# Clinico-Epidemiological Study on Cerebral Venous Sinus Thrombosis: Manifestations, Complications, Risk Factors, and Diagnostic Challenges

## TL;DR

This study examines the characteristics, risk factors, and diagnostic challenges of cerebral venous sinus thrombosis, highlighting its impact on young women and the importance of early detection.

## Contribution

The study provides a detailed clinical and epidemiological analysis of CVST cases in a single center, emphasizing diagnostic challenges and outcomes.

## Key findings

- CVST predominantly affects young to middle-aged women, with hormonal factors and infections being major contributors.
- Headache was the most common presenting symptom, and diagnostic delays were frequent due to non-specific symptoms and imaging limitations.
- Persistent headaches and epilepsy were the most frequent long-term complications despite anticoagulation therapy.

## Abstract

Cerebral venous sinus thrombosis (CVST) is a rare but potentially serious cerebrovascular disorder caused by thrombosis of the cerebral venous sinuses, which can result in raised intracranial pressure, cerebral edema, and hemorrhagic complications. The clinical presentation is highly variable, often leading to diagnostic delays despite advances in neuroimaging. This study aimed to describe the clinical, demographic, and epidemiological characteristics of patients with CVST, identify associated risk factors and comorbidities, and evaluate complications and long-term outcomes. In addition, the study sought to assess diagnostic practices and challenges in the detection of CVST. This single-center cross-sectional study included 21 patients with radiologically confirmed CVST who presented to the Neurology Unit at Basra Teaching Hospital between January 2024 and January 2025. Clinical, demographic, imaging, and outcome data were retrospectively collected and analyzed. The mean age of the patients was 37 years (range: 14-95 years), with a predominance of women (n = 13, 61.9%). The most common risk factors identified were oral contraceptive use and infections (n = 7, 33.3% each), followed by obesity (n = 5, 23.8%), smoking (n = 5, 23.8%), and pregnancy/postpartum state (n = 4, 19%). The most frequent presenting symptom was headache (n = 15, 71.4%), followed by seizures and visual disturbances (n = 9, 42.9% each). The sagittal sinus was the most common site of thrombosis (n = 9, 42.9%), followed by the cavernous sinus (n = 8, 38.1%) and the transverse/sigmoid sinus (n = 4, 19.0%). Diagnostic challenges were prevalent, with non-specific symptoms (n = 12, 57.1%), delayed presentation (n = 11, 52.4%), and limitations of imaging techniques (n = 9, 42.9%) contributing to late diagnosis. Regarding treatment, all patients received symptomatic management, while anticoagulation therapy was administered to 95.2% (n = 20). Immediate complications included acute seizures (n = 10, 47.6%) and intracranial hemorrhage (n = 6, 19.0%). Persistent headaches (n = 13, 61.9%) and epilepsy (n = 6, 28.6%) were the most frequent long-term complications. Statistical analysis revealed no significant association between demographic factors, risk factors, or clinical features with the type of venous sinus thrombosis. In conclusion, CVST predominantly affects young to middle-aged women, with hormonal factors and infections being major contributors. The diagnosis remains challenging due to non-specific symptoms and imaging limitations, often leading to delays in treatment. Despite advances in management, CVST is associated with significant immediate and long-term complications, emphasizing the need for early recognition and intervention. Improved awareness, risk factor identification, and timely imaging are crucial to enhancing outcomes in CVST patients.