Risk Factors for Cerebral Sinus Venous Thrombosis
Cerebral sinus venous thrombosis (CSVT) is primarily caused by a combination of prothrombotic conditions, hormonal factors, and mechanical/inflammatory processes, with the most significant risk factors being pregnancy/puerperium, oral contraceptive use, and inherited thrombophilias. Recognizing these risk factors is essential for early diagnosis and treatment, as they directly impact morbidity and mortality outcomes.
Major Risk Factor Categories
Prothrombotic Conditions (34% of cases)
- Inherited thrombophilias are present in a significant proportion of CSVT cases, with deficiencies in natural anticoagulants being particularly important 1:
- Hyperhomocysteinemia is another significant prothrombotic risk factor 1
Hormonal and Gender-Specific Factors
- Exogenous estrogen exposure through combined oral contraceptives is a major risk factor, particularly in young women 1, 2
- Pregnancy and puerperium represent significant risk periods, with hormonal changes creating a prothrombotic state 1, 3
- Polycystic ovary syndrome has emerged as a newly recognized risk factor 2
Mechanical and Local Factors
- Surgery and trauma, particularly head trauma, can precipitate CSVT 1, 3
- Central venous catheterization, especially jugular catheterization 3
- Lumbar puncture has been associated with CSVT in case reports 3
- Dural arteriovenous malformations can lead to venous hypertension and thrombosis 3
Inflammatory and Infectious Conditions
- Local and systemic infections can trigger CSVT through inflammatory mechanisms 3
- Inflammatory diseases such as vasculitis and inflammatory bowel disease 3
- COVID-19 infection has been identified as an emerging risk factor 2
Other Medical Conditions
- Cancer and malignancies create prothrombotic states that increase CSVT risk 1, 3
- Obesity is an emerging risk factor that may compound other risk factors 2
- Nephrotic syndrome creates a hypercoagulable state 3
- Spontaneous intracranial hypotension has been associated with CSVT 3
Iatrogenic and Medication-Related Factors
- Vaccine-induced thrombotic thrombocytopenia, particularly with vector COVID-19 vaccines 4
- Various medications beyond hormonal contraceptives may increase risk 3
Age-Related Considerations
- CSVT shows a bimodal age distribution with peaks in:
- Overall, CSVT predominantly affects younger individuals, with 78% of cases occurring in patients under 50 years of age 1
Clinical Implications
- Thrombophilia screening is not universally recommended but should be considered in:
- Young patients with spontaneous CSVT
- Patients with recurrent thrombosis
- Those with positive family history of venous thromboembolism 4
- D-dimer testing is not reliable for ruling out CSVT and should not be routinely performed 4
- Women with previous CSVT related to hormonal contraceptives should avoid estrogen-containing contraceptives due to recurrence risk 4
Diagnostic Approach Based on Risk Factors
- MRI with MR venography is the preferred initial imaging modality for patients with suspected CSVT 5
- CT venography can be used when MRI is not readily available 5
- Catheter angiography may be necessary in cases with high clinical suspicion but negative initial imaging 5
Understanding these risk factors is crucial for early identification and appropriate management of CSVT, which significantly improves outcomes by preventing thrombus propagation and reducing mortality and disability 6, 5.