Advertisement

Cerebral Venous Sinus Thrombosis in the Emergency Department: Retrospective Analysis of 17 Cases and Review of the Literature

Published:December 23, 2009DOI:https://doi.org/10.1016/j.jemermed.2009.08.061

      Abstract

      Background: Cerebral venous sinus thrombosis (CVST) is a rare but serious cause of neurologic impairment. Due to its relative rarity, there is limited research that describes the incidence and clinical features of CVST in the emergency department (ED). Objectives: To describe the demographic, clinical, and historical characteristics of patients with CVST who were initially seen in the ED. Methods: This is a retrospective analysis of all patients presenting to three urban, tertiary care hospitals between January 2001 and December 2005 who were diagnosed with CVST. Patients were excluded if they were transferred from other hospitals, or admitted directly to the hospital without evaluation in the ED. We use one representative case to describe the presentation, evaluation, and treatment of CVST. Results: Seventeen patients met the inclusion criteria. Patients had a mean age of 42 years. Presenting complaints included headache (70%), focal neurologic complaints (numbness, weakness, aphasia) (29%), seizure (24%), and head injury (12%). Ninety-four percent of patients had a focal neurologic finding in the ED. A likely contributing cause of thrombosis was identified in all but one patient. More than half of the patients had been evaluated in the ED in the previous 60 days. Two patients died, both as a result of their thrombosis and resulting cerebral infarctions and edema. Of the patients who survived, 80% had a good functional outcome. Conclusions: CVST is rare, but it can have significant associated morbidity and mortality. Whereas the clinical outcome and functional outcomes of treated patients can vary, prompt recognition of the disease is important.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bogousslavsky J.
        • Pierre P.
        Ischemic stroke in patients under age 45.
        Neurol Clin. 1992; 10: 113-124
        • Stam J.
        Thrombosis of the cerebral veins and sinuses.
        N Engl J Med. 2005; 352: 1791-1798
        • Ferro J.M.
        • Lopes M.G.
        • Rosas M.J.
        • Fontes J.
        Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis.
        Cerebrovasc Dis. 2005; 19: 152-156
        • Ferro J.M.
        • Canhao P.
        • Stam J.
        • Bousser M.G.
        • Barinagarrementeria F.
        Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT).
        Stroke. 2004; 35: 664-670
        • Rosamond W.
        • Flegal K.
        • Friday G.
        • et al.
        Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2007; 115: e69-e171
        • Martinelli I.
        • Sacchi E.
        • Landi G.
        • Taioli E.
        • Duca F.
        • Mannucci P.M.
        High risk of cerebral-vein thrombosis in carriers of a prothrombin-gene mutation and in users of oral contraceptives.
        N Engl J Med. 1998; 338: 1793-1797
        • de Bruijn S.F.
        • Stam J.
        • Koopman M.M.
        • Vandenbroucke J.P.
        Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in [correction of who are] carriers of hereditary prothrombotic conditions.
        BMJ. 1998; 316: 589-592
        • Deschiens M.A.
        • Conard J.
        • Horellou M.H.
        • et al.
        Coagulation studies, factor V Leiden, and anticardiolipin antibodies in 40 cases of cerebral venous thrombosis.
        Stroke. 1996; 27: 1724-1730
        • Lanska D.J.
        • Kryscio R.J.
        Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis.
        Stroke. 2000; 31: 1274-1282
        • Scheid R.
        • Teich N.
        Neurologic manifestations of ulcerative colitis.
        Eur J Neurol. 2007; 14: 483-493
        • Krayenbuhl H.A.
        Cerebral venous and sinus thrombosis.
        Clin Neurosurg. 1966; 14: 1-24
        • de Bruijn S.F.
        • de Haan R.J.
        • Stam J.
        Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients.
        J Neurol Neurosurg Psychiatry. 2001; 70: 105-108
        • de Bruijn S.F.
        • Stam J.
        • Kappelle L.J.
        Thunderclap headache as first symptom of cerebral venous sinus thrombosis.
        Lancet. 1996; 348: 1623-1625
        • Lin A.
        • Foroozan R.
        • Danesh-Meyer H.V.
        • De Salvo G.
        • Savino P.J.
        • Sergott R.C.
        Occurrence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension.
        Ophthalmology. 2006; 113: 2281-2284
        • Cantu C.
        • Barinagarrementeria F.
        Cerebral venous thrombosis associated with pregnancy and puerperium.
        Stroke. 1993; 24: 1880-1884
        • Mehraein S.
        • Ortwein H.
        • Busch M.
        • Weih M.
        • Einhaupl K.
        • Masuhr F.
        Risk of recurrence of cerebral venous and sinus thrombosis during subsequent pregnancy and puerperium.
        J Neurol Neurosurg Psychiatry. 2003; 74: 814-816
        • Canhao P.
        • Ferro J.M.
        • Lindgren A.G.
        • Bousser M.G.
        • Stam J.
        • Barinagarrementeria F.
        Causes and predictors of death in cerebral venous thrombosis.
        Stroke. 2005; 36: 1720-1725
        • Canhao P.
        • Batista P.
        • Falcao F.
        Lumbar puncture and dural sinus thrombosis—a causal or casual association?.
        Cerebrovasc Dis. 2005; 19: 53-56
        • Lalive P.H.
        • de Moerloose P.
        • Lovblad K.
        • Sarasin F.P.
        • Mermillod B.
        • Sztajzel R.
        Is measurement of D-dimer useful in the diagnosis of cerebral venous thrombosis?.
        Neurology. 2003; 61: 1057-1060
        • Kosinski C.M.
        • Mull M.
        • Schwarz M.
        • et al.
        Do normal D-dimer levels reliably exclude cerebral sinus thrombosis?.
        Stroke. 2004; 35: 2820-2825
        • Vatankhah B.
        • Furst A.
        • Schlachetzki F.
        Do normal d-dimer levels reliably exclude cerebral sinus thrombosis?.
        A solution of problems? Stroke. 2005; 36 (author reply 2529): 2528-2529
        • Leach J.L.
        • Fortuna R.B.
        • Jones B.V.
        • Gaskill-Shipley M.F.
        Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls.
        Radiographics. 2006; 26 (discussion S42–3): S19-S41
        • Renowden S.
        Cerebral venous sinus thrombosis.
        Eur Radiol. 2004; 14: 215-226
        • Linn J.
        • Ertl-Wagner B.
        • Seelos K.C.
        • et al.
        Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses.
        AJNR Am J Neuroradiol. 2007; 28: 946-952
        • Khandelwal N.
        • Agarwal A.
        • Kochhar R.
        • et al.
        Comparison of CT venography with MR venography in cerebral sinovenous thrombosis.
        AJR Am J Roentgenol. 2006; 187: 1637-1643
      1. Stam J, De Bruijn SF, DeVeber G. Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev 2002(4):CD002005.

        • Canhao P.
        • Falcao F.
        • Ferro J.M.
        Thrombolytics for cerebral sinus thrombosis: a systematic review.
        Cerebrovasc Dis. 2003; 15: 159-166
        • Horowitz M.
        • Purdy P.
        • Unwin H.
        • et al.
        Treatment of dural sinus thrombosis using selective catheterization and urokinase.
        Ann Neurol. 1995; 38: 58-67
        • Kim S.Y.
        • Suh J.H.
        Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of alteplase.
        AJNR Am J Neuroradiol. 1997; 18: 639-645
        • Einhaupl K.
        • Bousser M.G.
        • de Bruijn S.F.
        • et al.
        EFNS guideline on the treatment of cerebral venous and sinus thrombosis.
        Eur J Neurol. 2006; 13: 553-559

      Linked Article

      • Cerebral Venous Thrombosis
        Journal of Emergency MedicineVol. 38Issue 2
        • Preview
          A 26-year-old African-American woman presented to our Emergency Department due to acute-onset severe headache accompanied by vomiting. She denied a history of migraine, trauma, fever, neck stiffness, alteration of vision, or seizures. She reported a prior history of two miscarriages. She was on no oral medications; however, she used a systemically absorbed vaginal ring contraceptive. She denied tobacco use. On examination she was afebrile with a mildly elevated blood pressure (148/78 mm Hg) and was lethargic.
        • Full-Text
        • PDF