Background
Data from African countries regarding diagnosis, prognosis, management, and outcome
of patients with cerebral venous thrombosis (CVT) are limited. The aim of the present
study is to characterize clinical presentation, predisposing factors, neuroimaging
findings, and outcomes of the disease in the Tunisian population.
Methods
This is a prospective study including patients referred to the Neurology Department
of the Military Hospital of Tunis between January 2009 and December 2012. The diagnosis
of CVT was confirmed in all patients using magnetic resonance imaging and magnetic
resonance venography. The demographic, clinical, radiological, and outcome data were
recorded and analyzed. Median follow-up was 16 months (range 6 months to 4 years).
Primary outcome was death or dependency as assessed by modified Rankin score more
than 2 at the end of follow-up.
Results
This study included 41 patients with CVT. Mean age was 41.24 years, predominantly
women (68%). The mode of onset was acute in 10 patients (24%), subacute in 26 (64%),
and chronic in 5 (12%). The most common presenting features were headache, observed
in 83% of the patients, followed by seizures, focal motor deficits, papilledema, and
mental status changes. Lateral (56%) and superior longitudinal (51%) sinuses were
the most commonly involved. Multiple sinuses were involved in 46% of cases. Nineteen
patients (46%) had a d-dimer level more than 500 ng/mL. Major causes of CVT were thrombophilia (56%), either
genetic or acquired, obstetric and gynecological (50%), and septic (34%). Outcome
was favorable in 83% of patients. At the end of follow-up, 32 patients (78%) had complete
recovery (modified Rankin Scale [mRs] score 0-1), 2 (5%) had partial recovery (mRs
score 2), and 4 (10%) were dependent (mRs score 3-5). One patient (2.5%) had a recurrent
sinus thrombosis.
Conclusions
Our Tunisian population presented distinct risk factors profile with high frequency
of thrombophilia, infections, and postpartum state. Oral contraceptive use is not
a major risk factor in our population. The overall prognosis was good.
Key Words
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Article info
Publication history
Published online: January 24, 2014
Accepted:
October 24,
2013
Received in revised form:
September 9,
2013
Received:
July 28,
2013
Footnotes
All authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. They received no financial support for the research, authorship, and/or publication of this article.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.10.025
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
