Clinical and radiological correlation in the diagnosis of patients with cerebral venous sinus thrombosis (CVST)

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon but important cause of stroke in young adults, with varied clinical and radiological features. Correlating clinical presentation with imaging findings is essential for accurate diagnosis and prognostication, particularly in resource-limited settings. Methods: This cross-sectional observational study included 50 consecutive adults (≥18 years) with CVST admitted to Department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2023 to January 2025. Clinical features, risk factors, laboratory values, and imaging findings were recorded. Outcomes at discharge were categorised as complete recovery, neurological deficit, or mortality. Statistical analyses included Chi-square/Fisher’s exact test for categorical variables, t-test/ANOVA for continuous variables, and exploratory logistic regression to assess predictors of parenchymal involvement. Results: The mean age was 32.3 ± 9.1 years (range 18-53), with a female predominance (58%). Headache was the most frequent symptom (68%), followed by seizures (24%) and focal neurological deficits (20%). Leading risk factors were puerperium (26%) and oral contraceptive use (18%), followed by infection (18%) and thrombophilia (12%); no cause was identified in 24%. MR venography was the primary diagnostic modality (58%), with superior sagittal (30%) and transverse sinuses (28%) most commonly involved. Nearly half (48%) had normal parenchyma, while venous infarcts (26%), haemorrhagic infarcts (14%), and cerebral oedema (12%) were also observed. At discharge, 68% recovered fully, 22% had residual neurological deficits, and 10% died, all within the haemorrhagic infarct subgroup. Logistic regression did not identify significant independent predictors of parenchymal involvement. Conclusion: CVST in this cohort predominantly affected young females with reproductive risk factors. MR venography was essential for diagnosis, and haemorrhagic infarcts strongly predicted adverse outcomes. Early suspicion, timely venographic imaging, and vigilant management remain critical to improving prognosis.