Headache in cerebral venous thrombosis: incidence, pattern and location in 200 consecutive patients

Abstract

We analyzed the incidence, pattern and location of headache in consecutive 200 patients with proven diagnosis of CVT to identify an association between localization of headache and site of sinus involvement. Headache was present in 136 (68%) patients. The duration of headache (reported in 128 patients) was reported as acute (1–3 days), 81 patients (60%); sub-acute (4–14 days), 33 patients (24%); and chronic (more than 14 days), 14 patients (10%). The quality of headache (reported in 72 patients) was reported as throbbing 12 (9%), band like 27 (20%), thunderclap 7 (5%), and other (pounding, exploding, stabbing, etc.) 26 (20%). The location of headache (reported in 101 patients) was reported as unilateral (one side of head) 48 (37%), localized (frontal, temporal, occipital, and neck) 25 (19%), and diffuse (whole head) 28 (20%). 43 (32%) patients had normal neurological examination (normal mental status, cranial nerves, motor and sensory examination with down going planters). 93 (68%) patients have abnormal findings on neurological examination including papilledema 29 (15%) patients, altered mental status 38 (19%), and focal neurological deficit 45 (22%) patients. There was no association between headache and presence of hemorrhage on CT and MRI (P = 0.1) or hydrocephalus (P = 0.09). There was no association between localization of headache and site of sinus thrombosis except sigmoid sinus thrombosis, where 17 out of 28 patients with involvement of sigmoid sinus alone or in combination with transverse sinus had pain in the occipital and neck region (P < 0.05). There was no association between lateralization of pain and site of thrombosis (P = 0.66).

Clinical Reasoning: A young woman with progressive headache and pancytopenia

“…2 Interestingly, there is no correlation between the side of the headache and the side of the thrombosis. 3 CVST was particularly high on the differential for our patient given her APS and her signs of intracranial hypertension (pulsatile headache worsened with maneuvers that increase intracranial pressure). The most common etiologies of CVST include heritable and acquired thrombophilias, oral contraceptives, pregnancy, malignancy, dehydration, infection, and traumatic head injury.…”

Intracerebral hemorrhage in the context of cerebral amyloid angiopathy and varied time of onset of cerebral venous thrombosis: a case report

“…The spectrum of clinical presentation of CVT ranges from headache within papilledema to focal deficit, seizures and coma [2,25]. Sudden onset of diseases and generalized seizures can both be suspected as ICH and CVT [23].…”

“…Subarachnoid hemorrhage mostly involves the cerebral convexity and spares the basal cisterns and skull base [1,18]. The transverse sinus, sigmoid sinus, and concomitant sinus and vein are the most common locations of venous thrombosis [6,25]. The coexistence of intracerebral hemorrhage (ICH), SAH and CVT is also possible, especially in patients with diagnosed cerebral amyloid angiopathy (CAA) [11,22].…”

Headache as the isolated presentation of cerebral venous thrombosis

“…İzole baş ağrısı bulgusu veren serebral ven trombozları Lateral sinüs tutulumu izole baş ağrısı ile gelen hastalarda en sık tutulan sinüstür (11,12). Cumurciuc ve ark.…”

“…İzole baş ağrısı ile gelen hastalarımızın kraniyal MR'larında anormal bulgu yoktu. Bousser'in 62 hastalık lateral sinüs trombozu serisinde de %94 oranında MR normal tesbit edilmiş ve izole lateral sinüs trombozlarında nöbet, fokal defisit, bilinç bozukluğu daha az görülmüştür (12). Aynı seride prognozun iyi olduğu bildirilmiştir, bizim hastalarımızın da prognozu mükemmeldi, tümü tamamen iyileşmişti.…”