Clinico-epidemiological characteris cs of cerebral venous sinus thrombosis in Kenya: a retrospec ve case series Authors

Taby Siika¹Jaskirat Kaur Sokhi¹Juzar Hooker²Sheila Waa¹Anna Nkirote Mwirigi¹Jasmit Shah¹Dilraj Singh Sokhi^1*

• ¹Aga Khan University (Kenya), Nairobi, Kenya
• ²Aga Khan University Hospital, Nairobi, Nairobi, Kenya

Background Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that is more common in young, especially female, adults, and can be challenging to diagnose due to its frequently non-specific presentation and diverse risk factors. Most cases are idiopathic, and international guidelines do not recommend routine investigations for underlying thrombophilia. Timely diagnosis with prompt neuroimaging and guideline-based treatment leads to good outcomes. However, there is a substantial gap in the literature on CVST from sub-Saharan Africa, with the few cases described being related to systemic and/or brain infections. We describe here the largest cohort of CVST from the region with novel findings that may be relevant to everyday clinical practice. Methods We conducted a retrospective cross-sectional study of patients diagnosed with CVST from 2010-2022 at our tertiary regional neurology referral centre in Nairobi, Kenya. Results:We identified 122 cases: 67.2% (82/122) were female, 80.3% (98/122) were Black African, and the median (interquartile range) age was 36.8 (31.5-45.7) years. Apart from headaches [86.9% (106/122)], the commonest presenting symptoms were visual disturbance [26.2% (32/122)], and seizures 23.8% [(29/122)]; 11 patients developed seizures later. Intracranial hemorrhage with/without venous infarction occurred in 27.9% (34/122). New diagnoses of thrombophilia were made in 30.3% (37/122). Other causes found were: HIV, hepatitis B/C or other brain infections [18.0% (22/118)]; pregnancy including postpartum [14.6% (12/82)]; contraceptive use [8.5% (7/82)]; and malignancy [8.1% (10/122)]. The most common treatment was with warfarin in 50% (61/122), followed by rivaroxaban [29.5% (36/122)] and dabigatran [14.8% (18/122)]. Complete thrombus resolution occurred in only 53.9% (55/102) at follow-up scanning (median 178 days later). In terms of outcomes (modified Rankin Score, mRS): 32.8% (40/122) had mRS=0, 59.9% (73/122) had mRS=1-2, and there was one fatality who also had concurrent systemic malignancy. Conclusions:Thrombophilia was more prevalent in our cohort than infections, a novel finding compared to what has been published about CVST from SSA. Most patients were managed with appropriate anticoagulants, but only about half the patients had complete resolution of the CVST at last follow-up. We therefore recommend thrombophilia should be routinely investigated in all patients with CVST in our setting.