Neurosciences (Riyadh, Saudi Arabia) · 2011
Cerebral venous thrombosis in Kuwait. Clinical presentation, risk factors, and management.
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Vembu Periasamy, John John K, Mohammed Mohammed I, Al-Shubaili Asmahan F
Аннотация
OBJECTIVE: To explore the pattern of clinical presentations, risk factors, and the sinuses involved in cases of cerebral venous thrombosis (CVT) treated in a tertiary neurological center in Kuwait.
METHODS: A retrospective analysis of cases of CVT treated at Ibn Sina Hospital, Kuwait, from January 2000 to October 2010. The records of 71 patients were retrieved and entered in a database. All patients were evaluated with hypercoagulable work up and relevant neuro-imaging studies.
RESULTS: Seventy-one patients were included in our study, with a male to female ratio of 1:1.5. The clinical presentations were: headache (93%), seizures (31%), and focal neurological signs (37%). Over two-thirds (n=30) of female patients had a history of oral contraceptive use. Papilledema with raised intracranial pressure was recorded in 20 patients (28%), ovarian hyper-stimulation syndrome with CVT in one patient, and possible Neuro-Behcet`s in 10% (n=7). The venous sinuses involved were superior sagittal sinus in 59% (n=42), and transverse and straight sinuses in 54% (n=38). Hemorrhagic venous infarctions were seen in 18% (n=13). Fifty percent of patients recovered within 2-4 weeks, 15 patients (21%) recovered within 4-12 weeks, and 15 patients (21%) required intensive care unit care with ventilator support for 1-2 weeks.
CONCLUSION: Oral contraceptive use was the primary risk factor in female patients. Early diagnosis and immediate treatment with anticoagulants reduce the morbidity and mortality. Serum D-dimer level is more helpful for early diagnosis with sensitivity of 58%.
METHODS: A retrospective analysis of cases of CVT treated at Ibn Sina Hospital, Kuwait, from January 2000 to October 2010. The records of 71 patients were retrieved and entered in a database. All patients were evaluated with hypercoagulable work up and relevant neuro-imaging studies.
RESULTS: Seventy-one patients were included in our study, with a male to female ratio of 1:1.5. The clinical presentations were: headache (93%), seizures (31%), and focal neurological signs (37%). Over two-thirds (n=30) of female patients had a history of oral contraceptive use. Papilledema with raised intracranial pressure was recorded in 20 patients (28%), ovarian hyper-stimulation syndrome with CVT in one patient, and possible Neuro-Behcet`s in 10% (n=7). The venous sinuses involved were superior sagittal sinus in 59% (n=42), and transverse and straight sinuses in 54% (n=38). Hemorrhagic venous infarctions were seen in 18% (n=13). Fifty percent of patients recovered within 2-4 weeks, 15 patients (21%) recovered within 4-12 weeks, and 15 patients (21%) required intensive care unit care with ventilator support for 1-2 weeks.
CONCLUSION: Oral contraceptive use was the primary risk factor in female patients. Early diagnosis and immediate treatment with anticoagulants reduce the morbidity and mortality. Serum D-dimer level is more helpful for early diagnosis with sensitivity of 58%.