G. B. Kulkarni, M. A. Mirza, V. Mustare, R. Yadav, A. K. Gupta
Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India
Introduction: Among patients with Cerebral Venous Thrombosis (CVT), Lateral Sinus is commonly involved, there is a paucity of studies involving large cohort of single center experience.
Objective: To define the clinical profile and outcome of patients with LST seen at our hospital.
Methods: Prospective, hospital based study of patients with clinical and imaging features of LST admitted to stroke unit of NIMHANS Bengaluru, during 2 years (2012-13). Ethics approval and informed consent were taken.
Results: There were 100 (M:F: 44:56) patients of LST (Isolated-27, combined-73 (with SSS-37, SSS and cortical veins/deep vein-36) mean age 31.45 + 11.3 years among 180 patients of CVT. Median delay for presentation was 11 days. Headache (97%), Seizure (46%), language deficit (26%) and motor weakness (35%) were common symptoms. Risk factors (sometimes multiple) were Anemia (57%), Hyperhomocysteinemia (61%), Puerperium (39%), Polycythemia (15%) and Oral Contraceptive Pill (OCP) intake (29%). MRI was taken as gold standard for diagnosis, sensitivity of CT brain was 69%. The other advantages of MRI were predicting the age and extent of thrombus, detecting subtle parenchymal lesions, micro-bleeds and additional sinus involvement not seen on CT. All patients were managed with anticoagulants, anti-epileptics, anti-edema measures and supportive care. Neurosurgical interventions were required in 17% patients and comprised of decompressive craniectomy-12, thecoperitoneal shunt-2 and EVD-3. The mortality was 4% - meningitis-1, brain stem herniation-2, pulmonary embolism-1. Patients were followed up for a mean duration of 6.5 + 4.01 months, 86% made good functional recovery (MRS 0-2).
Conclusions: LST is usually associated with sagittal sinus and cortical vein thrombosis. Patients present with recent onset of headache and focal deficits. MRI is preferred investigation for diagnosis. Majority improve with anti-coagulation and standard care, 17% require neurosurgical intervention suggesting these cases to be managed in a comprehensive center with neurosurgical facility, if required.