Original Article| Volume 23, ISSUE 6, P1291-1295, July 2014

Cerebral Venous Thrombosis: Clinical Features, Risk Factors, and Long-term Outcome in a Tunisian Cohort


      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.


      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.


      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.


      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

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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stam J.
        Thrombosis of the cerebral veins and sinuses.
        N Engl J Med. 2005; 352: 1791-1798
        • Ameri A.
        • Bousser M.G.
        Cerebral venous thrombosis.
        Neurol Clin. 1992; 10: 87-111
        • Wasay M.
        • Bakshi R.
        • Bobustuc G.
        • et al.
        Cerebral venous thrombosis: analysis of a multicenter cohort from the United States.
        J Stroke Cerebrovasc Dis. 2008; 17: 49-54
        • Ferro J.M.
        • Canhão P.
        • Stam J.
        • et al.
        • ISCVT Investigators
        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
        • Napon C.
        • Diallo O.
        • Kanyala E.
        • et al.
        Cerebral venous thrombosis in the hospital environment in Ouagadougou (Burkina Faso).
        Rev Neurol. 2010; 166: 433-437
        • Ben Salem-Berrabah O.
        • Fekih-Mrissa N.
        • N'siri B.
        • et al.
        Thrombophilic polymorphisms—factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T—in Tunisian patients with cerebral venous thrombosis.
        J Clin Neurosci. 2012; 19: 1326-1327
        • Ben Salem-Berrabah O.
        • Fekih-Mrissa N.
        • Louati I.
        • et al.
        Cerebral venous thrombosis: prospective etiological study of 26 Tunisian patients.
        Rev Neurol. 2011; 167: 141-149
        • Bamford J.M.
        • Sandercock P.A.
        • Warlow C.P.
        • et al.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1989; 20: 828
        • Bousser M.G.
        Cerebral venous thrombosis: diagnosis and management.
        J Neurol. 2000; 247: 252-258
        • Bousser M.G.
        • Ferro J.M.
        Cerebral venous thrombosis: an update.
        Lancet Neurol. 2007; 6: 162-170
        • Bousser M.G.
        • Russell R.R.
        Cerebral venous thrombosis.
        in: Warlow C.P. Van Gijn J. Major problems in neurology. WB Saunders, London1997 (p.27-29)
        • Connor S.E.
        • Jarosz J.M.
        Magnetic resonance imaging of cerebral venous sinus thrombosis.
        Clin Radiol. 2002; 57: 449-461
        • Cumurciuc R.
        • Crassard I.
        • Sarov M.
        • et al.
        Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases.
        J Neurol Neurosurg Psychiatry. 2005; 76: 1084
        • Crassard I.
        • Soria C.
        • Tzourio C.
        • et al.
        A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients.
        Stroke. 2005; 36: 1716-1719
        • Dentali F.
        • Squizzato A.
        • Marchesi C.
        • et al.
        D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature.
        J Thromb Haemost. 2012; 10: 582-589
        • Crassard I.
        • Bousser M.G.
        Cerebral venous thrombosis.
        Rev Med Interne. 2006; 27: 117-124
        • Weih M.
        • Vetter B.
        • Castell S.
        • et al.
        Hereditary thrombophilia in cerebral venous thrombosis.
        Cerebrovasc Dis. 2000; 10: 161-162
        • Narayan D.
        • Kaul S.
        • Ravishankar K.
        • 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: 154-159
        • Bousser M.G.
        • Crassard I.
        Cerebral venous thrombosis, pregnancy and oral contraceptives.
        Thromb Res. 2012; 130: S19-S22
        • Alkema L.
        • Kantorova V.
        • Menozzi C.
        • et al.
        National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis.
        Lancet. 2013; 381: 1642-1652
        • Touati S.
        • Abdelaziz A.B.
        • Mtiraoui A.
        • et al.
        Contraceptive prevalence in a peri-urban area of Sousse, Tunisia.
        East Mediterr Health J. 2001; 7: 943-955
        • Dentali F.
        • Crowther M.
        • Ageno W.
        Thrombophilic abnormalities, oral contraceptives, and risk of cerebral vein thrombosis: a meta-analysis.
        Blood. 2006; 1: 2766-2773
        • Libourel E.J.
        • ten Kate M.K.
        • Brouwer J.L.
        • et al.
        Contribution of multiple thrombophilic and transient risk factors in the development of cerebral venous thrombosis.
        Thromb Res. 2007; 121: 301-307
        • Ferro J.M.
        • Correia M.
        • Pontes C.
        • et al.
        Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998.
        Cerebrovasc Dis. 2001; 11: 177-182
        • Zaidan R.
        • Al Tahan A.R.
        Cerebral venous thrombosis: a new manifestation of neurobrucellosis.
        Clin Infect Dis. 1999; 28: 399-400
        • Sacco R.L.
        Prognosis of stroke.
        in: Ginsberg M.D. Bogousslavsky J. Cerebrovascular disease: pathophysiology, diagnosis, and management. 2. Blackwell Science, Malden, MA1998: 879-891
        • Stolz E.
        • Rahimi A.
        • Gerriets T.
        • et al.
        Cerebral venous thrombosis: an all or nothing disease? Prognostic factors and long-term outcome.
        Clin Neurol Neurosurg. 2005; 107: 99-107
        • Ferro J.M.
        • Lopes M.G.
        • Rosas M.J.
        • et al.
        Long-term prognosis of cerebral vein and dural sinus thrombosis: results of the VENOPORT study.
        Cerebrovasc Dis. 2002; 13: 272-278
        • Alonso-Cánovas A.
        • Masjuan J.
        • González-Valcárcel J.
        • et al.
        Cerebral venous thrombosis: when etiology makes the difference.
        Neurologia. 2009; 24: 439-445
        • Einhäupl K.
        • Stam J.
        • Bousser M.G.
        • et al.
        • European Federation of Neurological Societies
        EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients.
        Eur J Neurol. 2010; 17: 1229-1235
        • Caprio F.
        • Bernstein R.A.
        Duration of anticoagulation after cerebral venous sinus thrombosis.
        Neurocrit Care. 2012; 16: 335-342