Risk Factors of Cerebral Vein and Sinus Thrombosis

Abstract

The risk factors for deep venous thrombosis (and for cerebral vein and sinus thrombosis, CVST) differ from those for arterial disease. The risk factors for venous thrombosis are linked to the Virchow triad of stasis of the blood, changes in the vessel wall, and changes in the composition of the blood, especially the first and third of these. Risk factors are usually divided into acquired (e.g. surgery, trauma, pregnancy, puerperium, lupus anticoagulant, malignant disease, and female hormones) and genetic (congenital thrombophilia). However, the separation of genetic and acquired risk factors is somewhat artificial, since they have additive effects and venous thrombosis is often multifactorial. In this review, we discuss acquired risk factors for CVST. These include hormonal changes (e.g. oral contraceptives use, hormone replacement therapy, pregnancy and puerperium), mechanical precipitants (e.g. head trauma, jugular catheterization, surgery, lumbar puncture), local and generalized infections, cancer, acquired prothrombotic states (e.g. hyperhomocysteinemia, nephrotic syndrome), inflammatory diseases (e.g. vaculitis, intestinal inflammatory disease), hematological disorders, neurological diseases (e.g. dural arteriovenous malformations, spontaneous intracranial hypotension), drugs and other situations. However, only some conditions are consistently present in case series, while many appear only in anecdotal reports. Thus, in most situations, a causal link cannot be established. Determining a cause-and-effect relationship is essential for developing preventive, diagnostic, and therapeutic strategies. Therefore, further multicentered, case-controlled studies are crucial for better understanding the pathogenesis of CVST.

Diagnosis and Management of Cerebral Venous Thrombosis

“…Risk factors are usually divided into acquired risks (eg, surgery, trauma, pregnancy, puerperium, antiphospholipid syndrome, cancer, exogenous hormones) and genetic risks (inherited thrombophilia). Table 3 summarizes the evidence for a cause-and-effect relationship 10,11 between prothrombotic factors and CVT. Evidence for the strength and consistency of association, biological plausibility, and temporality is summarized.…”

“…Recently, another group in the United States reported that 21% of 182 CVT case subjects in 10 hospitals had a prothrombotic condition. 11 …”

A rare case of post-partum cerebral venous sinus thrombosis

“…6 Moreover, there are increased circulating levels of several clotting factors in pregnancy. The incidence of venous thrombo-embolism during pregnancy and the puerperal period has been estimated to be 5.5-6 times higher than in the general female population of child bearing age.…”

“…6,7 Pregnancy related risk factors include sepsis, preeclampsia, thrombophilias and delivery by caesarean section. It is more common in those patients who have inherited thrombophilias, lupus anticoagulant, or antiphospholipid antibodies.…”

Spontaneous Intracranial Hypotension Plus Cerebral Venous Thrombosis: A Case Report Study

“…Radioisotope cisternography was not performed in this patient. Several studies have shown that SIH is a risk factor for developing CVT (3,15,16). Increased blood viscosity secondary to loss of CSF absorption into cerebral venous sinuses, traction of the cerebral veins and sinuses due to sagging of the brain, and slowing of the venous blood velocity induced by cerebral veins engorgement, are three proposed mechanisms that can contribute to the development of CVT in the course of SIH (2).…”