THROMBOPHILIA PROFILE IN CEREBRAL VENOUS SINUS THOMBOSIS: A STUDY FROM EASTERN INDIA Mishra Ajit P Senior resident, department of neurology, S.C.B Medical college, cuttack, odisha Original Research Paper Neurology INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is the formation of blood clot in the dural venous and/or sinuses, which drain blood from the 1 brain . The exact incidence varies place to place as well as studies to study. Broadly it is documented with estimated 3-4 cases per million 1 annually in adults . But the incidence is quite higher in children 2 amounting to 7 cases per million annually . Slight preponderance in females is probably due to specific causes such as oral contraceptives, 2 pregnancy and puerperium . This preponderance of females did not 3 exist before the era of the oral contraceptive pills . There is no reliable data on racial or geographical distribution but researches done in India on CVST claim that this disease is more common in underdeveloped 4 countries of Asia than the western world . The most widely studied risk factors for CVST include the prothrombotic conditions. Resistance to activated protein-C is mainly caused by the presence of the factor V Leiden gene mutation, which is a common inherited thrombophilic disorder. Hyperhomocysteinemia is a risk factor for deep vein thrombosis (DVT) and stroke but has not been clearly associated with an increased risk of CVST. Pregnancy and the puerperium are common causes of transient prothrombotic states. Approx. 2% of pregnancy- associated strokes are attributable to CVST. The frequency of CVST in the puerperium is estimated at 12 cases per 100 000 deliveries, only 5 slightly lower than puerperal arterial stroke . During pregnancy and for 6 to 8 weeks after birth, women are at increased risk of venous 6 thromboembolic events . The objective of this study was to identify the thrombotic factor commonly responsible for CVST in our hospital and compare it with other parameters. MATERIALS AND METHODS: It was a prospective observational hospital based study in the department of Neurology, S.C.B. Medical College & Hospital, Cuttack, odisha from October 2015 to September 2017. Inclusion criteria- Ÿ Patients with diagnosis of cerebral venous sinus thrombosis (CVST), confirmed by imaging of brain with MRI/MRV scan of brain. Ÿ Patients who had done the thrombophilia profile testing after hospitalization. Exclusion criteria: Ÿ Patients who were clinically diagnosed as having CVST, but had normal imaging of brain (i.e. MRI/MRV scan of brain– normal). Ÿ Patients who were not admitted to in patient department of neurology. Ÿ Patients who didn't give consent for the study. Ÿ Patients who denied doing the thrombophilia assay. Consent- Patients were included in the study after obtaining informed written consent. They were explained regarding inclusion in the study, with their mother tongue. All study related information was anonymized, kept confidential and used only for addressing the study objectives. We included eligible participants qualifying the criteria. They were evaluated according to the epidemiological and clinical parameters. All data were tabulated in a prestructured format. Thrombophilia profile was done in a standard lab after collection of 2 ml blood with all aseptic procedure. MRI/MRV was done by 1.5 tesla MRI on day 2 of hospitalization. Treatment was done according to recent EAN guidelines. The study data was managed in MS Excel spreadsheet. Categorical data were expressed as number and percentage. Continuous data were expressed as number, mean and standard deviation depending on the distribution. Statistical significance was tested at 5% using the SPSS version 20.0. Ethical approval was obtained from institutional ethics committee. RESULTS: Ÿ Total 24 patients did thrombophilia assay. (n=24) Ÿ Out of 24 patients 14 were female and 10 were male which reveals female to male ratio was 1.4:1. Ÿ Most common age group of presentation was 21-40 years and average age was 31 year. Ÿ Headache was the most common presentation which was seen in 20 /24 patients (83.3%). Ÿ Papillodema was the most common finding in the group.(75%) Ÿ Table-1 Distribution Of Different Thrombophilia Factor Abnormality (n=24) While assessing various type of coagulation factor abnormality, protein s deficiency was found to be most common (in 4 patients). KEYWORDS : CVST, Thrombophilia, protein S, Transverse sinus Background: Cerebral venous sinus thrombosis (CVST) is the formation of blood clot in the dural venous and/or sinuses, which drain blood from the brain. It is one of the commonest causes of stroke in young. In most cases it hypercoagulable factors are responsible for it. Materials & methods: prospective observational hospital based study in the department of Neurology, S.C.B. Medical College & Hospital, Cuttack, odisha from October 2015 to September 2017. Those patients with diagnosis of CVST with magnetic resonance imaging and venogram confirmation with thrombophilia profile were included in the study. Thrombophilia assay was done. They were treated with recent guidelines. All the data were analyzed according to spss software version 20.0. Results: Total 24 patients did the profile. Most common age group was 21-40 yrs. Protein S was the most common factor. Transverse sinus was the most common sinus. Multifactorial thrombofilia patients were more resistant to therapy. Conclusion: All the CVST patients must be exposed to thrombophilia profile assay. It will not only help treatment of the disease but also it will help in prognosticate the outcome. In our area protein S deficiency is the most common factor abnormality. Further large studies are needed to obtain further knowledge about the factors and their clinicoradiological correlation. ABSTRACT Mallick Ashok K.* Professor, department of neurology, S.C.B Medical college, cuttack, Odisha *Corresponding Author Mishra Shubhankar Senior resident, department of neurology, S.C.B Medical college, cuttack, odisha Factor assay Number of patient % among the patients with thrombophilia assay (n=24) Protein C deficiency 2 8.4 Protein S deficiency 4 16.7 Hyperhomocystinemia 3 12.5 Factor V mutation analysis 2 8.4 18 INDIAN JOURNAL OF APPLIED RESEARCH Volume-8 | Issue-12 | December-2018 | PRINT ISSN No 2249-555X