Risk of seizure is significantly higher in cerebral vein and dural sinus thrombosis (CVST) compared to other stroke subtypes. There is paucity of literature on predictors of presenting seizures in CVST. This study was designed to investigate the risk and predictors of seizures in CVST at presentation.
Total 181 consecutive patients with CVST were retrospectively analyzed.
Total 181 patients with CVST were enrolled (age range, 14 to 96 years; mean age, 34.64±14.66 years). A total of 44 patients had presenting seizures. Younger age (
About one fourth of the patients with CVST had presenting seizures. The patients with hemorrhagic venous infarct in the frontal region are more prone to have presenting seizures.
Risk of a seizure is significantly higher in cerebral vein and dural sinus thrombosis (CVST) compared to hemorrhagic or ischemic stroke.
Patients with CVST in a tertiary care teaching hospital from January 2011 to December 2013 were enrolled in this study. CVST was confirmed by magnetic resonance venography (MRV). Magnetic resonance imaging (MRI) and MRV data of 181 patients with CVST were included in final analysis. Data was extracted from the medical record. Occurrence of seizure at presentation of CVST was noted.
MRI included diffusion-weighted images, axial T1, axial fast spin-echo (FSE) T2, coronal and sagittal FSE T2, and gradient-echo sequences. Maximum intensity projections (MIPs) were created at the MR operating console for 3D-MR venography data set. The MIP images were viewed in the sagittal, transverse and coronal planes.
The presence of supratentorial parenchymal lesions, their location (frontal, parietal, temporal or occipital), type (non-hemorrhagic or hemorrhagic venous infarction), and presence of intraventricular or subarachnoid hemorrhage (SAH) on magnetic resonance imaging were noted. The location and extent of the thrombosis and the number of sinuses affected on MRV were noted. The direct evidence of cortical veins thrombosis on MRI was also noted.
Numeric values were shown as the mean±standard deviation. Demographic, clinical and radiological variables among patients with CVST with or without presenting seizures were analyzed by using chi-square contingency analysis to explore the statistically significant difference. A difference was considered significant at a
Total 181 patients with CVST were enrolled (age range, 14 to 96 years; mean age, 34.64±14.66 years). One hundred twenty one patients (66.8%) were female. A total of 44 patients (24.3%) had presenting seizures. Out of 44, 79.5% were females. Distribution and types of brain parenchymal lesions in patients presenting with seizures have been shown in
Younger age (
In this retrospective analysis, 24.3% patients with CVST had presenting seizures. Hemorrhagic venous infarct in frontal lobe was the independent predictor of presenting seizures in the CVST. Limited data is available regarding frequency of seizures and clinico-radiological findings of CSVT patients with seizures. In a large prospective study, 39.3% patients with CVST had seizures at presentation.
In a prospective study of 194 consecutive patients with acute CVST, 44.3% of patients had early symptomatic seizures. Motor deficit, intracranial hemorrhage and cortical venous thrombosis were independent predictors of early epileptic seizures.
The main limitation of the present study is its retrospective nature. Other limitations are single center study, lack of etiology, outcome and follow up data. Single center study may cause case selection bias. Reporting by single radiologist in the present study may also cause bias in the interpretation.
About one fourth of the patients with CVST had presenting seizures. The patients with hemorrhagic venous infarct in the frontal region are more prone to have presenting seizures.
The authors declare that they have no conflicts of interest.
Distribution and types of brain parenchymal lesions in patients presenting with seizures
Site of lesion | Hemorrhagic venous infarct | Non hemorrhagic venous infarct | Intraparenchymal hemorrhage | Total |
---|---|---|---|---|
Frontal | 9 (33.3) | 7 (87.5) | 3 (75) | 19 (48.7) |
Parietal | 3 (11.1) | 0 (0.0) | 0 (0.0) | 3 (7.7) |
Fronto-parietal | 6 (22.2) | 0 (0.0) | 0 (0.0) | 6 (15.4) |
Temporo-parietal | 2 (7.4) | 0 (0.0) | 0 (0.0) | 2 (5.1) |
Parieto-occipital | 2 (7.4) | 0 (0.0) | 0 (0.0) | 2 (5.1) |
Temporo-occipital | 2 (7.4) | 1 (12.5) | 1 (25) | 4 (10.2) |
Fronto-temporo-parietal | 1 (3.7) | 0 (0.0) | 0 (0.0) | 1 (2.6) |
Temporo-parieto-occipital | 1 (3.7) | 0 (0.0) | 0 (0.0) | 1 (2.6) |
Cerebellum and Fronto-parieto-occipital | 1 (3.7) | 0 (0.0) | 0 (0.0) | 1 (2.6) |
Total | 27 | 8 | 4 | 39 |
Values are presented as number (%).
One patient had or subarachnoid hemorrhage. Four patients with seizures had no brain parenchymal lesions.
Univariate analysis of predictors of presenting seizures in patients with cerebral venous sinus thrombosis
Variable | Seizure (n=44) | No seizure (n=137) | OR | 95% CI | |
---|---|---|---|---|---|
Age (years) | 30.43±9.30 | 35.99±15.80 | - | - | 0.03 |
Female | 35 | 86 | 2.31 | 1.03–5.19 | 0.06 |
Isolated SSS | 11 | 18 | 2.20 | 0.95–5.12 | 0.10 |
SSS with other venous sinuses | 23 | 57 | 1.54 | 0.78–3.04 | 0.29 |
Isolated TS | 1 | 6 | 0.51 | 0.06–4.34 | 0.86 |
TS with other venous sinuses | 29 | 105 | 0.59 | 0.28–1.23 | 0.22 |
Isolated SS | 0 | 2 | - | - | 0.98 |
SS with other venous sinuses | 27 | 92 | 0.78 | 0.38–1.57 | 0.60 |
Isolated straight sinus | 0 | 1 | - | - | 0.55 |
Straight sinus with other venous sinuses | 7 | 26 | 0.81 | 0.32–2.01 | 0.82 |
Straight sinus, internal cerebral veins and vein of gallen | 0 | 3 | - | - | 0.76 |
Internal cerebral veins and vein of gallen | 0 | 2 | - | - | 0.98 |
Involvement of superficial cortical veins | 4 | 1 | 13.6 | 1.48–125.16 | 0.02 |
All superficial and deep venous sinuses | 6 | 14 | 1.39 | 0.50–3.86 | 0.72 |
Hemorrhagic venous infarct | 27 | 41 | 3.72 | 1.83–7.55 | <0.01 |
Non hemorrhagic venous infarct | 8 | 27 | 0.91 | 0.38–2.17 | 0.99 |
Intraparenchymal hemorrhage | 4 | 7 | 1.86 | 0.52–6.67 | 0.55 |
Intraventricular hemorrahge | 0 | 1 | - | - | 0.55 |
Subarachnoid hemorrhage | 1 | 0 | - | - | 0.55 |
Frontal | 19 | 10 | 9.65 | 4.01–23.22 | <0.01 |
Parietal | 3 | 3 | 3.27 | 0.64–16.82 | 0.31 |
Occipital | 0 | 4 | - | - | 0.58 |
Fronto-temporal | 0 | 4 | - | - | 0.58 |
Fronto-parietal | 6 | 19 | 0.98 | 0.37–2.63 | 0.83 |
Temporo-parietal | 2 | 4 | 1.58 | 0.28–8.95 | 0.97 |
Parieto-occipital | 2 | 6 | 1.04 | 0.20–5.35 | 0.71 |
Temporo-occipital | 4 | 4 | 3.33 | 0.79–13.90 | 0.19 |
Fronto-temporo-parietal | 1 | 1 | 3.16 | 0.19–51.65 | 0.98 |
Temporo-parieto-occipital | 1 | 5 | 0.61 | 0.07–5.40 | 0.97 |
Bilateral thalamic | 0 | 6 | - | - | 0.35 |
Bilateral thalamo-capsuloganglionic | 0 | 4 | - | - | 0.58 |
Bilateral caudate nuclei | 0 | 1 | - | - | 0.55 |
Bilateral thalamic and fronto-parietal | 0 | 1 | - | - | 0.55 |
Cerebellum | 0 | 2 | - | - | 0.98 |
Cerebellum and fronto-parieto-occipital | 1 | 1 | 3.16 | 0.19–51.65 | 0.98 |
Values are presented as mean±standard deviation or number.
OR, odds ratio; CI, confidence interval; SSS, superior sagittal sinus; TS, transverse sinus; SS, sigmoid sinus.
Multivariate analysis of predictors of presenting seizures in patients with cerebral venous sinus thrombosis
Variable | OR | 95% CI | Regression coefficient | |
---|---|---|---|---|
Hemorrhagic venous infarct | 4.44 | 1.89–10.44 | 0.001 | 0.21 |
Frontal | 10.66 | 4.02–28.29 | <0.001 | 0.45 |
OR, odds ratio; CI, confidence interval.