PB1468 - A Systematic Review of Risk factors, Clinical presentation, Investigations, Management, and Long-term Follow-up of Patients diagnosed with Cerebral Venous Sinus Thrombosis (CVST).

Background: Cerebral venous sinus thrombosis (CVST) is a rare disorder. The variability in its etiology, severity, and clinical presentation pose a diagnostic challenge, leading to life-threatening consequences if left untreated.

Aims: To systematically review the risks, clinical presentation, investigations, management, and long-term follow-up of patients diagnosed with CVST.

Methods: MEDLINE, EMBASE, and Cochrane databases were searched for relevant studies (1990-2022). The search strategies included MeSH headings, keywords, and text words related to CVST risks, clinical presentation, investigations, management, and follow-up. The results were expressed as ratios and percentages.

Results: A total of 61 studies were reviewed including 31 research articles, 23 case reports, and 7 case series. The total number of patients was 756 with a female-to-male ratio of 1.5:1, and a mean age of 32.7 years (19-63). The percentage of provoked cases was 67%. The most common provoking factor for CVST in females was oral contraceptives (32%) followed by pregnancy/puerperium (21%) while in males the most common risk factor was an underlying disease/local infection. The predominant complaint was headache (70%), papilledema (57%), seizures (23%), and weakness (11%). 10% of the patients had a concurrent intracranial hemorrhage (ICH). All patients underwent either CT-Venogram or Magnetic Resonance Imaging (MRI). Lupus anticoagulant positivity was noted in 12%, whilst 8% population had either heterozygous Factor V Leiden or heterozygous prothrombin gene variant. 2% of the patients had either homozygous prothrombin or antithrombin lll deficiency. 91% of the patients were given low molecular weight heparin initially, whilst warfarin was used for long-term anticoagulation. The overall mortality rate was 3.7% with 50% mortality in those with ICH. The recurrent thrombosis rate was 9.5%.

Conclusion(s): A relatively low pick-up rate of high-risk heritable thrombophilia was noted in patients with CVST. Patients having acquired thrombophilia/high-risk heritable thrombophilia needed long-term anticoagulation. Patients with concurrent intracranial hemorrhage or multifocal neurological deficits had inferior outcomes.