Clinico-radiological patterns of cerebral venous thrombosis in adult males working in the mountainous region of North India - A pilot study from tertiary care hospital

Abstract

Introduction: Working adults in high-altitude regions (HARs) are at higher risk of developing cerebral venous thrombosis (CVT) due to multiple factors. The clinico-radiological patterns pertaining to the high altitude associated with CVT can be different compared to those without HAR exposure. Objective: We aimed to study the clinico-radiological patterns of CVT in adult males diagnosed with CVT while working in mountainous regions at an altitude higher than 8000 feet above sea level. Methodology: The study population consists of adult males aged >18 years who suffered symptomatic CVT while working in mountains at high altitudes. They were divided into groups according to the altitude at which they were working as high-altitude (8202–11,483 ft), very high-altitude (11,484–19,029 ft), and extremely high-altitude (above 19,030 ft) regions. Meticulous history, clinical examination, imaging with computed tomography, magnetic resonance imaging, and laboratory investigations including procoagulation profile were done. The outcome was classified according to the modified Rankin score at 3-month follow-up. Results: Among the forty patients with CVT, 100% had a headache, 65% had vomiting, and 20% suffered convulsions at presentation. Increasing altitude was associated with higher clot load, increasing extent of involvement within the venous sinuses, and a tendency to involve deep veins in isolation or conjunction with the sinuses. Twenty-three recovered without any deficit and 15 were symptomatic without disability at the 3-month follow-up. Conclusion: In patients of CVT who are exposed to high altitudes in mountains, the increasing altitude is associated with higher clot load, increasing extent of involvement within the venous sinuses, and a tendency to involve deep veins. Polycythemia, smoking, alcohol, and deficiency of protein C are the coexisting factors.