostasis. 2014; 20(1): 78
[Pubmed] | [DOI]
47 Toward a Better Model of Cerebral Venous Sinus Thrombosis
Jason P. Rahal,Adel M. Malek,Carl B. Heilman
World Neurosurgery. 2013;
[Pubmed] | [DOI]
48 Neurological emergencies in pregnant and post-partum women in resource-poor settings: Authoræs reply
Jonathan A Edlow,Louis R Caplan,Karen OæBrien,Carrie Tibbles
The Lancet Neurology. 2013; 12(4): 330
[Pubmed] | [DOI]
49 Hereditary thrombophilia in cerebral venous thrombosis
Navin Pai,Kanjaksha Ghosh,Shrimati Shetty
Blood Coagulation & Fibrinolysis. 2013; 24(5): 540
[Pubmed] | [DOI]
50 Cerebral venous thrombosis and thrombophilia: A systematic review and meta-analysis
Lauw, M.N., Barco, S., Coutinho, J.M., Middeldorp, S.
Seminars in Thrombosis and Hemostasis. 2013; 39(8): 913-327
51 Progress in diagnosis and treatment of cerebral venous and sinus thrombosis
Ma, S.-C. and Meng, R. and Li, S.-J.
Chinese Journal of Cerebrovascular Diseases. 2012; 9(12): 656-660


Print this article  Email this article
Online since 20th March '04
Published by Wolters Kluwer - Medknow