title: Cerebral venous thrombosis in Kuwait. Clinical presentation, risk factors, and management.
abstract: OBJECTIVE
  To explore the pattern of clinical presentations, risk factors, and the sinuses involved in cases of cerebral venous thrombosis (CVT) treated in a tertiary neurological center in Kuwait.
  
  
  METHODS
  A retrospective analysis of cases of CVT treated at Ibn Sina Hospital, Kuwait, from January 2000 to October 2010. The records of 71 patients were retrieved and entered in a database. All patients were evaluated with hypercoagulable work up and relevant neuro-imaging studies.
  
  
  RESULTS
  Seventy-one patients were included in our study, with a male to female ratio of 1:1.5. The clinical presentations were: headache (93%), seizures (31%), and focal neurological signs (37%). Over two-thirds (n=30) of female patients had a history of oral contraceptive use. Papilledema with raised intracranial pressure was recorded in 20 patients (28%), ovarian hyper-stimulation syndrome with CVT in one patient, and possible Neuro-Behcet`s in 10% (n=7). The venous sinuses involved were superior sagittal sinus in 59% (n=42), and transverse and straight sinuses in 54% (n=38). Hemorrhagic venous infarctions were seen in 18% (n=13). Fifty percent of patients recovered within 2-4 weeks, 15 patients (21%) recovered within 4-12 weeks, and 15 patients (21%) required intensive care unit care with ventilator support for 1-2 weeks.
  
  
  CONCLUSIONS
  Oral contraceptive use was the primary risk factor in female patients. Early diagnosis and immediate treatment with anticoagulants reduce the morbidity and mortality. Serum D-dimer level is more helpful for early diagnosis with sensitivity of 58%.
authors.affiliation: Department of Neurology, Ibn Sina Hospital, PO Box 25427, Safat 13115, Kuwait. drvperiasamy@yahoo.com
authors.forename: Periasamy
authors.initials: P
authors.lastname: Vembu
authors.forename: John K
authors.initials: JK
authors.lastname: John
authors.forename: Mohammed I
authors.initials: MI
authors.lastname: Mohammed
authors.forename: Asmahan F
authors.initials: AF
authors.lastname: Al-Shubaili
mesh_terms: D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D003276:Contraceptives, Oral / Q000009:adverse effects; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D007730:Kuwait / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D003276:Contraceptives, Oral