Cerebral venous thrombosis-related stroke in India: Clinical patterns, risk factors, and outcomes from the hospital-based stroke registry programme.

Abstract

Background and objectives Cerebral venous thrombosis (CVT) is an uncommon cause of stroke, with limited multicentre data from India. This study describes the clinical profile, risk factors, management, and outcomes of CVT from ICMR-NINE Hospital-Based Stroke Registry Programme. Methods A cross-sectional analysis of CVT cases reported from 30 hospitals across India (January 2020-December 2022) was conducted. Sociodemographic, clinical, imaging, treatment, and outcome data were analysed. Functional outcome was assessed using the modified Rankin Scale (mRS). Multivariable logistic regression identified predictors of 3-month mortality. Results Among 34,792 registered stroke cases, 575 (1.6%) had CVT. Mean age was 37.5 years, with 72.4% (n= 416) aged 18-44 years, and 60% (n=345) were male. Headache (n=468, 81.4%), motor impairment (n=285, 49.6%), and seizures (n=259 ,45%) were the common presentations. Haemorrhagic infarction (n=177, 30.8%) was the predominant parenchymal imaging finding, with multiple sinus involvement in 62.4% (n=339). Anaemia (n=186, 32.6%), alcohol use (n=174, 30.9%), and hyperhomocysteinemia (n=152, 26.6%) were the leading risk factors. At 3 months, 74.8% (n=430) achieved good outcomes (mRS 0-2), (n=60) 10.4% remained with some disability, and 9.2% (n=53) died. Mortality was independently associated with age ≥45 years [Odds ration (OR) 12.11 to 18.32 depending on age group], impaired consciousness [OR =2.41, 95% confidence interval (CI): 1.03-5.67; P=0.044], dysphagia at onset (OR =3.36, 95% CI: 1.48-7.65, P=0.004), and delayed arrival at hospital between 12-24 h after symptom onset (OR =4.25, 95% CI: 1.08-16.74, P=0.038). Interpretation and conclusions In India, CVT-related stroke predominantly affects young males. Anaemia, alcohol use, and hyperhomocysteinemia are the major risk factors. Older age, delayed hospital presentation between 12-24 h, impaired consciousness, and dysphagia at onset, predict higher mortality.