What are the risk factors for cerebral sinus venous thrombosis?

Risk Factors of Cerebral Sinus Venous Thrombosis

Cerebral sinus venous thrombosis (CSVT) is primarily associated with prothrombotic conditions, with inherited thrombophilias being significant risk factors, including protein C deficiency, protein S deficiency, antithrombin III deficiency, and factor V Leiden mutation. 1

Prothrombotic Conditions

• Inherited thrombophilias are major risk factors for CSVT, with protein C deficiency having a combined odds ratio of 11.1 1
• Hyperhomocysteinemia is a significant prothrombotic risk factor 1
• Acquired prothrombotic states include antiphospholipid antibodies and nephrotic syndrome 2
• Genetic causes of thrombophilia such as factor V Leiden mutation and G20210A mutation of prothrombin are associated with increased risk, particularly in children and young adults 3

Hormonal and Gender-Related Factors

• Oral contraceptive use is one of the most common risk factors, affecting 74.1% of women with CSVT 4
• Pregnancy and puerperium represent significant risk periods due to hormonal changes 2
• Hormone replacement therapy can increase risk through similar mechanisms as oral contraceptives 2
• Polycystic ovary syndrome is an emerging risk factor 5

Infections and Inflammatory Conditions

• Local and systemic infections are present in approximately 16.3% of cases 4
• COVID-19 infection has emerged as a new risk factor for CSVT 5, 6
• Inflammatory diseases including vasculitis and inflammatory bowel disease can predispose to CSVT 2

Mechanical and Structural Factors

• Head trauma accounts for approximately 9.3% of cases 4
• Neurosurgical procedures can disrupt venous structures 2
• Jugular catheterization may lead to local trauma and thrombosis 2
• Dural arteriovenous malformations can predispose to CSVT 2
• Spontaneous intracranial hypotension has been associated with CSVT 2

Hematological Disorders

• Chronic myeloproliferative diseases are found in 11.6% of CSVT cases 4
• Malignancies can create a hypercoagulable state predisposing to thrombosis 2
• Vaccine-induced thrombotic thrombocytopenia (VITT) has been identified as a rare but serious risk factor 5, 6

Demographic Factors

• CSVT predominantly affects younger individuals, with 78% of cases occurring in patients under 50 years of age 1
• Bimodal age distribution in pediatric cases, with peaks in infancy (20%) and adolescence (50% in ages 11-18) 1
• Higher prevalence in women than men, contrasting with other forms of venous thrombosis 5

Other Risk Factors

• Obesity is an emerging risk factor 5
• Dysthyroidism is present in approximately 16.3% of cases 4
• Migraine has been associated with CSVT in 11.6% of patients 4
• Dehydration can contribute to blood stasis and increased risk 3

Multiple Risk Factor Consideration

• CSVT is often multifactorial, with additive effects between genetic and acquired risk factors 2
• The presence of multiple risk factors significantly increases the likelihood of developing CSVT 2
• Screening for both acquired and inherited risk factors is crucial for comprehensive management 4

Clinical Implications

• Early identification of risk factors is essential for timely diagnosis and management 1
• MRI with MR venography is the preferred initial imaging modality for patients with suspected CSVT 1
• Anticoagulation is the cornerstone of treatment, even in patients with hemorrhagic lesions 7
• Prompt treatment can significantly improve outcomes by preventing thrombus propagation 1