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| ORIGINAL ARTICLE |
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| 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)
Deekshanti Narayan1, Subhash Kaul1, K Ravishankar2, T Suryaprabha1, V. C. S. Srinivasarao Bandaru3, K Rukmini Mridula1, SA Jabeen1, Suvarna Alladi1, AK Meena1, Rupam Borgohain1
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 Submission | 11-Dec-2011 |
| Date of Decision | 03-Jan-2012 |
| Date of Acceptance | 04-Mar-2012 |
| Date of Web Publication | 19-May-2012 |
Correspondence Address:
Subhash Kaul
Department of Neurology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500082
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.96388
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 Mar 22];60:154-9. Available from: https://www.neurologyindia.com/text.asp?2012/60/2/154/96388 |
| » Introduction | |  |
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 | | |
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 | | |
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].
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].
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
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 | Figure 2: T1 weighted MRI brain sagittal image showing thrombus in superior saggital sinus
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 | Figure 3: (a-b) MRV phase contrast showing left transverse and superior sagittal sinus thrombosis
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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
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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].
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 | | |
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 | | |
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 | | |
| 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. 
[PUBMED]  |
| 2. | Nagaraja D, Sarma GR. Treatment of cerebral sinus/venous thrombosis. Neurol India 2002;50:114-6.
[PUBMED] |
| 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.
|
| 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
|
| 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.
[PUBMED] [FULLTEXT] |
| 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.
|
| 7. | Nagpal RD. Dural sinus and cerebral venous thrombosis. Neurosurg Rev 1983;6:155-60.
[PUBMED] |
| 8. | Srinivasan K, Natarajan M. Cerebral venous and arterial thrombosis in pregnancy and puerperium. Neurol India 1974;22:131-40.
|
| 9. | Srinivasan K, Natarajan M. Cerebral venous and sinus thrombosis in pregnancy and puerperium. A study of 135 patients. Angiology 1983;34:731-46.
[PUBMED] [FULLTEXT] |
| 10. | Nagaraja D, Taly AB. Cerebral venous thrombosis. J Assoc Physicians India 1987;35:876.
[PUBMED] |
| 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.
|
| 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.
|
| 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.
[PUBMED] |
| 14. | Carvalho KS, Bodensteiner JB, Connolly PJ, Garg BP. Cerebral venous thrombosis in children. J Child Neurol 2000;16:574-80.
|
| 15. | Barron TF, Gusnard DA, Zimmerman RA, Clancy RR. Cerebral venous thrombosis in neonates and children. Pediatr Neurol 1992;8:112-6.
[PUBMED] [FULLTEXT] |
| 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.
|
| 17. | de 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.
|
| 18. | de 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.
|
| 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.
|
| 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.
|
| 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.
|
| 22. | Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol 2007;6:162-70.
[PUBMED] [FULLTEXT] |
| 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.
[PUBMED] [FULLTEXT] |
| 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.
|
| 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.
[PUBMED] |
| 26. | Feinberg WM, Swenson MR. Cerebrovascular complications of C aspergenase therapy. Neurology 1988;38:127-33.
[PUBMED] |
| 27. | Anderson CM, Edelman RR, Turski PA. Magnetic resonance venography. Vol. 1. Raven, Philadelphia: Lippincott; 1993. pp. 289.
|
| 28. | Krayenbuhl H. Cerebral venous thrombosis. The diagnostic value of cerebral angiography Schweiz Arach Neuro Neurocli Psychiat 1954;74:261-87.
|
| 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.
|
| 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.
|
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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Cerebral venous thrombosis in Latin America: A critical review of risk factors, clinical and radiological characteristics |
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| 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] | | | 12 |
CLINICAL PROFILE, RISK FACTORS AND OUTCOMES IN PATIENTS WITH CEREBRAL VENOUS THROMBOSIS: A STUDY FROM SOUTH TELANGANA, INDIA |
|
| Sandeep Kumar G, Rakesh Reddy P, Venkateswarlu N, Nikhita Kailas | | GLOBAL JOURNAL FOR RESEARCH ANALYSIS. 2022; : 60 | | [Pubmed] | [DOI] | | | 13 |
ALCOHOL : A PROVOCATING FACTOR IN MALE CEREBRAL VENOUS THROMBOSIS – A PROSPECTIVE ANALYSIS IN WESTERN RAJASTHAN |
|
| Pratibha Prasad | | INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH. 2022; : 59 | | [Pubmed] | [DOI] | | | 14 |
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] | | | 15 |
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] | | | 16 |
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] | | | 17 |
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] | | | 18 |
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] | | | 19 |
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] | | | 20 |
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] | | | 21 |
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] | | | 22 |
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] | | | 23 |
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] | | | 24 |
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] | | | 25 |
Serebral venöz trombozlu hastalarda manyetik rezonans görüntüleme skoru ile Glasgow koma skoru arasindaki iliskinin arastirilmasi |
|
| Aylin GÜNESLI, Anil TANBUROGLU, Onur KESKIN, Halil I?brahim SÜNER | | Sakarya Medical Journal. 2020; | | [Pubmed] | [DOI] | | | 26 |
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] | | | 27 |
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] | | | 28 |
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] | | | 29 |
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] | | | 30 |
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] | | | 31 |
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] | | | 32 |
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] | | | 33 |
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] | | | 34 |
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] | | | 35 |
A STUDY OF CLINICAL AND INVESTIGATIVE PROFILE OF CORTICAL VENOUS THROMBOSIS |
|
| Dwijal Patel, Hetal Patel, Smita Trivedi | | Journal of Evidence Based Medicine and Healthcare. 2017; 4(62): 3752 | | [Pubmed] | [DOI] | | | 36 |
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] | | | 37 |
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] | | | 38 |
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] | | | 39 |
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] | | | 40 |
Cerebral venous thrombosis in a Caribbean population |
|
| C. Bodez,A. Landais | | Revue Neurologique. 2015; | | [Pubmed] | [DOI] | | | 41 |
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] | | | 42 |
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 | | [Pubmed] | | | 43 |
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] | | | 44 |
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] | | | 45 |
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] | | | 46 |
Toward a Better Model of Cerebral Venous Sinus Thrombosis |
|
| Jason P. Rahal,Adel M. Malek,Carl B. Heilman | | World Neurosurgery. 2013; | | [Pubmed] | [DOI] | | | 47 |
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] | | | 48 |
Hereditary thrombophilia in cerebral venous thrombosis |
|
| Navin Pai,Kanjaksha Ghosh,Shrimati Shetty | | Blood Coagulation & Fibrinolysis. 2013; 24(5): 540 | | [Pubmed] | [DOI] | | | 49 |
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 | | [Pubmed] | | | 50 |
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 | | [Pubmed] | |
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