Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study

Objectives: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]). Methods: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared. Results: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group. Conclusion: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.

Tek semptomu baş ağrısı olan serebral venöz sinüs trombozu: VENOST çalışmasından elde edilen verilerin alt grup analizi

Amaç: Baş ağrısı serebral venöz sinüs trombozunda (SVST) en sık görülen şikayettir ve bazen CVST ile başvuran hastalarda görülen tek semptom olabilir. Bu retrospektif ve prospektif çalışmada, izole başağrısı (IB) ile başvuran SVST olgularında ve baş ağrısı ile ilişkili diğer bulguları olan (izole olmayan başağrısı-İOBA) olgularda klinik risk faktörleri, radyoloji ve prognoz açısından herhangi bir farklılık olup olmadığını araştırdık. Gereç ve Yöntem: Serebral venöz sinüs trombozu (VENOST) çok merkezli çalışmasından 1144 hasta çalışmamıza alındı. Tüm demografik, biyokimyasal, klinik ve radyolojik yönler 287 IBA vakası ve 857 İOBA vakası için karşılaştırılmıştır. Bulgular: Toplam grup içinde kadın oranı iki kat daha yüksekti. İBA grubunda cinsiyet dağılımını yaş gruplarına göre değerlendirildiğinde istatistiksel olarak anlamlı bir fark bulunmadı. İBA grubunda, baş ağrısının başlangıcı sıklıkla subakut ve kronikti, ancak akut başlangıç, İOBA grubunda daha yaygındı. İBA grubunda% 29’luk takip sırasında diğer nörolojik bulgular eklenmiştir. Daha önce serebral, derin ve diğer venöz tromboembolizm öyküsü İBA grubunda İOBA grubuna göre daha azdı. Transvers sinüs tutulumu İBA grubunda daha yüksek iken sagital sinüs tutulumu İOBA grubunda daha fazlaydı. Plazminojen aktivatör inhibitörü (PAI) mutasyonu IBA grubunda anlamlı olarak daha yüksekti. Sonuç: Hastaların subakut veya kronik baş ağrısı varsa SVST tanısı için IBA akılda tutulmalıdır. Trombolitik olaylar için önemli bir role sahip olan PAI, SVST’da bir risk faktörü olabilir, bu nedenle ayrıntılı hematolojik araştırmalar düşünülmelidir. Daha ileri çalışmalara ihtiyaç vardır

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1. Bushnell C, Saposnik G. Evaluation and management of cerebral venous thrombosis. Continuum (Minneap Minn) 2014;20(2):335–51.

2. Aoun SG, Rahme RJ, Batjer HH, Bendok BR. New guidelines for the management of cerebral venous thrombosis. Neurosurgery 2011;69(2):N15–7.

3. Paciaroni M, Palmerini F, Bogousslavsky J. Clinical presentations of cerebral vein and sinus thrombosis. Front Neurol Neurosci 2008;23:77–88.

4. Cumurciuc R, Crassard I, Sarov M, Valade D, Bousser MG. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. J Neurol Neurosurg Psychiatry 2005;76(8):1084–7.

5. Shintani S, Murase H, Ota H, Tsukagoshi H, Shiozawa Z. “Pseudo-delta sign” on computed tomography in an extremely acute stage of superior sagittal sinus thrombosis- -a case report. Angiology 1990;41(5):417–20.

6. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; 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(3):664–70.

7. Ferro JM, Canhão P. Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep 2014;16(9):523.

8. Gulati D, Strbian D, Sundararajan S. Cerebral venous thrombosis: diagnosis and management. Stroke 2014;45(2):e16– 8.

9. Duman T, Uluduz D, Midi I, Bektas H, Kablan Y, Goksel BK, et al; VENOST Study Group. A Multicenter Study of 1144 Patients with Cerebral Venous Thrombosis: The VENOST Study. J Stroke Cerebrovasc Dis 2017;26(8):1848–57.

10. Uluduz D, Midi I, Duman T, Colakoglu S, Tüfekci A, Bakar M, et al. Behçet’s disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study. Rheumatology (Oxford) 2019;58(4):600–8.

11. Ravishankar K. Incidence and pattern of headache in cerebral venous thrombosis. J Pak Med Assoc 2006;56(11):561– 4.

12. Alvis-Miranda HR, Milena Castellar-Leones S, Alcala-Cerra G, Rafael Moscote-Salazar L. Cerebral sinus venous thrombosis. J Neurosci Rural Pract 2013;4(4):427–38.

13. Sparaco M, Feleppa M, Bigal ME. Cerebral Venous Thrombosis and Headache--A Case-Series. Headache 2015; 55(6):806–14.

14. Luo Y, Tian X, Wang X. Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. Front Aging Neurosci 2018;10:2.

15. Uzar E, Ekici F, Acar A, Yucel Y, Bakir S, Tekbas G, et al. Cerebral venous sinus thrombosis: an analyses of 47 patients. Eur Rev Med Pharmacol Sci 2012;16(11):1499–505.

16. Anadure RK, Wilson V, Sahu S, Singhal A, Kota S. A study of clinical, radiological and etiological profile of cerebral venous sinus thrombosis at a tertiary care center. Med J Armed Forces India 2018;74(4):326–32.

17. Issar P, Chinna S, Issar SK. Evaluation of Cerebral Venous Thrombosis by CT, MRI and MR Venography. J Assoc Physicians India 2017;65(11):16–21.

18. Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, et al; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42(4):1158–92.

19. Silvis SM, de Sousa DA, Ferro JM, Coutinho JM. Cerebral venous thrombosis. Nat Rev Neurol 2017;13(9):555–65.

20. Coutinho JM, Ferro JM, Canhão P, Barinagarrementeria F, Cantú C, Bousser MG, et al. Cerebral venous and sinus thrombosis in women. Stroke 2009;40(7):2356–61.

21. Kiliç T, Akakin A. Anatomy of cerebral veins and sinuses. Front Neurol Neurosci 2008;23:4–15.

22. Bindala S, Coskun O, Alioglu B, Inan LE, Sahin BE, Ocal R. Elevation of Blood Plasminogen Activator Inhibitor Level in Patients With Cerebral Venous Thrombosis. J Neurol Res 2018;8(1-2):4–9.

23. Maksimova MY, Dubovitskaya YI, Shuvakhina NA. Clinical presentations, diagnosis and treatment of cerebral vein and sinus thrombosis. Zh Nevrol Psikhiatr Im S S Korsakova 2018;118(3. Vyp. 2):3–8. [Article in Russian]

24. Pai N, Ghosh K, Shetty S. Hereditary thrombophilia in cerebral venous thrombosis: a study from India. Blood Coagul Fibrinolysis 2013;24(5):540–3.

25. Akhtar N, Deleu D, Kamran S. Haematologic disorders and cerebral venous thrombosis. J Pak Med Assoc 2006;56(11):498–501.

26. Koenig W. Haemostatic risk factors for cardiovascular diseases. Eur Heart J 1998;19(Suppl C):C39–43.

27. Seguí R, Estellés A, Mira Y, España F, Villa P, Falcó C, et al. PAI1 promoter 4G/5G genotype as an additional risk factor for venous thrombosis in subjects with genetic thrombophilic defects. Br J Haematol 2000;111(1):122–8.

28. Zuluaga MI, Massaro M, Franco CA. Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis. Biomedica 2015;35(2):196–203. [Article in Spanish]

29. Karsy M, Harmer JR, Guan J, Brock AA, Ravindra VM, Chung LS, et al. Outcomes in adults with cerebral venous sinus thrombosis: A retrospective cohort study. J Clin Neurosci 2018;53:34–40.