Neurological health in women: A retrospective review of 101 cases from East Africa of cerebral venous sinus thrombosis

Abstract

Background and Aims: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that is more common in the young adults and females and can be precipitated by being on contraceptive treatments or having a thrombophilia. Timely diagnosis with prompt neuroimaging and guideline-based treatment leads to good outcomes. We sought to describe the first large case series of CVST from  East Africa to elucidate causes and outcomes.

Material and Methods: We conducted a retrospective review of medical records between 2010 – 2021 of patients diagnosed and/or  managed with cerebral venous sinus thrombosis. The primary outcome was to identify the proportion of patients with good outcome  (Modified Rankin score 0-2). The secondary outcomes included risk factors, neuroimaging findings, and treatment offered.

Results: Of  101 cases, 69.6% (71/101) were female, with the majority [84.3% (86/101)] being Black African with a median age of 31 years at diagnosis.  Apart from presenting with new headaches, the most common symptoms were visual disturbance [26.5% (27/101)] and seizures [20.6%  (21/101)]. Approximately 21% of patients had CVST due to being on hormonal contraceptives but were allegedly not informed of this  potential complication. A similar percentage also had a new diagnosis of protein S or protein C deficiency. Most patients (>67%) were managed with warfarin, and the remainder on rivaroxaban or dabigatran. Only 35.1% of patients had complete resolution of the CVST at  the last scan. One patient died as a result of a CVST.

Conclusions: Our cohort demonstrate that CVST is indeed predominant in females  but also occur in males. A significant proportion were ascribed to having newly diagnosed thrombophilia. Most patients were appropriately managed on anticoagulants but not all had complete resolution of the CVST.