IP Indian Journal of Neurosciences

Cerebral venous sinus thrombosis: Clinical profile and surgical outcome

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Article Type : Original Article

Author Details: Bhagwati Salgotra, Dhruv Patel

Volume : 4

Issue : 3

Online ISSN : 2581-916X

Print ISSN : 2581-8236

Article First Page : 140

Article End Page : 143

Abstract

Thrombosis of the cerebral venous sinuses (CVST) is common cause of acute neurological deficit and altered sensorium. Most of the patients are young and can suffer severe morbidity and mortality if not treated aggressively. Early diagnosis and management is necessary for good outcome in case of CVST.
Material and Methods: Retrospective observational study over a period of 4 year 3 months from oct' 2013 to feb'2018 in our institute. CVST was affirmed by MRI brain venogram of 84 patients were included in this study. Decompressive craniectomy done in case of mass effect or herniation. All patients were treated according to standard guideline and protocol.
Result:This study include 51 (60.7%) females and 33 (39.2%) males with the age of 39 ± 10 years and 29 ± 7 years, respectively. Out of which 25 patients (29.7%) had hemiparesis/hemiplegia, vomiting and headache was manifested in 79 (94%) patients, seizures in 13(15%), and fever in 30(35.7%). 38(45.2%) out of 84 patients were presented with sagittal sinus thrombosis, 10(11.9%) of 84 with multiple sinus thrombosis and 35(41.6) of 84 patients with transverse/sigmoid sinus thrombosis. On funduscopic examination papilledema in 25(29.7%) patients. Patients had diagnosis of CVST during peripartum period altogether 8(15.6%) out of 51 female. 1 patient had bilateral cavernous sinus thrombosis. Signs of infection seen in patients in the study as Chronic supportive otitis media (CSOM), fever, 11(13.09%) patients had paranasal sinus (PNS) infections, 10 (11.9%) patients had evidence and history of lack of hydration. 8 (9.5%) patients of the total deceased during the course of treatment and 79 (94%) out of 84 patients were discharged with partial or/and total recovery. Three 25(29.7%) required decompressive craniectomy. Multiple sinus thrombosis had poor prognosis.
Conclusion:Most commonly involved sinus is superior sagittal sinus while transverse or sigmoid sinus and bilateral cavernous sinus thrombosis follows it being uncommon fondness in CVST.’ Third part of the female population was influenced because of oral contraceptive pills and the peripartum period has high risk for CVST'. The lack of hydration and/or infection was the most commonly related accelerating event for the advancement of CVST and hyper homocysteinemia which is seen in more than one fourth of the population. Mortality and morbidity was more in patients of multiple sinus involvement. The treatment must be aggressive as mortality and morbidity is relatively minimal compared with the arterial stroke.

Keywords: Cerebral venous sinuses thrombosis, Decompressive craniectomy, Thrombosis of sagittal sinus

Doi No:-10.18231/2455-8451.2018.0033