Cerebral Venous Thrombosis: A Clinico Radiological study in Rural Population visiting Tertiary Care Center, Kanchipuram District, Tamilnadu

BACKGROUND: Cerebral Venous/sinus Thrombosis (CVT) has been recognized since the early 19th century but still remains a diagnostic and therapeutic challenge. Cerebral vein and sinus thrombosis is rare compared to arterial stroke often occurs in young individuals. Patient of CVT usually presents with headache, seizure, papilledema, altered sensorium and focal deficits due to thrombosis of intracranial veins and sinuses resulting in haemorrhagic infarctions and raised intracranial tension. The above features are present in various combinations ranging from the syndrome of raised intracranial pressure without localization to deeply altered sensorium and dense hemiparesis. CVT forms a distinct subgroup of cerebrovascular disease in India and is a leading cause of mortality in women of reproductive age group. Review of CVT cases from Asian countries is suggestive of differences in risk factors profile and outcome in these patients as compared to European studies. The present study was therefore carried out to find the pattern of presentation, correlate radiological findings and incidence of venous stroke in rural population of Kanchipuram district Tamilnadu. OBJECTIVES: PRIMARY OBJECTIVE: To study the pattern of clinical presentation of cerebral venous thrombosis. SECONDARY OBJECTIVES: 1. To study the varied findings in CT scan studies. 2. To correlate the clinical findings with radiological findings. 3. To study the incidence of venous stroke in patients of stroke in rural population visiting tertiary care centre. METHODS: The present Descriptive study was performed in the Department of General Medicine in collaboration with radiological and imaging department at Karpaga Vinayaga institution of medical sciences. The study was carried out during the period of August -2017 to October -2019 (15months). A total of 43 patients were studied. A standard neurological questionnaire was given to all patients presenting with symptoms suggestive of stroke and cerebral venous thrombosis. Routine blood workup done and CT imaging of brain done for patients suspected to have CVT and MRI with MRV in required cases. Further workup for prothrombotic states was done on case basis based on presentation, risk factors and history. Fundus examination was done using ophthalmoscope for all patients. RESULTS AND CONCLUSION: In our study there was no correlation between clinical presentation and topographical radiological substrate in our study except for association of mastoiditis with lateral sinus thrombosis .Out of 43 27 pts (54%) had idiopathic intracranial hypertension type of presentation, 23 (46%) had focal deficits, 29(58%) had seizures 6 (12%) had generalized seizures. Focal seizures in 15(30%) and status epilepticus in 2(4%) pts. Headache in 31(62%) pts, multiple cranial nerves in 5(10%) of Patients. Transverse sinus was the next most common sinus involved 33 pts (isolated in 4pts) followed by sigmoid sinus 22 pts. Superficial venous system was involved in 5 pts. (isolated in 2Pts) while the deep venous system was involved in 5pts. The majority (39 pts.) of patients had a combination of sinuses and veins involvement 11 pts. had only isolated sinus involvement. Procoagulant state and infections are the most common predisposing factors for cerebral venous thrombosis in this study. Presence of altered sensorium and focal neurological deficit at admission and CT findings of parenchymal haemorrhage and parenchymal hypodense lesions also predict poor outcome. MRI with MR venogram is the imaging of choice in diagnosing and follow-up of Dural sinus thrombosis