To study the clinical, radiological and therapeutic prognostic factors that predict poor outcome in patients with cerebral venous sinus thrombosis. 

Cerebral venous sinus thrombosis (CVST) is a life threatening condition which requires prompt diagnosis and treatment. The prognosis of cerebral venous sinus thrombosis is variable, and the outcome may range from complete recovery to death and disability. Various factors determine the outcome in CVST.

All patients admitted with CVST from September 2016 to September 2018 in a tertiary centre in South India were included in this prospective observational study. After obtaining informed consent, patients' demographic characteristics, clinical features, laboratory investigations, Magnetic Resonance Imaging  with Magnetic Resonance Venography  findings and treatment provided were recorded. Follow-up visits were performed at 1, 3, and  6 months. Modified Rankin Scale (MRS) was applied at each visit. Findings were analysed using Fisher’s exact test and Chi square test in SPSS software version 22.

Ninety patients (56.7% men, 43.3% women) with mean age of 33±10.96 years were identified. Most common presenting features were headache (78%), and generalized tonic clonic seizures (42%). The most frequent clinical sign was papilledema in 68.9% of patients, hemiparesis (22.2%) and aphasia (18.9%). Risk factors were puerperium (23.3%), alcohol consumption (21.1%), hyperhomocysteinemia (16.7%), infections (8.9%), Protein C and S deficiency (3%), malignancy (3%) and trauma (1%). Superior sagittal sinus was the commonest sinus to be involved. Mortality was seen in 6(7%) patients. Outcome was favourable with 93% survival rate. Factors causing poor outcome were altered consciousness, coma, intracerebral hemorrhage, infarcts, midline shift,generalized tonic clonic seizures and involvement of parietal lobe.

Most common presenting symptom in our study was headache. Papilledema was seen in almost two third of them. In conclusion, coma, intracerebral hemorrhage, mid line shift, generalized tonic clonic seizures and parietal lobe involvement are independent predictors for poor outcome of CVST.