Venous thrombosis of the brain. Retrospective review of 110 patients in Kuwait

OBJECTIVE: To highlight the importance of neurological presentation and complications in the early diagnosis and management of cerebral venous thrombosis (CVT).

METHODS: We performed a retrospective case analysis of 110 patients with CVT treated at the Neurology Center, Ibn Sina Hospital, in Kuwait from January 2000 to September 2013. The records of patients with CVT were retrieved and entered in a data sheet. The different neurological presenting signs and symptoms were analyzed based on their frequency, pathogenesis, and treatment.

RESULTS: One hundred and ten (110) patients were included in this study, with a male to female ratio of 1:1.7. Neurological signs and symptoms were headache (82%), seizures (42%), and focal neurological deficits (33%). Papilledema with raised intracranial pressure was recorded in 35 patients (32%). Venous and hemorrhagic venous infarctions were recorded in 27 patients, and multiple intracerebral or subarachnoid hemorrhages in 7 patients. The venous sinuses involved were the superior sagittal sinus in 54.5%, and transverse sigmoid sinuses in 52%.

CONCLUSION: Headache, seizures, and focal neurological deficits were the most common neurological presentation. Anticoagulants (systemic heparin) were used as first-line therapy, including patients with intracerebral hemorrhage. The use of steroids and osmotic diuretics as anti-edema measures were recorded in 25% of cases. Treating raised ICP by repeated lumbar puncture and CSF drain could prevent visual failure.