Cerebral Venous Sinus Thrombosis Incidence Is Higher Than Previously Thought

Abstract

Background and Purpose— The incidence of cerebral venous thrombosis (CVT) varies between studies, but it is estimated to be between 2 and 5 per million per year. A recent study in the Netherlands with comprehensive ascertainment suggested a much higher incidence. It is uncertain whether these differing estimates reflect the quality of ascertainment or true variation. The purpose of this study was to determine the incidence of CVT in Adelaide, using a novel clinical and radiological methodology. Methods— We retrospectively identified CVT International Classification of Diseases-coded cases from all Adelaide public hospitals from 2005 to 2011. We also searched all neuroimaging studies (259 101) from these hospitals for text variations containing venous thromb. All potential cases were reviewed, and cases of incident CVT ascertained. Associations and outcomes were determined. Results— Of 169 possible cases, 105 cases of CVT were confirmed (59 cases by both coding and neuroimaging, 40 from neuroimaging alone, and 6 from coding alone). In our population of 953 390 adults, this represented an incidence of 15.7 million per year (95% confidence interval, 12.9–19.0), the highest incidence reported. Of these cases, a possible procoagulant predisposition was identified in 48%. Fifty-five of 105 cases occurred in females. Relative risk of CVT in females of reproductive age was insignificantly higher than in males (1.18 [95% confidence interval, 0.94–1.48]). Conclusions— Cerebral venous sinus thrombosis in our study was more common than previously reported, perhaps because of more complete ascertainment. Future CVT incidence studies should include comprehensive capture and review of neuroimaging.

Venous collateral drainage patterns predict clinical worsening in dural venous sinus thrombosis

“…In our study as well as many others on DVST, the most common sites of occlusion are the transverse/sigmoid sinus and superior sagittal sinus 1 3 9. The most common routes to alternate sinuses from the territories drained by these sinuses would be through the Sylvian vein into the ipsilateral superior anastomotic vein (in the case of transverse sinus occlusion) or ipsilateral inferior anastomotic vein (in the case of superior sagittal sinus occlusion).…”

“…DVST affects an estimated 15.7/million a year, with an incidence that increases with time as awareness has improved 3. Importantly, the condition of approximately 23% of patients with DVST will worsen after initial presentation 4.…”

Cerebral Venous Thrombosis

“…5 The article by Devasagayam et al in this issue continuous this trend with an even higher incidence of 15.7 per million inhabitants per year and, yet, may be underestimating the real incidence because at least some private hospitals could not be covered. 1 Their findings do not alone prove that Australia has a higher incidence for CVT, but suggest that the better we investigate, the higher incidence rates we find for CVT. Finding CVT patients through imaging repositories by using key words is an interesting approach, used also previously by Iranian investigators (although not described in detail by them).…”

“…11 The contraceptive preparates used in Australia are hardly different regarding their consistency compared with other industrialized countries. The likely explanation for surprisingly high proportion of male patients in the study of Devasagayam et al is, 1 therefore, a chance finding. In summary, CVT epidemiology is not well-investigated, and our knowledge comes from rather small mostly singlecenter studies.…”

“…1 Their study, despite having the typical limitations of retrospective registries, offers some new insights.…”