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Diagnosis of cerebral venous thrombosis: a single centre experience
Petr Mikulenka1, Tomas Peisker1, Peter Vasko1
1Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.
Insights
Delayed diagnosis of cerebral venous thrombosis (CVT) is common due to varied symptoms. Identifying risk factors and atypical headaches prompts timely diagnosis via imaging, improving patient outcomes.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Cerebral venous thrombosis (CVT) is a critical cerebrovascular condition often presenting with non-specific symptoms, leading to diagnostic delays.
- The variability in clinical presentation and rarity of CVT contribute to challenges in early identification.
Purpose of the Study:
- To elucidate the risk factors associated with cerebral venous thrombosis.
- To characterize the initial clinical manifestations and diagnostic findings of CVT.
- To evaluate the role of imaging modalities in confirming CVT diagnoses.
Main Methods:
- Retrospective analysis of 34 patients diagnosed with CVT between 2004 and 2016.
- Review of demographic data, clinical symptoms, D-dimer levels, risk factors, and Magnetic Resonance (MR) findings.
- Assessment of time from symptom onset to diagnosis.
Main Results:
- Headache was the most frequent initial symptom (82.4%).
- Focal neurological deficits or encephalopathy occurred in 64.7% of patients.
- Risk factors were identified in 76.5% of patients, including hormonal contraceptive use (68% in women of childbearing potential) and recent inflammation.
- MR venography confirmed CVT in all cases.
- Hereditary thrombophilia was present in 68% of tested patients.
- Elevated D-dimer levels were observed in 86% of cases.
- The average diagnostic delay was 6.9 days.
Conclusions:
- Cerebral venous thrombosis exhibits a diverse clinical course, frequently resulting in delayed diagnosis.
- Atypical headaches and the presence of risk factors are crucial indicators for initiating diagnostic imaging for CVT.
- Prompt recognition and appropriate imaging are essential for timely CVT diagnosis and management.
Objectives:
Cerebral venous thrombosis is a serious cerebrovascular disease. Due to the variability of clinical symptoms and the scarcity of occurrence, this diagnosis is often delayed. The aim of the study was to describe the risk factors, the initial findings and the imaging methods that lead to the diagnosis.
Methods:
We included 34 patients treated for cerebral venous thrombosis in the years 2004-2016. We retrospectively analyzed demographic data, initial clinical symptoms, baseline D-dimer levels, risk factors, time to diagnosis, and MR findings.
Results:
The most common initial clinical symptom was headache (28 patients, 82.4%). Focal neurological symptoms or signs of encephalopathy developed in 22 patients (64.7%). In 26 patients, we identified at least one risk factor in their history. In women of childbearing potential, 68% of patients (15/22) were taking hormonal contraceptives; in six people the diagnosis was immediately preceded by inflammation. In all patients, the diagnosis was confirmed by MR venography. Positive hereditary thrombophilic conditions were identified in 68% and acquired in 8% of 25 examined patients. In 22 cases, baseline D-dimer levels were examined and found to be increased in 86% of them. The mean time from the first onset of symptoms to diagnosis was 6.9 days.
Conclusion:
Cerebral venous thrombosis has a variable clinical course and the diagnosis is determined a relatively long time after the onset of symptoms. Atypical headache in the patient's history and a set of risk factors are the key findings for indication of imaging methods and confirmation of the diagnosis.
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