Acute seizures in cerebral venous sinus thrombosis: What predicts it?

- Risk of an acute seizure after the diagnosis of CVT is unknown.
- Hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus predicts seizure.
- High D-dimer are novel risk factor for acute seizures.

BackgroundSeizures are the presenting feature of cerebral venous sinus thrombosis (CVST) in 12-31.9% of patients. 44.3% of patients have seizures in the early stage of the disease. Acute seizures (AS), refers to seizures which take place before the diagnosis or during the first 2 weeks afterward.ObjectiveTo report the predictors of acute seizures in cerebral venous sinus thrombosis (CVST).Methods100 patients with CVST were included in the study. The occurrence of acute seizures was noted. The predictors of acute seizure were evaluated by univariate analysis including the demographic (gender, age), clinical (headache, focal neurological deficit, papilloedema, GCS score), type and number of risk factors, MRI findings (Type of lesion: hemorrhagic infarction or hematoma, location of lesion) and MRV findings (superficial or deep sinus, cortical veins).ResultsA total of 46 patients had acute seizures. On univariate analysis, altered mental status (p < 0.001), paresis (p = 0.03), GCS score <8 (p = 0.009), hemorrhagic infarct on imaging (p = 0.04), involvement of frontal lobe (p = 0.02), superior sagittal sinus (p = 0.008), and high D-dimer levels (p = 0.03) were significantly associated with acute seizure. On multivariate analysis, the hemorrhagic infarct on MRI and high D-dimer was independently predictive for early seizure.ConclusionThe predictive factors for the acute seizures are altered mental status (GCS < 8), focal deficits, hemorrhagic infarct, involvement of frontal lobe and superior sagittal sinus with high D-dimer levels.