Cerebral venous and sinus thrombosis in women.
OBJECTIVE
Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men.


METHODS
We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenter prospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis.


RESULTS
Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l P=0.01), which was entirely due to a better outcome in female patients with gender-specific risk factors. Women without gender-specific risk factors are similar to men in clinical presentation, risk factor profile, and outcome. Logistic regression analysis confirmed that the absence of gender-specific risk factors is a strong and independent predictor of poor outcome in women with sinus thrombosis (OR, 3.7; CI, 1.9 to 7.4).


CONCLUSIONS
Our study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients.
Coutinho
Jonathan M
JM
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Ferro
José M
JM
Canhão
Patrícia
P
Barinagarrementeria
Fernando
F
Cantú
Carlos
C
Bousser
Marie-Germaine
MG
Stam
Jan
J
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003276:Contraceptives, Oral / Q000009:adverse effects; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
D003276:Contraceptives, Oral