Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study
Taşkın Duman1, Nilgün Çınar2, Derya Uludüz3, Füsun Mayda Domaç4, Serefnur Öztürk5, Vildan Yayla6, Ali Yavuz Karahan7, Nazire Afşar8, Mehmet Ali Sungur9, Eylem Özaydın Göksu10, Vedat Ali Yürekli11, Hamit Genç12, Uygar UTKU13, Şevki Şahin2, Hakan Tekeli14, Firdevs Ezgi Tokuç10, Nevzat Uzuner15, Mehmet Güney Şenol14, Arda Yılmaz12, Mustafa Gökçe13, Seden Demirci11, Özge Yılmaz Küsbeci16, Gülnur Tekgöl Uzuner15, Hale Zeynep Batur Çağlayan17, Mustafa Açıkgöz18, Hatice Kurucu19, Mehmet Fatih Özdağ14, Sevim Baybaş20, Hakan Ekmekçi5, Murat Çabalar6, Mehmet Yaman21, Hesna Bektaş22, Yüksel Kaplan23, Başak Karakurum Göksel24, Aysel Milanlioğlu25, Dilek Necioglu Örken26, Mehmet Ufuk Aluclu27, Sena Çolakoğlu1, Ahmet Tüfekçi28, Mustafa Bakar29, Bijen Nazliel17, Nida Tasçılar18, Baki Göksan3, Hasan Hüseyin Kozak30, Cemile Handan Mısırlı31, Hayriye Küçükoğlu20, İpek Midi32, Necdet Mengüllüoğlu33, Emrah Aytaç34, Nilüfer Yeşilot35, Birsen İnce3, Osman Özgür Yalın36, Taşkın Güneş37, Serdar Oruç21, Serkan Demir381Department of Neurology, Mustafa Kemal University, Hatay, Turkey2Department of Neurology, Maltepe University, İstanbul, Turkey
3Department of Neurology, İstanbul Cerrahpaşa University, İstanbul, Turkey;
4Department of Neurologic and Psychiatric Diseases, Erenköy Training and Research Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
5Department of Neurology, Selçuk University, Konya, Turkey
6Department of Neurology, Bakırköy Training and Research Hospital, İstanbul, Turkey
7Department of Physical Medicine and Rehabilitation, Uşak University, Uşak, Turkey
8Department of Neurology, Acıbadem University, İstanbul, Turkey
9Department of Biostatistics, Düzce University, Düzce, Turkey
10Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
11Department of Neurology, Süleyman Demirel University, lsparta, Turkey
12Department of Neurology, Mersin University, Mersin, Turkey
13Department of Neurology, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
14Department of Neurology, Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Turkey
15Department of Neurology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
16Department of Neurology, Bozyaka Education, Research and Training Hospital, İzmir, Turkey
17Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
18Department of Neurology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
19Dementia Research Institute, Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh W1T 7NF, UK
20Department of Neurology, Bakirköy Training and Research Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
21Department of Neurology Kocatepe University Faculty of Medicine Afyon, Turkey
22Department of Neurology, Atatürk Training and Research Hospital, Ankara, Turkey
23Department of Neurology, İnonu University Faculty of Medicine, Malatya, Turkey
24Department of Neurology, Başkent University Faculty of Medicine, Adana, Turkey
25Department of Neurology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
26Department of Neurology, İstanbul Bilim University Faculty of Medicine, İstanbul, Turkey
27Department of Neurology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
28Department of Neurology, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Turkey
29Department of Neurology, Uludag University Faculty of Medicine, Bursa, Turkey
30Department of Neurology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
31Department of Neurology, Health Sciences University Haydarpaşa Training and Research Hospital, İstanbul, Turkey
32Department of Neurology, Marmara University Faculty of Medicine, İstanbul, Turkey
33Department of Neurology, Eskişehir State Hospital, Eskişehir, Turkey
34Department of Neurology, Ankara Training and Research Hospital, Ankara
35Department of Neurology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
36Department of Neurology, Health Sciences University, İstanbul Training and Research Hospital, İstanbul, Turkey
37Department of Neurology, Maltepe State Hospital, İstanbul, Turkey
38Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
Objectives: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]).
Methods: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared.
Results: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group.
Conclusion: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.
Tek semptomu baş ağrısı olan serebral venöz sinüs trombozu: VENOST çalışmasından elde edilen verilerin alt grup analizi
Taşkın Duman1, Nilgün Çınar2, Derya Uludüz3, Füsun Mayda Domaç4, Serefnur Öztürk5, Vildan Yayla6, Ali Yavuz Karahan7, Nazire Afşar8, Mehmet Ali Sungur9, Eylem Özaydın Göksu10, Vedat Ali Yürekli11, Hamit Genç12, Uygar UTKU13, Şevki Şahin2, Hakan Tekeli14, Firdevs Ezgi Tokuç10, Nevzat Uzuner15, Mehmet Güney Şenol14, Arda Yılmaz12, Mustafa Gökçe13, Seden Demirci11, Özge Yılmaz Küsbeci16, Gülnur Tekgöl Uzuner15, Hale Zeynep Batur Çağlayan17, Mustafa Açıkgöz18, Hatice Kurucu19, Mehmet Fatih Özdağ14, Sevim Baybaş20, Hakan Ekmekçi5, Murat Çabalar6, Mehmet Yaman21, Hesna Bektaş22, Yüksel Kaplan23, Başak Karakurum Göksel24, Aysel Milanlioğlu25, Dilek Necioglu Örken26, Mehmet Ufuk Aluclu27, Sena Çolakoğlu1, Ahmet Tüfekçi28, Mustafa Bakar29, Bijen Nazliel17, Nida Tasçılar18, Baki Göksan3, Hasan Hüseyin Kozak30, Cemile Handan Mısırlı31, Hayriye Küçükoğlu20, İpek Midi32, Necdet Mengüllüoğlu33, Emrah Aytaç34, Nilüfer Yeşilot35, Birsen İnce3, Osman Özgür Yalın36, Taşkın Güneş37, Serdar Oruç21, Serkan Demir381Department of Neurology, Mustafa Kemal University, Hatay, Turkey2Department of Neurology, Maltepe University, İstanbul, Turkey
3Department of Neurology, İstanbul Cerrahpaşa University, İstanbul, Turkey;
4Department of Neurologic and Psychiatric Diseases, Erenköy Training and Research Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
5Department of Neurology, Selçuk University, Konya, Turkey
6Department of Neurology, Bakırköy Training and Research Hospital, İstanbul, Turkey
7Department of Physical Medicine and Rehabilitation, Uşak University, Uşak, Turkey
8Department of Neurology, Acıbadem University, İstanbul, Turkey
9Department of Biostatistics, Düzce University, Düzce, Turkey
10Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
11Department of Neurology, Süleyman Demirel University, lsparta, Turkey
12Department of Neurology, Mersin University, Mersin, Turkey
13Department of Neurology, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
14Department of Neurology, Sultan Abdülhamid Han Training and Research Hospital, İstanbul, Turkey
15Department of Neurology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
16Department of Neurology, Bozyaka Education, Research and Training Hospital, İzmir, Turkey
17Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
18Department of Neurology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
19Dementia Research Institute, Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh W1T 7NF, UK
20Department of Neurology, Bakirköy Training and Research Hospital for Neurologic and Psychiatric Diseases, İstanbul, Turkey
21Department of Neurology Kocatepe University Faculty of Medicine Afyon, Turkey
22Department of Neurology, Atatürk Training and Research Hospital, Ankara, Turkey
23Department of Neurology, İnonu University Faculty of Medicine, Malatya, Turkey
24Department of Neurology, Başkent University Faculty of Medicine, Adana, Turkey
25Department of Neurology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
26Department of Neurology, İstanbul Bilim University Faculty of Medicine, İstanbul, Turkey
27Department of Neurology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
28Department of Neurology, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Turkey
29Department of Neurology, Uludag University Faculty of Medicine, Bursa, Turkey
30Department of Neurology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
31Department of Neurology, Health Sciences University Haydarpaşa Training and Research Hospital, İstanbul, Turkey
32Department of Neurology, Marmara University Faculty of Medicine, İstanbul, Turkey
33Department of Neurology, Eskişehir State Hospital, Eskişehir, Turkey
34Department of Neurology, Ankara Training and Research Hospital, Ankara
35Department of Neurology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
36Department of Neurology, Health Sciences University, İstanbul Training and Research Hospital, İstanbul, Turkey
37Department of Neurology, Maltepe State Hospital, İstanbul, Turkey
38Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
Amaç: Baş ağrısı serebral venöz sinüs trombozunda (SVST) en sık görülen şikayettir ve bazen CVST ile başvuran hastalarda görülen tek semptom olabilir. Bu retrospektif ve prospektif çalışmada, izole başağrısı (IB) ile başvuran SVST olgularında ve baş ağrısı ile ilişkili diğer bulguları olan (izole olmayan başağrısı-İOBA) olgularda klinik risk faktörleri, radyoloji ve prognoz açısından herhangi bir farklılık olup olmadığını araştırdık.
Gereç ve Yöntem: Serebral venöz sinüs trombozu (VENOST) çok merkezli çalışmasından 1144 hasta çalışmamıza alındı. Tüm demografik, biyokimyasal, klinik ve radyolojik yönler 287 IBA vakası ve 857 İOBA vakası için karşılaştırılmıştır.
Bulgular: Toplam grup içinde kadın oranı iki kat daha yüksekti. İBA grubunda cinsiyet dağılımını yaş gruplarına göre değerlendirildiğinde istatistiksel olarak anlamlı bir fark bulunmadı. İBA grubunda, baş ağrısının başlangıcı sıklıkla subakut ve kronikti, ancak akut başlangıç, İOBA grubunda daha yaygındı. İBA grubunda% 29’luk takip sırasında diğer nörolojik bulgular eklenmiştir. Daha önce serebral, derin ve diğer venöz tromboembolizm öyküsü İBA grubunda İOBA grubuna göre daha azdı. Transvers sinüs tutulumu İBA grubunda daha yüksek iken sagital sinüs tutulumu İOBA grubunda daha fazlaydı. Plazminojen aktivatör inhibitörü (PAI) mutasyonu IBA grubunda anlamlı olarak daha yüksekti.
Sonuç: Hastaların subakut veya kronik baş ağrısı varsa SVST tanısı için IBA akılda tutulmalıdır. Trombolitik olaylar için önemli bir role sahip olan PAI, SVST’da bir risk faktörü olabilir, bu nedenle ayrıntılı hematolojik araştırmalar düşünülmelidir. Daha ileri çalışmalara ihtiyaç vardır.
Manuscript Language: English