Clinical Profile, Risk Factors and Outcome of the Patient with Cerebral Venous Sinus Thrombosis in a Tertiary Care Hospital: A Prospective Cohort Study

Abstract

Background: Cerebral venous sinus thrombosis (CVST) one of the cause of venous stroke. With the advent of the newer imaging technique, it is now increasingly diagnosed in our country.There are limited studies regarding venous stroke specially about its outcome in Bangladesh. So, we conducted the study to observe the clinical profile, risk factors and outcome of the patients with Cerebral venous sinus thrombosis (CVST) at 3 months in a tertiary care hospital.

Objective: To see the clinical profile, risk factor and outcome of the patient with cerebral venous sinus thrombosis at 3 months in a tertiary care hospital.

Methods: This Prospective observational and non-interventional descriptive study was carried out in the Department of Neurology, Neurosurgery, Gynecology and Obstectric & Medicine of Dhaka Medical College Hospital during January 2022 to December 2023. The patients suffering from cerebral venous sinus thrombosis were included in this study. Age > 18 year, both male & female patients with features of cerebral venous sinus thrombosis enrolled in this study.

Results: During the study period, total 58 patients admitted to this institute with Thrombosis of the cerebral venous sinus (CVST). Among the 58 patients about two/third were female. The mean age of the was 36.46 ±13.56. Most of the patients were between 20 and 40 years. The most common clinical presentations were headache which was present more than two/third of the patients, vomiting was present near half of the patient, seizure was present one/third of patients, focal neurological deficit was present one quatar of patients, near half of patient suffer from visual disturbances. In this study papilloedema was the commonest clinical finding which was present more than half of patients. CVST has multifactorial. The risk factors for developing cerebral venous sinus thrombosis are infection, pregnancy and puerperium, post vaccination, Oral Contraceptive Pill and other hormonal prepration, malignancy and idiopathic. Most common risk factors among the study were infection (22.41%), then pregnancy and puerperium (8.62%), intake of Oral Contraceptive Pills and other hormonal prepration (6.90%), Covid -19 infection and post vaccination (6.90%), and no risk factors was found among (34.48%). In our study anemia was found in more than one/third of patients, D-dimer was found to be raised in half of total patients in this study. The commonest sinus involve most are transverse sinus 31(65.51%), then superior sagitta sinus 13 (43.10%), multiple sinus involvement was present in more than two/third cases and single sinus involvement in only one quatar patients. Average hospital stay was 12.46±3.81 days. There was significant improvement of symptoms and signs during discharge from hospital after medical treatment as evidence by (mRS> 3). The mortality rate was 10.34%.

Conclusion: The transverse sinus thrombosis was the most common and bilateral cavernous sinus thrombosis was the uncommon affection in CVST. Mortality was more in patients who has multiple sinus involvement, male sex and had some multiple comorbid conditions.