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Clinical Profile and Outcome of Patients with Cerebral Venous Thrombosis Secondary to Bacterial Infections
Manna S Jacob1, Karthik Gunasekaran1, Angel T Miraclin2
1Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Background:
Cerebral venous thrombosis (CVT) secondary to infectious aetiology has become rare in the antibiotic era, but is still encountered in clinical practice occasionally. In this study, we describe the clinical profile, diagnosis, and management of patients with CVT secondary to an infectious aetiology.
Methods:
This retrospective study included all adult patients over 15 years (1 January 2002 to 1 January 2017). Adult patients with a diagnosis of infective CVT secondary to bacterial infections were included in the study.
Results:
Totally, 22 patients were identified with CVT complicating bacterial infections. The focus of infection in 12 (54.54%) patients was pyogenic meningitis, 9 (40.9%) patients had a parameningeal focus and one patient developed CVT secondary to bacterial sepsis from a remote focus. Fever was the most common symptom seen in 77.3% followed by headache and depressed sensorium in 72.7% and 63.6%, respectively. The most common organism in the meningitis group was Streptococcus species, and in the parameningeal group was Staphylococcus aureus. At presentation MRI identified CVT in all 7 patients as compared to CT brain with contrast in 2/3 (66.6%). Transverse sinus was the most commonly involved sinus in meningitis. All patients were treated with appropriate antibiotics and anticoagulation was used in 50% of the patients. The in hospital, mortaility was 9%.
Conclusion:
Septic CVT, though rare can be a complication of bacterial meningitis and facial infections. Clinical symptoms that suggest a co-existing CVT should be identified and diagnosed at the earliest. The mainstay of treatment is antibiotics; the role of anticoagulation is controversial.
Insights
Septic cerebral venous thrombosis (CVT) is rare but can complicate bacterial meningitis and facial infections. Early diagnosis and antibiotic treatment are crucial, though the use of anticoagulation remains debated.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Medicine
Background:
- Cerebral venous thrombosis (CVT) secondary to infection is uncommon in the antibiotic era.
- However, it remains an occasional clinical challenge requiring specific diagnostic and management strategies.
Purpose of the Study:
- To describe the clinical profile, diagnostic methods, and treatment outcomes of patients with CVT caused by bacterial infections.
- To highlight the importance of early recognition and management of this rare condition.
Main Methods:
- A retrospective study of adult patients (≥15 years) diagnosed with infective CVT secondary to bacterial infections between January 1, 2002, and January 1, 2017.
- Inclusion criteria focused on bacterial infections as the etiology of CVT.
Main Results:
- Twenty-two patients with CVT complicating bacterial infections were identified.
- Pyogenic meningitis was the most common infectious focus (54.54%), followed by parameningeal infections (40.9%). Fever, headache, and depressed sensorium were the most frequent symptoms.
- MRI demonstrated CVT in all evaluated cases, while CT with contrast identified it in 66.6%. The in-hospital mortality rate was 9%.
Conclusions:
- Septic CVT, although rare, is a significant complication of bacterial meningitis and facial infections.
- Prompt identification and diagnosis of CVT in patients with suggestive symptoms are essential.
- Antibiotics form the cornerstone of treatment, while the role of anticoagulation is still considered controversial.
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