Document Type : Original Article
Authors
1 Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
2 Neurology department, Afzalipour faculty, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Background: Cerebral venous thrombosis (CVT) is an uncommon condition with an estimated annual occurrence of five cases per million individuals. This research aimed to investigate the risk factors associated with CVT and their correlation with optical coherence tomography (OCT) findings.
Methods: The study involved 30 patients diagnosed with CVT confirmed through neuroimaging, alongside a control group of 30 healthy individuals. The patients underwent OCT assessments following their diagnosis. Healthy participants, randomly selected from hospital staff without any known health issues, were examined by an ophthalmologist. Those with normal eye examinations proceeded to OCT, where their macular thickness and retinal nerve fiber layer (RNFL) were measured.
Results: The majority of participants in the CVT group were female (80%), with a mean age of 34.98±3.78 years. Headaches were reported as the most prevalent symptom (66.7%). All patients in the CVT group were pregnant, contrasting with none in the control group, indicating a significant association with CVT (P=0.03). Notably, the inferior temporal layer thickness was greater in the CVT group compared to controls (P=0.04). Additionally, patients exhibiting papilledema had a thicker superior temporal layer than those without papilledema (P=0.02). Women in the postpartum period showed an 18.61-fold increase in the likelihood of developing CVT (P=0.03).
Conclusion: Findings from this study indicate that while macular thickness tends to decrease in CVT patients, various layers of the RNFL show increased thickness. The clinical implications of these observations remain unclear.
Keywords
Main Subjects
- Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007;6(2):162-70. doi: 10.1016/ s1474-4422(07)70029-7.
- Ferro JM, Canhão P, Stam J, Bousser MG, 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(3):664-70. doi: 10.1161/01.Str.0000117571.76197.26.
- Singh RJ, Saini J, Varadharajan S, Kulkarni GB, Veerendrakumar M. Headache in cerebral venous sinus thrombosis revisited: exploring the role of vascular congestion and cortical vein thrombosis. Cephalalgia. 2018;38(3):503-10. doi: 10.1177/0333102417698707.
- Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791-8. doi: 10.1056/NEJMra042354.
- Aaron S, Alexander M, Maya T, Mathew V, Goel M, Nair SC, et al. Underlying prothrombotic states in pregnancy associated cerebral venous thrombosis. Neurol India. 2010;58(4):555-9. doi: 10.4103/0028-3886.68676.
- Zétola VH, Nóvak EM, Camargo CH, Carraro H Jr, Coral P, Muzzio JA, et al. [Stroke in young adults: analysis of 164 patients]. Arq Neuropsiquiatr. 2001;59(3-B):740-5. doi: 10.1590/s0004-282x2001000500017. [Portuguese].
- van Kammen MS, Zuurbier SM, Coutinho JM. Understanding cerebral venous thrombosis: rare but sometimes fatal. Stroke. 2019:1-10.
- Atalu A, Fattahzadeh-Ardalani G, Sharghi A, Ezzativand H. Risk factors and clinical manifestations of cerebral venous thrombosis (CVT) in patients admitted to Ardabil city hospitals during 2012-2017. JSM Neurol Disord Stroke. 2019;5(4):1-4.
- Buccino G, Scoditti U, Patteri I, Bertolino C, Mancia D. Neurological and cognitive long-term outcome in patients with cerebral venous sinus thrombosis. Acta Neurol Scand. 2003;107(5):330-5. doi: 10.1034/j.1600-0404.2003.00031.x.
- Koennecke HC. Cerebral venous thrombosis in adults. Vasa. 2019;48(6):473-82. doi: 10.1024/0301-1526/a000788.
- Vembu P, John JK, Mohammed MI, Al-Shubaili AF. Cerebral venous thrombosis in Kuwait. Clinical presentation, risk factors, and management. Neurosciences (Riyadh). 2011;16(2):129-36.
- Duncan IC, Fourie PA. Imaging of cerebral isolated cortical vein thrombosis. AJR Am J Roentgenol. 2005;184(4):1317-9. doi: 10.2214/ajr.184.4.01841317.
- Coutinho JM, Ferro JM, Canhão P, Barinagarrementeria F, Cantú C, Bousser MG, et al. Cerebral venous and sinus thrombosis in women. Stroke. 2009;40(7):2356-61. doi: 10.1161/strokeaha.108.543884.
- Sajjad Z. MRI and MRV in cerebral venous thrombosis. J Pak Med Assoc. 2006;56(11):523-6.
- Hiltunen S, Putaala J, Haapaniemi E, Tatlisumak T. Longterm outcome after cerebral venous thrombosis: analysis of functional and vocational outcome, residual symptoms, and adverse events in 161 patients. J Neurol. 2016;263(3):477-84. doi: 10.1007/s00415-015-7996-9.
- Azin H, Ashjazadeh N. Cerebral venous sinus thrombosis-- clinical features, predisposing and prognostic factors. Acta Neurol Taiwan. 2008;17(2):82-7.
- Stolz E, Rahimi A, Gerriets T, Kraus J, Kaps M. Cerebral venous thrombosis: an all or nothing disease? Prognostic factors and long-term outcome. Clin Neurol Neurosurg. 2005;107(2):99- 107. doi: 10.1016/j.clineuro.2004.06.002.
- Koban Y, Ozlece H, Karayol S, Huseyinoglu N. Decreased retinal nerve fiber layer thickness in patients with cerebral venous thrombosis. BMC Ophthalmol. 2019;19(1):57. doi: 10.1186/s12886-019-1046-9.
- Narayan D, Kaul S, Ravishankar K, Suryaprabha T, Bandaru VC, Mridula KR, et al. Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: insights from Nizam’s Institute Venous Stroke Registry, Hyderabad (India). Neurol India. 2012;60(2):154-9. doi: 10.4103/0028-3886.96388.
- Aghsaei Fard M, Fakhree S, Abdi P, Hassanpoor N, Subramanian PS. Quantification of peripapillary total retinal volume in pseudopapilledema and mild papilledema using spectraldomain optical coherence tomography. Am J Ophthalmol. 2014;158(1):136-43. doi: 10.1016/j.ajo.2014.03.008.
- Zhou D, Ding JY, Ya JY, Pan LQ, Yan F, Yang Q, et al. Understanding jugular venous outflow disturbance. CNS Neurosci Ther. 2018;24(6):473-82. doi: 10.1111/cns.12859.
- Vartin CV, Nguyen AM, Balmitgere T, Bernard M, Tilikete C, Vighetto A. Detection of mild papilloedema using spectral domain optical coherence tomography. Br J Ophthalmol. 2012;96(3):375-9. doi: 10.1136/bjo.2010.199562.
- Bassi ST, Mohana KP. Optical coherence tomography in papilledema and pseudopapilledema with and without optic nerve head drusen. Indian J Ophthalmol. 2014;62(12):1146- 51. doi: 10.4103/0301-4738.149136.
- Alqahtani MS, Alhazzani AA, Alnaami I, Alqahtani SA, Alahmari TM, Alqarni AM, et al. Clinical and epidemiological profile of cerebral venous thrombosis. Neurosciences (Riyadh). 2020;25(5):380-5. doi: 10.17712/nsj.2020.5.20200028.
- Foroughipoor M, Moghaddam Ahmadi A, Fadaei S, Ravankhah Moghaddam K, Sharifi Razavi A. Causes of cerebral venous thrombosis and its clinical manifestation in patients admitted in emergency unit and neurology ward of Ghaem hospital. J Mazandaran Univ Med Sci. 2013;22(98):86-90. [Persian].
- Khomand P, Ahsan B, Gharibi F, Khadami AH. An evaluation of the frequency of cerebral venous sinus thrombosis and its associated factors in Sanandaj, 2010-2011, Iran. Qom Univ Med Sci J. 2014;8(3):49-54. [Persian].
- Alang O, Asadollahi M. Evaluation of Risk Factors for Venous Sinus Thrombosis in Patients Admitted to Loghman Hospital. Tehran: Shahid Beheshti University of Medical Sciences, School of Medicine; 2017. [Persian].
- Shobairi E, Razazian N, Rezaie M, Shaykh Esmaeli MR. Incidence rate of cerebral venous thrombosis and its related factors in Kermanshah city in 2009-2010. Sci J Kurdistan Univ Med Sci. 2010;15(2):64-9. [Persian].
)