Research · MD (General Medicine) dissertation · 2021
What 40 patients taught me about clots in the brain's veins
Clinical Profile and Radio-Imaging Features in Patients of Cerebral Venous Thrombosis at a Tertiary Care Centre: A Cross-Sectional Study
MD (General Medicine) · N.K.P. Salve Institute of Medical Sciences & Research Centre, Nagpur · Maharashtra University of Health Sciences (MUHS), Nashik
Under the guidance of Dr. Neelima R. Saoji
40
Patients studied
30 yrs
Mean age
20–30
Commonest age group
3 : 1
Male : female
Hospital-based cross-sectional observational study · 2 years · Tertiary care teaching hospital · CT brain, MRI brain, MR venography
The question
What I set out to answer
In patients who arrive at a tertiary hospital with cerebral venous thrombosis, who are they, how do they present, what puts them at risk — and what does imaging actually show?
- Study the demographic profile of patients with CVST.
- Evaluate common presenting symptoms and neurological findings.
- Assess etiological and laboratory risk factors.
- Describe CT, MRI and MR Venography findings.
- Correlate imaging features with clinical presentation.
The findings
What the study showed
Every figure below is a proportion of the same 40 patients, shown with the patient count beside it.
How patients presented
Symptoms overlap — most patients had more than one, so these do not add to 100%.
Headache
72.5%29/40
Focal neurological deficit
37.5%15/40
Seizures
20%8/40
Papilloedema
17.5%7/40
What the workup showed
Unprovoked (no identifiable trigger)
77.5%31/40
Raised homocysteine
55%22/40
Anaemia
42.5%17/40
What imaging showed
Superior sagittal sinus involved
75%30/40
Empty delta sign
17.5%7/40
Cerebral infarction
12.5%5/40
Haemorrhagic infarction
7.5%3/40
One patient in the cohort died (2.5%). MRI combined with MR venography was the most sensitive way to make the diagnosis.
The conclusions
What it means
CVST predominantly affected young adults in this cohort.
Young men with unprovoked thrombosis made up the largest subgroup — the reverse of the female predominance reported in much of the Western literature.
Raised homocysteine emerged as an important associated risk factor.
Headache was the commonest presenting symptom.
The superior sagittal sinus was the most frequently thrombosed venous sinus.
MRI with MR venography was the most sensitive imaging modality for diagnosis.
Why it matters at the bedside
Keep a high index of suspicion for cerebral venous thrombosis in a young patient with a new, unexplained headache or unexplained neurological symptoms. It is treatable, and the imaging that finds it is ordinary — but only if someone thinks of ordering it.
What this study could not answer
- A single-centre study — the pattern seen here may not hold elsewhere.
- A small cohort (40 patients), so percentages move by 2.5% with every single patient.
- Cross-sectional by design: patients were not followed up, so the study says nothing about what happened to them afterwards.
From that ward to this cath lab
It is a neurology question, and I am a cardiologist — but the thread runs straight through. Thrombosis, anticoagulation and reading an image carefully enough to act on it are the same disciplines I use in the cath lab every week. This is where I learned them.
Questions about the evidence behind your treatment?
Bring your reports — and your scepticism. Both are welcome at the consultation.