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Cerebral venous thrombosis: comparing characteristics of infective and non-infective aetiologies: a 12-year retrospective study
  1. Pat Korathanakhun1,
  2. Wongchan Petpichetchian2,
  3. Pornchai Sathirapanya1,
  4. Sarayut Lucien Geater1
  1. 1Faculty of Medicine, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
  2. 2Faculty of Nursing Science, Department of Surgical Nursing, Prince of Songkla University, Hat Yai, Songkhla, Thailand
  1. Correspondence to Pornchai Sathirapanya, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand; sporncha{at}medicine.psu.ac.th

Abstract

Background Most cases of cerebral venous thrombosis (CVT) have non-infective causes. Infective CVT, though less common, often results in a catastrophic outcome. The distinctive clinical characteristics of infection-associated CVT (IACVT) and non-infection-associated CVT (NIACVT) would facilitate early detection and proper management.

Objective To compare the characteristics of IACVT and NIACVT.

Methods All patients with CVT admitted to Songklanagarind Hospital between January 2002 and December 2013 with the ICD10 codes I636, I676, O225 and G08 were identified and recruited. We compared the clinical presentations, neuroimaging results and hospital outcomes for patients with IACVT and those with NIACVT. We analysed the differences using descriptive statistics. Additionally, for patients with IACVT, we described the primary sites of infection, associated CVT, host immune status and microbiological results.

Results Twenty of the 83 patients with CVT (24.1%) had IACVT. Male gender (70.0% vs 34.9%) and pre-existing diabetes mellitus (35.0% vs 4.8%) were significantly more prevalent in the IACVT than the NIACVT group. Additionally, cavernous sinus thrombosis predominated in IACVT (80.0% vs 11.1%), whereas focal neurological syndrome was more common among patients with NIACVT (50.8% vs 15.0%). Paracranial infections, mostly sinusitis and orbital cellulitis, were common primary infections (80.0%) among patients with IACVT. Lastly, fungus was a devastating causative pathogen in IACVT—five of six patients with fungal infection had intracranial complications.

Conclusions Cavernous sinus thrombosis is a distinctive clinical presentation of IACVT, whereas focal neurological syndrome is a hallmark feature of NIACVT. Paracranial fungal infections are highly virulent and frequently associated with intracranial complications.

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