Patients with Prior Cerebral Venous Sinus Thrombosis Presenting to the Emergency Department with Neurological Symptoms: The Yield of Neuroimaging

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening condition. Despite advances in diagnostic imaging and therapeutic strategies, data regarding risk factors for CVST progression among patients remain limited. Methods: The retrospective cohort study aimed to evaluate the yield of neuroimaging and to assess risk factors for CVST progression among patients presenting to the emergency department (ED) after a prior CVST diagnosis. We collected data from the hospital’s electronic medical records on patients diagnosed with CVST at our tertiary care center between January 2002 and April 2023. For patients who had subsequent ED visits related to their initial CVST diagnosis, data regarding demographics, clinical presentation, imaging outcomes, and alterations in therapeutic management were retrieved. Results: Our initial cohort included 251 patients diagnosed with CVST. Of these, 107 (43%) patients returned to the ED with symptoms potentially related to CVST. Headache was the most common presenting symptom (59%), and imaging was performed in 71% of relevant ED visits. Thrombus progression was observed in only 6% of cases. No significant associations were found between demographic factors, clinical presentation, anticoagulation status, and neuroimaging findings. Among patients whose initial CVST diagnosis occurred more than 2 years prior to ED evaluation, only those with thrombophilia experienced thrombus progression. Conclusions: Thrombus progression is a rare finding among patients with a history of CVST presenting to the ED with neurological complaints. Pediatric patients showed low rates of thrombotic worsening, suggesting a more judicious use of neuroimaging in this population. No significant risk factor was found to predict the risk of CVST progression.