Cerebral venous thrombosis: clinical features, risk factors, and long-term outcome in a Tunisian cohort.
BACKGROUND
Data from African countries regarding diagnosis, prognosis, management, and outcome of patients with cerebral venous thrombosis (CVT) are limited. The aim of the present study is to characterize clinical presentation, predisposing factors, neuroimaging findings, and outcomes of the disease in the Tunisian population.


METHODS
This is a prospective study including patients referred to the Neurology Department of the Military Hospital of Tunis between January 2009 and December 2012. The diagnosis of CVT was confirmed in all patients using magnetic resonance imaging and magnetic resonance venography. The demographic, clinical, radiological, and outcome data were recorded and analyzed. Median follow-up was 16 months (range 6 months to 4 years). Primary outcome was death or dependency as assessed by modified Rankin score more than 2 at the end of follow-up.


RESULTS
This study included 41 patients with CVT. Mean age was 41.24 years, predominantly women (68%). The mode of onset was acute in 10 patients (24%), subacute in 26 (64%), and chronic in 5 (12%). The most common presenting features were headache, observed in 83% of the patients, followed by seizures, focal motor deficits, papilledema, and mental status changes. Lateral (56%) and superior longitudinal (51%) sinuses were the most commonly involved. Multiple sinuses were involved in 46% of cases. Nineteen patients (46%) had a D-dimer level more than 500 ng/mL. Major causes of CVT were thrombophilia (56%), either genetic or acquired, obstetric and gynecological (50%), and septic (34%). Outcome was favorable in 83% of patients. At the end of follow-up, 32 patients (78%) had complete recovery (modified Rankin Scale [mRs] score 0-1), 2 (5%) had partial recovery (mRs score 2), and 4 (10%) were dependent (mRs score 3-5). One patient (2.5%) had a recurrent sinus thrombosis.


CONCLUSIONS
Our Tunisian population presented distinct risk factors profile with high frequency of thrombophilia, infections, and postpartum state. Oral contraceptive use is not a major risk factor in our population. The overall prognosis was good.
Neurology Department, Military Hospital, Tunis, Tunisia. Electronic address: youssef.sidhom@gmail.com.
Youssef
Y
Sidhom
Neurology Department, Military Hospital, Tunis, Tunisia.
Malek
M
Mansour
Neurology Department, Military Hospital, Tunis, Tunisia.
Mariem
M
Messelmani
Neurology Department, Military Hospital, Tunis, Tunisia.
Hajer
H
Derbali
Hematology Department, Military Hospital, Tunis, Tunisia.
Nejiba
N
Fekih-Mrissa
Neurology Department, Military Hospital, Tunis, Tunisia.
Jamel
J
Zaouali
Neurology Department, Military Hospital, Tunis, Tunisia.
Ridha
R
Mrissa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014416:Tunisia; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D055815:Young Adult
D000925:Anticoagulants; D006493:Heparin
Cerebral venous thrombosis; North Africa; prognosis; risk factors