Cerebral Veins and Dural Sinuses Thrombosis: Data from a Monocentric Cohort Study of 55 Romanian Patients

Cerebral venous sinus thrombosis (CVST) is a rare form of stroke with heterogeneous clinical presentation and etiological profile. This study aimed to evaluate the demographic, clinical, imaging, etiological, treatment, and outcome characteristics of CVST in a Romanian population. We conducted a retrospective monocentric cohort study including 55 patients diagnosed over a six-year period in a tertiary neurological center. CVST accounted for 1.2% of all stroke cases, with an incidence of 13.75 per million per year. Gender distribution was relatively balanced, differing from international cohorts, and traditional female-specific risk factors were less prominent. Thrombophilia (68.6%) and infections (38.2%) were the most frequent etiologies. Younger patients were more frequently associated with thrombophilia, while a higher inflammatory response was observed in older individuals; additionally, female patients showed a higher prevalence of the MTHFR C677T mutation. Transverse and sigmoid sinuses were the most affected, while cavernous sinus involvement was more frequent than typically reported and associated with infections. At discharge, long-term anticoagulation was recommended in 67.3% of patients, tailored to underlying etiology and risk profile. Outcomes were favorable, with 70-80% achieving a modified Rankin Scale score ≤2 at discharge and over 90% at 90-day follow-up, despite inconsistent correlation with imaging findings. These results highlight the heterogeneous nature of CVST and the need for comprehensive, individualized evaluation and management.