Is cerebral venous sinus thrombosis (CVST) more prevalent in certain racial or ethnic groups?

CVST Racial and Ethnic Predominance

CVST predominantly affects women and younger individuals, but there is limited high-quality evidence specifically addressing racial or ethnic predominance in CVST incidence. The available data suggest that CVST does not show the same racial disparities seen in other forms of venous thromboembolism, though women are disproportionately affected due to sex-specific risk factors.

Demographic Patterns in CVST

Age and Sex Distribution

• CVST primarily affects younger populations, with 78% of cases occurring in patients under 50 years of age 1
• Women are more frequently affected than men, particularly those taking oral contraceptives or who are pregnant/postpartum 1
• The incidence in adults is 3-4 cases per million people, making it a rare condition 2
• In children and neonates, the incidence is higher at 7 cases per million 2

Limited Evidence on Racial Differences

Contrast with Other Venous Thromboembolism

• The ASCO guidelines note that rates of VTE may differ by race and ethnicity, with some studies suggesting greater risk of VTE in Black patients with cancer and lower risk in Asian patients with cancer 3
• However, these findings relate to general VTE, not specifically to CVST 3
• CVST represents only 0.5-1% of all strokes and has distinct risk factors compared to other forms of venous thrombosis 1

Key Distinction from Arterial Stroke

• Unlike arterial stroke, where Black women and men have significantly higher risk and mortality compared to most other sex and race-ethnic groups in the US, CVST does not demonstrate the same well-established racial disparities 3
• Arterial stroke shows pronounced disparities in young and middle-aged Black populations, particularly in the Stroke Belt region, but this pattern has not been documented for CVST 3

Dominant Risk Factors Override Racial Considerations

Sex-Specific Risk Factors

• Oral contraceptive use is the single most important modifiable risk factor, with 85-96% of young female CVST patients using oral contraceptives, conferring a 13-22 fold increased risk 4
• Pregnancy and puerperium account for approximately 12 cases per 100,000 deliveries, with most occurring postpartum 4
• The combination of oral contraceptives with inherited thrombophilia dramatically amplifies risk: Factor V Leiden + oral contraceptives yields OR 30.0, while Prothrombin G20210A mutation + oral contraceptives yields OR 79.3 4

Prothrombotic Conditions

• Inherited thrombophilias including protein C deficiency (OR 11.1), protein S deficiency, and antithrombin III deficiency are significant risk factors regardless of race 4
• Emerging risk factors include obesity, polycystic ovary syndrome, and COVID-19 infection 5

Clinical Implications

Assessment Priorities

• When evaluating suspected CVST, immediately assess oral contraceptive use, determine pregnancy/postpartum status, screen for inherited thrombophilias, and evaluate for hyperhomocysteinemia 4
• The clinical presentation is nonspecific and highly variable, with headache as the most prominent symptom in most cases 1
• Seizures occur in approximately 40% of CVST patients, significantly higher than in arterial stroke 1

Common Pitfalls

• Do not assume CVST follows the same racial distribution patterns as arterial stroke or other cardiovascular diseases 3, 1
• Delayed diagnosis is common due to variable presentation, with a median 7 days from symptom onset to diagnosis 1
• Normal non-contrast CT does not exclude CVST; MRI with MR venography is the preferred diagnostic modality when clinical suspicion exists 1