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(Stroke. 2009;40:2356.)
© 2009 American Heart Association, Inc.

Original Contributions

Cerebral Venous and Sinus Thrombosis in Women

Jonathan M. Coutinho, MD, MSc; José M. Ferro, MD, PhD; Patrícia Canhão, MD; Fernando Barinagarrementeria, MD; Carlos Cantú, MD; Marie-Germaine Bousser, MD Jan Stam, MD, PhD

From the Department of Neurology (J.M.C., J.S.), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; the Department of Neurosciences (J.M.F., P.C.), Hospital Santa Maria, Lisboa, Portugal; the Department of Neurology (F.B., C.C.), Instituto Nacional de Neurologia y Neurocirurgia, México City, México; and the Department of Neurology (M.-G.B.), Hôpital Lariboisière, Paris, France.

Correspondence to Jan Stam, MD, PhD, Department of Neurology (Room H2-226), Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail j.stam{at}amc.uva.nl

Background and Purpose— Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men.

Methods— We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenter prospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis.

Results— Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l P=0.01), which was entirely due to a better outcome in female patients with gender-specific risk factors. Women without gender-specific risk factors are similar to men in clinical presentation, risk factor profile, and outcome. Logistic regression analysis confirmed that the absence of gender-specific risk factors is a strong and independent predictor of poor outcome in women with sinus thrombosis (OR, 3.7; CI, 1.9 to 7.4).

Conclusions— Our study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients.

Key Words: intracranial • sinus thrombosis • stroke • women