Clinical and Radiological Profile of Seven Patients with Cerebral Venous Thrombosis: A Case Series from Nepal

Clinical and Radiological Profile of Seven Patients with Cerebral Venous Thrombosis: A Case Series from Nepal | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Clinical and Radiological Profile of Seven Patients with Cerebral Venous Thrombosis: A Case Series from Nepal Abhishek Kumar Shah, Nishant Neupane, Dinesh Od, Rajeev Ojha² This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7917843/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Cerebral venous thrombosis (CVT) is an uncommon but potentially reversible cause of stroke, primarily affecting young adults and women. Despite global data, information from Nepal is limited. This study presents the first documented case series describing the clinical presentation, radiological characteristics, risk factors, management, and outcomes of CVT in a tertiary hospital setting in Nepal. Methods: A retrospective descriptive study was conducted at the Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, from September 2020 to August 2021. Seven patients with radiologically confirmed CVT were included. Demographic, clinical, radiological, and treatment data were extracted from hospital records and analyzed descriptively. Results: The mean age of the patients was 41.7 years (range: 20–78 years), with a female predominance (5 females, 2 males). The most common presenting symptom was headache (85.7%), followed by seizures and focal neurological deficits (each in 71.4%). MRI and MRV were the primary diagnostic modalities, revealing the superior sagittal sinus as the most frequently involved site (71.4%). Parenchymal changes, mainly venous or hemorrhagic infarctions, were seen in 71.4% of cases. Major risk factors included infections, autoimmune diseases, pregnancy/postpartum state, and COVID-19 infection. All patients received anticoagulation, with LMWH transitioned to warfarin or direct oral anticoagulants. At discharge, all patients improved clinically, with one achieving complete recovery and no recorded mortality. Discussion: The findings align with global literature highlighting CVT as a condition with diverse clinical manifestations and generally favorable prognosis when promptly recognized. The high frequency of headache and seizures corresponds to patterns observed in international cohorts. MRI and MRV continue to be indispensable for diagnosis, especially in atypical stroke presentations. The identification of postpartum, autoimmune, and COVID-19–related cases reflects evolving risk profiles in developing countries. The good recovery rates in this series reinforce the effectiveness of early anticoagulation and multidisciplinary management. Conclusions: This first Nepalese case series underscores that cerebral venous thrombosis presents with variable symptoms but favorable outcomes when diagnosed early and treated with anticoagulation. Risk factors mirror global patterns, including autoimmune and pregnancy-related conditions. MRI and MRV remain the diagnostic gold standards. Early recognition and multidisciplinary management are key to optimizing outcomes Cerebral venous thrombosis MRI MRV anticoagulation Nepal case series stroke COVID-19 postpartum Introduction Cerebral venous thrombosis (CVT) is partial or complete obstruction of venous pathways within the cranial cavity, encompassing the dural venous sinuses, cortical veins, and deep cerebral veins( 1 ). It is a rare cerebrovascular disorder that predominantly affects young adults and children, with an estimated annual incidence of 3–4 per million and a marked female predominance of around 75%( 2 ). Cerebral venous thrombosis can result from inherited thrombophilic disorders, pregnancy or the puerperium, autoimmune and inflammatory diseases, infections, oral contraceptive use, and systemic illnesses such as anemia or malignancy, though some cases remain idiopathic( 3 ). Suspected CVT cases should first have an unenhanced CT, followed by CT or MR venography for confirmation based on available resources( 4 ).The clinical spectrum of CVT depends on the site involved—most often the superior sagittal, transverse, or sigmoid sinuses—and typically presents with headache, nausea, vomiting, seizures, visual disturbances, or focal neurological deficits, while deep venous thrombosis may cause encephalopathy or coma( 3 ). The cornerstone of current management is early initiation of anticoagulation, while endovascular intervention may be considered in cases unresponsive to medical therapy to restore venous flow( 5 ). There is a lack of published data on cerebral venous thrombosis (CVT) from Nepal, and no prior case series have been reported to date. Existing literature on CVT is limited, leaving a significant knowledge gap regarding its clinical and radiological profile in our setting. This represents the first documented case series of CVT from Nepal, aiming to provide valuable insights into its presentation, risk factors, and outcomes, and to contribute to the broader understanding of this rare but treatable condition. Methodology A retrospective descriptive case series was conducted among patients admitted to the Department of Neurology, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal, between September 2020 and August 2021. TUTH is a major tertiary care referral center that admits approximately 2,000 neurology patients annually. Patient information was obtained from departmental audit and inpatient medical records. The Institutional Review Board (IRB) of Tribhuvan University Teaching Hospital waived the requirement for ethical approval for case reports and case series involving de-identified patient data. All data were anonymized prior to analysis, maintaining confidentiality throughout the process. Study Population A total of nine patients were diagnosed with cerebral venous thrombosis (CVT) during the study period. Of these, three were excluded due to incomplete data records, and seven patients meeting the inclusion criteria were analyzed. Inclusion criteria included all patients with a confirmed diagnosis of CVT based on neuroimaging (MRI/MRV or CT/CTV), irrespective of age, sex, or etiology. Exclusion criteria included cases with incomplete clinical, radiological, or outcome data, and those where imaging findings were inconclusive for venous thrombosis. Data Collection and Parameters Data were extracted from case files and hospital audit sheets using a structured data collection format. Parameters recorded included: Demographic information: age, sex, and duration from symptom onset to hospital admission. Clinical features: presenting symptoms, Glasgow Coma Scale (GCS) at admission, seizure occurrence, and focal neurological deficits. Comorbidities and risk factors: including infection, systemic illness, autoimmune disease, pregnancy, and lifestyle factors. Radiological findings: imaging modality used, sinus involvement, parenchymal and secondary changes, and recanalization status. Treatment details: type of anticoagulation, antiepileptic use, supportive and adjunct therapies. Outcomes: hospital stay, complications, and clinical status at discharge. Diagnostic and Treatment Protocol The diagnosis of CVT was established primarily by magnetic resonance imaging (MRI) combined with magnetic resonance venography (MRV). In selected cases, non-contrast CT (NCCT) and CT venography (CTV) were also utilized. The location and extent of venous sinus involvement, parenchymal changes, and signs of raised intracranial pressure were recorded. Management of all patients adhered to the American Heart Association/American Stroke Association (AHA/ASA) guidelines for CVT, including anticoagulation with low-molecular-weight heparin (LMWH) transitioned to either warfarin or direct oral anticoagulants (DOACs) as appropriate. Antiepileptic drugs (AEDs) were administered in patients with seizure activity. Supportive therapies such as intracranial pressure management, steroids for autoimmune flare, and antibiotics for infectious etiologies were given as indicated. Follow-up neuroimaging was performed in all patients to assess recanalization and parenchymal resolution. Data Analysis All collected data were compiled and analyzed using IBM SPSS Statistics version 27. A descriptive statistical analysis was performed. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized using mean and range. Outcomes were described qualitatively and quantitatively, and summarized in standard tables encompassing baseline demographics and clinical features, detailed radiological findings, and risk factors with treatment and outcomes. Results A total of seven patients diagnosed with cerebral venous thrombosis (CVT) were included in this case series. The mean age of presentation was 41.7 years (range: 20–78 years), with a female predominance (5 females, 2 males). The duration from symptom onset to hospital admission varied from less than 3 days to several months, with most cases presenting after more than 7 days of initial symptom onset. (Table 1 summarizes demographic and clinical characteristics.) Table 1 Baseline Demographic and Clinical Characteristics of Patients with Cerebral Venous Thrombosis Case ID Age (years) Sex Onset to Admission Interval Key Presenting Symptoms GCS at Admission Neurological Deficit Seizure at Presentation 1 78 F 4 days Seizures, weakness, altered sensorium 15 Yes (Rt LL weakness) Yes 2 44 M 4 days Headache, vomiting, speech impairment, altered sensorium, ataxia 9 Yes (Broca’s aphasia, ataxia) Yes (during stay) 3 20 F 4 days Headache, vomiting, left hemiparesis, dysarthria, seizures 15 Yes Yes 4 59 F 540 days with acute exacerbation over 15 days Headache, blurred vision, seizures, LOC 15 Yes (visual blurring) Yes 5 28 M 180-day history with exacerbation over 60 days Headache, diplopia, nystagmus 15 Yes (6th nerve palsy) No 6 25 F 3 days Headache, seizures, left weakness, altered sensorium 13 Yes Yes 7 38 F 4-year history with recent exacerbation Headache, nausea, dizziness 15 No No Clinical Presentation The most frequent presenting symptom was headache (observed in 6 of 7 patients, 85.7%), followed by seizures (in 5 patients, 71.4%) and focal neurological deficits (in 5 patients, 71.4%). Altered sensorium was reported in three cases. Other associated symptoms included vomiting, visual disturbances, dysarthria, and dizziness. At presentation, GCS ranged from 9 to 15, and neurological deficits such as hemiparesis, aphasia, and cranial nerve palsy were commonly documented. Radiological Findings MRI and MRV were the primary diagnostic modalities in all cases, supplemented by CT or CTV in selected patients. The superior sagittal sinus was the most frequently involved site (identified in 5 cases, 71.4%), followed by the transverse and sigmoid sinuses. One patient had isolated thrombosis of the left transverse, sigmoid sinus, and internal jugular vein, while another demonstrated cortical vein involvement. Parenchymal changes were observed in the majority of cases (5/7, 71.4%), typically presenting as venous or hemorrhagic infarctions with associated edema. Secondary radiological findings included collateral venous circulation and features of raised intracranial pressure. Partial recanalization on follow-up imaging was noted in six patients, while one achieved complete recanalization. (Details in Table 2 .) Table 2 Radiological Findings of Patients with CVT Case ID Imaging Modality Sinuses Involved Direct Signs of CVT Parenchymal Changes Secondary/Ancillary Signs Associated Findings Recanalization Status 1 MRI + MRV SSS, Lt Transverse, Lt Sigmoid Loss of flow void, filling defect Multifocal hemorrhagic venous infarcts, edema None Bilateral mastoiditis Partial 2 NCCT, CTV, MRI/MRV SSS, Bilateral Transverse, Cortical veins Cord sign, empty delta, filling defect Venous + hemorrhagic infarction, edema Collateral venous flow Pansinusitis (likely fungal) Complete 3 MRI + MRV SSS, Transverse, Sigmoid Loss of flow void, filling defect Hemorrhagic infarction (Rt frontal), edema, mass effect Collaterals, cortical vein prominence Pregnancy-related hypercoagulable state Partial 4 MRI + MRV SSS, unilateral Transverse & Sigmoid Loss of flow void, filling defect Venous & hemorrhagic infarction, edema, mass effect Cortical vein prominence, raised ICP Empty sella, chronic changes Partial 5 MRI + MRV Lt Transverse, Lt Sigmoid, Lt IJV Loss of flow void, filling defect None Collateral venous circulation None Partial 6 MRI + MRV SSS Loss of flow void, filling defect Venous & hemorrhagic infarction, edema Raised ICP features SLE-related vasculitis Partial 7 MRI + MRV Lt Transverse & Sigmoid Loss of flow void, filling defect None Collateral venous circulation Chronic postpartum changes Partial Abbreviations: SSS – Superior sagittal sinus; Lt – Left; Rt – Right; IJV – Internal jugular vein; ICP – Intracranial pressure. Risk Factors and Comorbidities Multiple predisposing factors were identified across the cohort. Infectious and inflammatory conditions (such as mastoiditis, pancreatitis, and systemic lupus erythematosus) and prothrombotic states (pregnancy, postpartum status, COVID-19 infection, and autoimmune disorders) were the predominant associations. Lifestyle-related factors such as smoking and alcohol use were also observed in two male patients. One case had no identifiable risk factor, suggesting possible idiopathic CVT. (Refer to Table 3 .) Table 3 Risk Factors, Comorbidities, Treatment and Outcomes of CVT Patients Case ID Major Risk Factors / Comorbidities Primary Anticoagulant Other Treatments Hospital Stay (days) Complications Clinical Outcome at Discharge 1 Acute pancreatitis, mastoiditis, COVID-19, dehydration LMWH → Warfarin AEDs, antibiotics, statin, physiotherapy 38 Status epilepticus, DVT, septic shock, pneumonia Partial recovery with residual deficits 2 Smoking, alcohol, severe COVID-19 pneumonia LMWH → Warfarin AEDs, amiodarone, ICU support 23 Arrhythmias, severe pneumonia Complete recovery 3 Pregnancy (8 wks), prior abortion LMWH → DOAC (Dabigatran) AEDs, ICP management, MVA (pregnancy termination) 23 Pregnancy termination Improved; partial recanalization 4 Hypertension, COPD, ex-smoker, alcohol LMWH → Dabigatran AEDs, steroids, COPD management 5 Seizure Improved, stable 5 None LMWH → Warfarin Acetazolamide, steroids, amitriptyline 4 None Improved; partial recanalization 6 SLE, positive APLA LMWH → Warfarin AEDs, steroids, ICP management 18 Seizures, infarction Improved; partial recanalization 7 Puerperium (remote, postpartum onset) LMWH → Warfarin Acetazolamide, amitriptyline 6 None Improved; partial recanalization Treatment and Outcomes All patients received anticoagulation therapy, initially with low-molecular-weight heparin (LMWH), followed by either warfarin or direct oral anticoagulants (DOACs) such as dabigatran. Antiepileptic drugs (AEDs) were administered to control seizure activity in symptomatic patients. Supportive treatments included antibiotics, intracranial pressure management, and disease-specific therapy such as steroids for SLE-related CVT and termination of pregnancy in one case. The mean hospital stay was 16.7 days (range: 4–38 days). Complications included seizures, deep vein thrombosis, septic shock, and pneumonia. At discharge, all patients were clinically improved, with one showing complete neurological recovery and six demonstrating partial improvement with varying degrees of residual deficits. No mortality was recorded in this series. (Summary in Table 3 .) Discussion Cerebral venous thrombosis, involving the cerebral veins and dural sinuses, is a rare condition in the general population but occurs more frequently in individuals under 40 years, those with thrombophilic disorders, and women who are pregnant or using hormonal contraceptives, with an estimated annual incidence of 3–4 per million( 2 ).Among pregnant women, the incidence of cerebral venous thrombosis rises significantly, reaching approximately 12 cases per 100,000 deliveries( 6 ). In our case series, seven patients with cerebral venous thrombosis were studied at Tribhuvan University Teaching Hospital. The mean age at presentation was 41.7 years (range: 20–78 years), suggesting a predominance among younger adults, consistent with findings reported by Shreenidhi et al( 7 ). Our study showed a female predominance (5 females, 2 males), with the highest CVT rates observed among younger women—likely related to hormonal and obstetric factors—consistent with previous reports( 8 , 9 ). The clinical presentation of cerebral venous thrombosis (CVT) varies widely depending on the sinus involved. The superior sagittal sinus is most commonly involved and presents with headache, nausea, vomiting, blurred vision, seizures, and focal neurological deficits such as aphasia or hemiparesis. Transverse sinus thrombosis may cause headache, seizures, or aphasia, while sigmoid sinus involvement often leads to mastoid pain and lower cranial nerve palsies. Deep venous system thrombosis is linked to altered consciousness, encephalopathy, or coma( 3 ). Symptoms arise from either raised intracranial pressure due to impaired venous drainage or focal brain injury from venous infarction or hemorrhage, and many patients present with features of both( 10 ). Headache, generally indicative of an increase in intracranial pressure, is the most common symptom in CVT( 11 ).It was frequently the initial symptom, observed in 82% of our cases. Similarly, it was reported in 82% of 40 cases from Saudi Arabia( 12 ) and in 75% of 110 cases documented by Ameri and Bousser( 13 ). In our case series, the second most common presenting features were seizures and focal neurological deficits, each observed in 5 patients (71.4%). This is notably higher than previously reported rates in the literature, where approximately 30–40% of patients present with seizures and 30–50% exhibit focal neurological deficits( 3 ).Ferro et al. also reported a greater frequency of seizures in superior sagittal sinus and cortical vein thrombosis affecting the motor and sensory cortices( 14 ), consistent with our findings. At presentation, the Glasgow Coma Scale (GCS) ranged from 9 to 15. Neurological findings included aphasia, ataxia, cranial nerve palsies (abducens and facial), and visual disturbances such as blurring, diplopia, and papilledema. Altered sensorium, vomiting, and dizziness were also common, while dysarthria and loss of consciousness occurred less frequently. These manifestations likely reflect venous congestion, elevated intracranial pressure, and cortical involvement secondary to sinus occlusion in CVT. Radiological evaluation reinforces the role of MRI and MRV as the gold-standard techniques for detecting sinus occlusion and assessing associated parenchymal damage ( 1 , 4 ).In this study, MRI and MRV served as the primary diagnostic tools for all cases, with CT or CTV performed in selected patients. In previous studies, the most commonly affected sites in CVT were the transverse sinuses (44–73%), superior sagittal sinus (39–62%), sigmoid sinus (40–47%), deep venous system (10.9%), and cortical veins (3.7–17.1%)( 3 , 15 ). In contrast, in our series, the superior sagittal sinus (SSS) was the most frequently involved site, identified in 5 patients (71.4%), followed by the transverse and sigmoid sinuses. The predominance of SSS involvement in our study may be attributed to its longer course and narrower caliber, predisposing it to a higher risk of thrombosis. In our study, parenchymal changes were observed in the majority of cases (5/7, 71.4%), typically presenting as venous or hemorrhagic infarctions with associated edema. The observed parenchymal changes in our cases can be attributed to venous congestion and infarction secondary to occlusion of the corresponding draining sinuses( 16 ). One patient had isolated thrombosis of the left transverse, sigmoid sinus, and internal jugular vein, while another demonstrated cortical vein involvement. Secondary radiological findings included collateral venous circulation and features of raised intracranial pressure. Partial recanalization on follow-up imaging was noted in six patients, while one achieved complete recanalization. Risk factors for cerebral venous thrombosis (CVT) include hereditary thrombophilic disorders such as prothrombin G20210A mutation (9–21%), factor V Leiden mutation (9–13%), and protein C or S deficiency, as well as acquired conditions like pregnancy and puerperium (11–59%), antiphospholipid antibody syndrome (6–17%), and severe anemia (9–27%). Other contributing factors include infections, oral contraceptive use (54–71%), malignancy, inflammatory diseases, and obesity, while a proportion of cases remain idiopathic( 3 ). In our series, multiple predisposing factors were identified, predominantly infectious and inflammatory conditions (mastoiditis, pancreatitis, and systemic lupus erythematosus) and prothrombotic states (pregnancy, postpartum status, COVID-19 infection, and autoimmune disorders). These findings align with existing literature emphasizing prothrombotic, infectious, autoimmune, and hormonal factors as major contributors to CVT pathogenesis( 3 ). Additionally, lifestyle-related factors such as smoking and alcohol use, noted in two male patients, may have promoted endothelial dysfunction and venous stasis, further increasing the risk of thrombosis. Notably, one patient had no identifiable risk factor, consistent with reports that up to 12.5% of CVT cases occur without a defined etiology( 3 ). Our treatment approach was consistent with prior American Heart Association/American Stroke Association and European guidelines, which recommend initial anticoagulation with low-molecular-weight heparin (LMWH) followed by oral vitamin K antagonists (VKAs) for variable durations depending on risk factors( 10 , 17 , 18 ). Recent evidence also supports the use of direct oral anticoagulants (DOACs) as safe and effective alternatives to VKAs in selected CVT patients ( 19 ). In our series, all patients received LMWH initially, followed by either warfarin or DOACs such as dabigatran, reflecting these evolving therapeutic recommendations. Although the optimal duration of therapy remains uncertain, antiepileptic drugs (AEDs) are recommended for patients with acute CVT who present with seizures and supratentorial lesions to prevent recurrence ( 17 ). AEDs were administered to symptomatic patients and proved effective in achieving seizure control in most cases. Supportive therapy was tailored to each patient’s clinical condition and underlying cause. In addition to anticoagulation, several patients required antibiotics for infectious triggers such as mastoiditis, pneumonia, or sinusitis, while ICP-lowering agents like acetazolamide and mannitol were used to manage raised intracranial pressure and cerebral edema. Corticosteroids were administered in autoimmune-related CVT to control inflammatory activity, and pregnancy termination was performed in one case to address the hypercoagulable state. Supportive measures also included antiepileptics, physiotherapy, bronchodilator or steroid inhalers for comorbid respiratory disease, and general care with fluids and nutrition. These interventions, combined with anticoagulation, were pivotal in stabilizing patients, preventing complications, and improving overall recovery. In the study by Shahid and Zafar et al. ( 20 ), less than one-fourth of patients with cerebral venous thrombosis (CVT) experienced poor functional outcomes. Factors such as older age, male sex, hereditary thrombophilia, infections, venous hemorrhagic infarction, and non-recanalization were identified as predictors of unfavorable prognosis. Additionally, age above 50 years and symptom duration beyond one month were associated with delayed recanalization and incomplete recovery. In contrast, all patients in our series survived, and most showed good functional outcomes with significant clinical improvement at discharge. The variation in recovery and hospital stay among our patients was primarily influenced by age, comorbidities, and the extent of cerebral involvement. The oldest patient (78 years) had the longest hospital stay (38 days) and the poorest outcome, complicated by status epilepticus, septic shock, and deep vein thrombosis—findings consistent with predictors of poor outcome noted in previous literature. In contrast, younger patients with isolated sinus thrombosis and no parenchymal changes (Patients 5 and 7) recovered rapidly within 4–6 days, underscoring how early diagnosis and preserved venous drainage contribute to favorable outcomes. Intermediate recoveries were noted in patients with systemic illnesses such as COVID-19 pneumonia, pregnancy-related hypercoagulability, and systemic lupus erythematosus, where underlying inflammatory and thrombotic states prolonged hospitalization (18–23 days) and delayed recovery. Patient 4, despite being older (59 years) with COPD and hypertension, had a brief admission (5 days) and favorable recovery, likely due to limited neurological involvement and stable systemic status. Overall, our findings indicate that advanced age, comorbid diseases, and extensive parenchymal infarction are associated with prolonged hospital stay and poorer outcomes, whereas younger patients with limited sinus thrombosis and early management experience shorter admissions and complete recovery. The absence of mortality in our cohort further highlights the effectiveness of timely anticoagulation and multidisciplinary care in optimizing recovery among CVT patients. Our study has certain limitations that should be acknowledged. Being a retrospective single-center case series with a small number of patients, the findings may not be fully generalizable to the broader population. The incomplete thrombophilia work-up in some cases might have led to an underestimation of underlying genetic or acquired prothrombotic conditions. Moreover, variations in referral timing, prior treatment, and lack of uniform long-term follow-up imaging limited our ability to assess complete recanalization and long-term functional recovery. Despite these limitations, this study provides valuable initial insights into the clinical and radiological characteristics of cerebral venous thrombosis (CVT) in the Nepalese population, serving as an important reference for future multicenter studies. Conclusion Our case series highlights diverse presentations of cerebral venous thrombosis with multiple underlying risk factors, including autoimmune disorders such as systemic lupus erythematosus, pregnancy-related hypercoagulability, infections, and lifestyle factors. This represents the first documented CVT case series from Nepal, demonstrating the effectiveness of MRI and MRV for diagnosis and the favorable outcomes achieved with timely anticoagulation and supportive care. Based on our findings, we suggest that patients with CVT in Nepal exhibit similar risk factors to those reported globally, but with variable clinical outcomes influenced by age, comorbidities, and extent of venous involvement. These observations are consistent with existing literature and underscore the importance of early recognition and multidisciplinary management to optimize recovery in CVT. Declarations Conflict of interest statement There were no conflicts of interest among all authors. Consent Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Declarations All the authors declare that the information provided here is accurate to the best of our knowledge. Funding This study received no funding. Author Contribution Abhishek Kumar Shah and Nishant Neupane collected clinical data, performed data analysis, and drafted the manuscript.Dinesh Od contributed to data interpretation, literature review, and manuscript editing.Rajeev Ojha supervised the study, provided critical revisions, and approved the final version of the manuscript.All authors read and approved the final manuscript. References Gaillard F, Agazzi GM, Le L. Cerebral venous thrombosis. In: Radiopaedia.org [Internet]. Radiopaedia.org; 2008. Available from: http://dx.doi.org/10.53347/rid-4449 Stam J. Thrombosis of the cerebral veins and sinuses. 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Functional outcome predictors and recanalization in cerebral venous thrombosis: A single-center cross-sectional study. Turk J Emerg Med [Internet]. 2024 [cited 2025 Oct 20];24(4):218–25. Available from: https://turkjemergmed.com/full-text-pdf/892 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Nov, 2025 Editor assigned by journal 23 Oct, 2025 Submission checks completed at journal 23 Oct, 2025 First submitted to journal 21 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Shah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYDACCQY2BsaGAzz8zMwHQFwZ4rVItrMlgLg8RGthMOjnMQDxCWuRn9387MHPHXdkDJh5Pr+6UWPBw8B++OgGfFoM7hwzN+w984zHnJl3m3XOMaDDeNLSbuDVIpFgJsHbdpjHspl3m3EOG1CLBI8ZXi3yM9K/Sf4FajE4zPPMOOcfEVoYbuSYSfNCtDA/zm0jQovBjZwyadkzh3kkm9nMmHP7JHjYCPkF6LBtkm93HLbn5z/8+HPOtzo5fvbDx/A7DAmwSYBJYpWDAPMHUlSPglEwCkbByAEA/15GZMCiZcoAAAAASUVORK5CYII=","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Abhishek","middleName":"Kumar","lastName":"Shah","suffix":""},{"id":533728846,"identity":"fa739e54-8548-4c76-a694-376a8a83c4df","order_by":1,"name":"Nishant Neupane","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nishant","middleName":"","lastName":"Neupane","suffix":""},{"id":533728847,"identity":"85ac1440-9e92-473b-80e4-3a5bbbd2113f","order_by":2,"name":"Dinesh Od","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dinesh","middleName":"","lastName":"Od","suffix":""},{"id":533728850,"identity":"82b70f99-6637-4362-b253-c93be26c21a0","order_by":3,"name":"Rajeev Ojha²","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rajeev","middleName":"","lastName":"Ojha²","suffix":""}],"badges":[],"createdAt":"2025-10-22 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08:20:17","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85051,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7917843/v1/b8686385074f70cff3d790bc.html"},{"id":94827245,"identity":"5a7c5b3f-5bcd-449a-a634-40b599841067","added_by":"auto","created_at":"2025-10-31 06:56:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":666085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7917843/v1/05365ec8-8eac-4976-938c-81fb1ca46b72.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical and Radiological Profile of Seven Patients with Cerebral Venous Thrombosis: A Case Series from Nepal","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCerebral venous thrombosis (CVT) is partial or complete obstruction of venous pathways within the cranial cavity, encompassing the dural venous sinuses, cortical veins, and deep cerebral veins(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is a rare cerebrovascular disorder that predominantly affects young adults and children, with an estimated annual incidence of 3\u0026ndash;4 per million and a marked female predominance of around 75%(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Cerebral venous thrombosis can result from inherited thrombophilic disorders, pregnancy or the puerperium, autoimmune and inflammatory diseases, infections, oral contraceptive use, and systemic illnesses such as anemia or malignancy, though some cases remain idiopathic(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Suspected CVT cases should first have an unenhanced CT, followed by CT or MR venography for confirmation based on available resources(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).The clinical spectrum of CVT depends on the site involved\u0026mdash;most often the superior sagittal, transverse, or sigmoid sinuses\u0026mdash;and typically presents with headache, nausea, vomiting, seizures, visual disturbances, or focal neurological deficits, while deep venous thrombosis may cause encephalopathy or coma(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The cornerstone of current management is early initiation of anticoagulation, while endovascular intervention may be considered in cases unresponsive to medical therapy to restore venous flow(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). There is a lack of published data on cerebral venous thrombosis (CVT) from Nepal, and no prior case series have been reported to date. Existing literature on CVT is limited, leaving a significant knowledge gap regarding its clinical and radiological profile in our setting. This represents the first documented case series of CVT from Nepal, aiming to provide valuable insights into its presentation, risk factors, and outcomes, and to contribute to the broader understanding of this rare but treatable condition.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eA retrospective descriptive case series was conducted among patients admitted to the Department of Neurology, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal, between September 2020 and August 2021. TUTH is a major tertiary care referral center that admits approximately 2,000 neurology patients annually. Patient information was obtained from departmental audit and inpatient medical records. The Institutional Review Board (IRB) of Tribhuvan University Teaching Hospital waived the requirement for ethical approval for case reports and case series involving de-identified patient data. All data were anonymized prior to analysis, maintaining confidentiality throughout the process.\u003c/p\u003e\u003cp\u003eStudy Population\u003c/p\u003e\u003cp\u003eA total of nine patients were diagnosed with cerebral venous thrombosis (CVT) during the study period. Of these, three were excluded due to incomplete data records, and seven patients meeting the inclusion criteria were analyzed. Inclusion criteria included all patients with a confirmed diagnosis of CVT based on neuroimaging (MRI/MRV or CT/CTV), irrespective of age, sex, or etiology.\u003c/p\u003e\u003cp\u003eExclusion criteria included cases with incomplete clinical, radiological, or outcome data, and those where imaging findings were inconclusive for venous thrombosis.\u003c/p\u003e\u003cp\u003eData Collection and Parameters\u003c/p\u003e\u003cp\u003eData were extracted from case files and hospital audit sheets using a structured data collection format. Parameters recorded included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDemographic information: age, sex, and duration from symptom onset to hospital admission.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eClinical features: presenting symptoms, Glasgow Coma Scale (GCS) at admission, seizure occurrence, and focal neurological deficits.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eComorbidities and risk factors: including infection, systemic illness, autoimmune disease, pregnancy, and lifestyle factors.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRadiological findings: imaging modality used, sinus involvement, parenchymal and secondary changes, and recanalization status.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTreatment details: type of anticoagulation, antiepileptic use, supportive and adjunct therapies.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOutcomes: hospital stay, complications, and clinical status at discharge.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eDiagnostic and Treatment Protocol\u003c/p\u003e\u003cp\u003eThe diagnosis of CVT was established primarily by magnetic resonance imaging (MRI) combined with magnetic resonance venography (MRV). In selected cases, non-contrast CT (NCCT) and CT venography (CTV) were also utilized. The location and extent of venous sinus involvement, parenchymal changes, and signs of raised intracranial pressure were recorded.\u003c/p\u003e\u003cp\u003e Management of all patients adhered to the American Heart Association/American Stroke Association (AHA/ASA) guidelines for CVT, including anticoagulation with low-molecular-weight heparin (LMWH) transitioned to either warfarin or direct oral anticoagulants (DOACs) as appropriate. Antiepileptic drugs (AEDs) were administered in patients with seizure activity. Supportive therapies such as intracranial pressure management, steroids for autoimmune flare, and antibiotics for infectious etiologies were given as indicated. Follow-up neuroimaging was performed in all patients to assess recanalization and parenchymal resolution.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eAll collected data were compiled and analyzed using IBM SPSS Statistics version 27. A descriptive statistical analysis was performed. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized using mean and range. Outcomes were described qualitatively and quantitatively, and summarized in standard tables encompassing baseline demographics and clinical features, detailed radiological findings, and risk factors with treatment and outcomes.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of seven patients diagnosed with cerebral venous thrombosis (CVT) were included in this case series. The mean age of presentation was 41.7 years (range: 20\u0026ndash;78 years), with a female predominance (5 females, 2 males). The duration from symptom onset to hospital admission varied from less than 3 days to several months, with most cases presenting after more than 7 days of initial symptom onset.\u003c/p\u003e\u003cp\u003e(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes demographic and clinical characteristics.)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Demographic and Clinical Characteristics of Patients with Cerebral Venous Thrombosis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase ID\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOnset to Admission Interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eKey Presenting Symptoms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGCS at Admission\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNeurological Deficit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSeizure at Presentation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSeizures, weakness, altered sensorium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes (Rt LL weakness)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHeadache, vomiting, speech impairment, altered sensorium, ataxia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes (Broca\u0026rsquo;s aphasia, ataxia)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes (during stay)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHeadache, vomiting, left hemiparesis, dysarthria, seizures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e540 days with acute exacerbation over 15 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHeadache, blurred vision, seizures, LOC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes (visual blurring)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180-day history with exacerbation over 60 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHeadache, diplopia, nystagmus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes (6th nerve palsy)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHeadache, seizures, left weakness, altered sensorium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4-year history with recent exacerbation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHeadache, nausea, dizziness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eClinical Presentation\u003c/p\u003e\u003cp\u003eThe most frequent presenting symptom was headache (observed in 6 of 7 patients, 85.7%), followed by seizures (in 5 patients, 71.4%) and focal neurological deficits (in 5 patients, 71.4%). Altered sensorium was reported in three cases. Other associated symptoms included vomiting, visual disturbances, dysarthria, and dizziness. At presentation, GCS ranged from 9 to 15, and neurological deficits such as hemiparesis, aphasia, and cranial nerve palsy were commonly documented.\u003c/p\u003e\u003cp\u003eRadiological Findings\u003c/p\u003e\u003cp\u003eMRI and MRV were the primary diagnostic modalities in all cases, supplemented by CT or CTV in selected patients. The superior sagittal sinus was the most frequently involved site (identified in 5 cases, 71.4%), followed by the transverse and sigmoid sinuses. One patient had isolated thrombosis of the left transverse, sigmoid sinus, and internal jugular vein, while another demonstrated cortical vein involvement.\u003c/p\u003e\u003cp\u003eParenchymal changes were observed in the majority of cases (5/7, 71.4%), typically presenting as venous or hemorrhagic infarctions with associated edema. Secondary radiological findings included collateral venous circulation and features of raised intracranial pressure. Partial recanalization on follow-up imaging was noted in six patients, while one achieved complete recanalization. (Details in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRadiological Findings of Patients with CVT\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase ID\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImaging Modality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSinuses Involved\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDirect Signs of CVT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eParenchymal Changes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSecondary/Ancillary Signs\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAssociated Findings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eRecanalization Status\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMRI\u0026thinsp;+\u0026thinsp;MRV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSS, Lt Transverse, Lt Sigmoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLoss of flow void, filling defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMultifocal hemorrhagic venous infarcts, edema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBilateral mastoiditis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePartial\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNCCT, CTV, MRI/MRV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSS, Bilateral Transverse, Cortical veins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCord sign, empty delta, filling defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVenous\u0026thinsp;+\u0026thinsp;hemorrhagic infarction, edema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCollateral venous flow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePansinusitis (likely fungal)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eComplete\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMRI\u0026thinsp;+\u0026thinsp;MRV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSS, Transverse, Sigmoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLoss of flow void, filling defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHemorrhagic infarction (Rt frontal), edema, mass effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCollaterals, cortical vein prominence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePregnancy-related hypercoagulable state\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePartial\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMRI\u0026thinsp;+\u0026thinsp;MRV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSS, unilateral Transverse \u0026amp; Sigmoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLoss of flow void, filling defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVenous \u0026amp; hemorrhagic infarction, edema, mass effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCortical vein prominence, raised ICP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEmpty sella, chronic changes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePartial\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMRI\u0026thinsp;+\u0026thinsp;MRV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLt Transverse, Lt Sigmoid, Lt IJV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLoss of flow void, filling defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCollateral venous circulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePartial\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMRI\u0026thinsp;+\u0026thinsp;MRV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLoss of flow void, filling defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVenous \u0026amp; hemorrhagic infarction, edema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRaised ICP features\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSLE-related vasculitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePartial\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMRI\u0026thinsp;+\u0026thinsp;MRV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLt Transverse \u0026amp; Sigmoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLoss of flow void, filling defect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCollateral venous circulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eChronic postpartum changes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePartial\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eAbbreviations: SSS \u0026ndash; Superior sagittal sinus; Lt \u0026ndash; Left; Rt \u0026ndash; Right; IJV \u0026ndash; Internal jugular vein; ICP \u0026ndash; Intracranial pressure.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRisk Factors and Comorbidities\u003c/p\u003e\u003cp\u003eMultiple predisposing factors were identified across the cohort. Infectious and inflammatory conditions (such as mastoiditis, pancreatitis, and systemic lupus erythematosus) and prothrombotic states (pregnancy, postpartum status, COVID-19 infection, and autoimmune disorders) were the predominant associations. Lifestyle-related factors such as smoking and alcohol use were also observed in two male patients. One case had no identifiable risk factor, suggesting possible idiopathic CVT. (Refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRisk Factors, Comorbidities, Treatment and Outcomes of CVT Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase ID\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMajor Risk Factors / Comorbidities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrimary Anticoagulant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOther Treatments\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHospital Stay (days)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eComplications\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eClinical Outcome at Discharge\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute pancreatitis, mastoiditis, COVID-19, dehydration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLMWH \u0026rarr; Warfarin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAEDs, antibiotics, statin, physiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStatus epilepticus, DVT, septic shock, pneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePartial recovery with residual deficits\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSmoking, alcohol, severe COVID-19 pneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLMWH \u0026rarr; Warfarin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAEDs, amiodarone, ICU support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eArrhythmias, severe pneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete recovery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePregnancy (8 wks), prior abortion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLMWH \u0026rarr; DOAC (Dabigatran)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAEDs, ICP management, MVA (pregnancy termination)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePregnancy termination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eImproved; partial recanalization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertension, COPD, ex-smoker, alcohol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLMWH \u0026rarr; Dabigatran\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAEDs, steroids, COPD management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSeizure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eImproved, stable\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLMWH \u0026rarr; Warfarin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAcetazolamide, steroids, amitriptyline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eImproved; partial recanalization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSLE, positive APLA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLMWH \u0026rarr; Warfarin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAEDs, steroids, ICP management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSeizures, infarction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eImproved; partial recanalization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePuerperium (remote, postpartum onset)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLMWH \u0026rarr; Warfarin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAcetazolamide, amitriptyline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eImproved; partial recanalization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTreatment and Outcomes\u003c/p\u003e\u003cp\u003eAll patients received anticoagulation therapy, initially with low-molecular-weight heparin (LMWH), followed by either warfarin or direct oral anticoagulants (DOACs) such as dabigatran. Antiepileptic drugs (AEDs) were administered to control seizure activity in symptomatic patients. Supportive treatments included antibiotics, intracranial pressure management, and disease-specific therapy such as steroids for SLE-related CVT and termination of pregnancy in one case.\u003c/p\u003e\u003cp\u003eThe mean hospital stay was 16.7 days (range: 4\u0026ndash;38 days). Complications included seizures, deep vein thrombosis, septic shock, and pneumonia. At discharge, all patients were clinically improved, with one showing complete neurological recovery and six demonstrating partial improvement with varying degrees of residual deficits. No mortality was recorded in this series. (Summary in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCerebral venous thrombosis, involving the cerebral veins and dural sinuses, is a rare condition in the general population but occurs more frequently in individuals under 40 years, those with thrombophilic disorders, and women who are pregnant or using hormonal contraceptives, with an estimated annual incidence of 3\u0026ndash;4 per million(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).Among pregnant women, the incidence of cerebral venous thrombosis rises significantly, reaching approximately 12 cases per 100,000 deliveries(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn our case series, seven patients with cerebral venous thrombosis were studied at Tribhuvan University Teaching Hospital. The mean age at presentation was 41.7 years (range: 20\u0026ndash;78 years), suggesting a predominance among younger adults, consistent with findings reported by Shreenidhi et al(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Our study showed a female predominance (5 females, 2 males), with the highest CVT rates observed among younger women\u0026mdash;likely related to hormonal and obstetric factors\u0026mdash;consistent with previous reports(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe clinical presentation of cerebral venous thrombosis (CVT) varies widely depending on the sinus involved. The superior sagittal sinus is most commonly involved and presents with headache, nausea, vomiting, blurred vision, seizures, and focal neurological deficits such as aphasia or hemiparesis. Transverse sinus thrombosis may cause headache, seizures, or aphasia, while sigmoid sinus involvement often leads to mastoid pain and lower cranial nerve palsies. Deep venous system thrombosis is linked to altered consciousness, encephalopathy, or coma(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSymptoms arise from either raised intracranial pressure due to impaired venous drainage or focal brain injury from venous infarction or hemorrhage, and many patients present with features of both(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Headache, generally indicative of an increase in intracranial pressure, is the most common symptom in CVT(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).It was frequently the initial symptom, observed in 82% of our cases. Similarly, it was reported in 82% of 40 cases from Saudi Arabia(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and in 75% of 110 cases documented by Ameri and Bousser(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In our case series, the second most common presenting features were seizures and focal neurological deficits, each observed in 5 patients (71.4%). This is notably higher than previously reported rates in the literature, where approximately 30\u0026ndash;40% of patients present with seizures and 30\u0026ndash;50% exhibit focal neurological deficits(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).Ferro et al. also reported a greater frequency of seizures in superior sagittal sinus and cortical vein thrombosis affecting the motor and sensory cortices(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), consistent with our findings. At presentation, the Glasgow Coma Scale (GCS) ranged from 9 to 15. Neurological findings included aphasia, ataxia, cranial nerve palsies (abducens and facial), and visual disturbances such as blurring, diplopia, and papilledema. Altered sensorium, vomiting, and dizziness were also common, while dysarthria and loss of consciousness occurred less frequently. These manifestations likely reflect venous congestion, elevated intracranial pressure, and cortical involvement secondary to sinus occlusion in CVT.\u003c/p\u003e\u003cp\u003eRadiological evaluation reinforces the role of MRI and MRV as the gold-standard techniques for detecting sinus occlusion and assessing associated parenchymal damage (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).In this study, MRI and MRV served as the primary diagnostic tools for all cases, with CT or CTV performed in selected patients. In previous studies, the most commonly affected sites in CVT were the transverse sinuses (44\u0026ndash;73%), superior sagittal sinus (39\u0026ndash;62%), sigmoid sinus (40\u0026ndash;47%), deep venous system (10.9%), and cortical veins (3.7\u0026ndash;17.1%)(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In contrast, in our series, the superior sagittal sinus (SSS) was the most frequently involved site, identified in 5 patients (71.4%), followed by the transverse and sigmoid sinuses. The predominance of SSS involvement in our study may be attributed to its longer course and narrower caliber, predisposing it to a higher risk of thrombosis. In our study, parenchymal changes were observed in the majority of cases (5/7, 71.4%), typically presenting as venous or hemorrhagic infarctions with associated edema. The observed parenchymal changes in our cases can be attributed to venous congestion and infarction secondary to occlusion of the corresponding draining sinuses(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). One patient had isolated thrombosis of the left transverse, sigmoid sinus, and internal jugular vein, while another demonstrated cortical vein involvement. Secondary radiological findings included collateral venous circulation and features of raised intracranial pressure. Partial recanalization on follow-up imaging was noted in six patients, while one achieved complete recanalization.\u003c/p\u003e\u003cp\u003eRisk factors for cerebral venous thrombosis (CVT) include hereditary thrombophilic disorders such as prothrombin G20210A mutation (9\u0026ndash;21%), factor V Leiden mutation (9\u0026ndash;13%), and protein C or S deficiency, as well as acquired conditions like pregnancy and puerperium (11\u0026ndash;59%), antiphospholipid antibody syndrome (6\u0026ndash;17%), and severe anemia (9\u0026ndash;27%). Other contributing factors include infections, oral contraceptive use (54\u0026ndash;71%), malignancy, inflammatory diseases, and obesity, while a proportion of cases remain idiopathic(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In our series, multiple predisposing factors were identified, predominantly infectious and inflammatory conditions (mastoiditis, pancreatitis, and systemic lupus erythematosus) and prothrombotic states (pregnancy, postpartum status, COVID-19 infection, and autoimmune disorders). These findings align with existing literature emphasizing prothrombotic, infectious, autoimmune, and hormonal factors as major contributors to CVT pathogenesis(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Additionally, lifestyle-related factors such as smoking and alcohol use, noted in two male patients, may have promoted endothelial dysfunction and venous stasis, further increasing the risk of thrombosis. Notably, one patient had no identifiable risk factor, consistent with reports that up to 12.5% of CVT cases occur without a defined etiology(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur treatment approach was consistent with prior American Heart Association/American Stroke Association and European guidelines, which recommend initial anticoagulation with low-molecular-weight heparin (LMWH) followed by oral vitamin K antagonists (VKAs) for variable durations depending on risk factors(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Recent evidence also supports the use of direct oral anticoagulants (DOACs) as safe and effective alternatives to VKAs in selected CVT patients (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In our series, all patients received LMWH initially, followed by either warfarin or DOACs such as dabigatran, reflecting these evolving therapeutic recommendations. Although the optimal duration of therapy remains uncertain, antiepileptic drugs (AEDs) are recommended for patients with acute CVT who present with seizures and supratentorial lesions to prevent recurrence (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). AEDs were administered to symptomatic patients and proved effective in achieving seizure control in most cases. Supportive therapy was tailored to each patient\u0026rsquo;s clinical condition and underlying cause. In addition to anticoagulation, several patients required antibiotics for infectious triggers such as mastoiditis, pneumonia, or sinusitis, while ICP-lowering agents like acetazolamide and mannitol were used to manage raised intracranial pressure and cerebral edema. Corticosteroids were administered in autoimmune-related CVT to control inflammatory activity, and pregnancy termination was performed in one case to address the hypercoagulable state. Supportive measures also included antiepileptics, physiotherapy, bronchodilator or steroid inhalers for comorbid respiratory disease, and general care with fluids and nutrition. These interventions, combined with anticoagulation, were pivotal in stabilizing patients, preventing complications, and improving overall recovery.\u003c/p\u003e\u003cp\u003eIn the study by Shahid and Zafar et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), less than one-fourth of patients with cerebral venous thrombosis (CVT) experienced poor functional outcomes. Factors such as older age, male sex, hereditary thrombophilia, infections, venous hemorrhagic infarction, and non-recanalization were identified as predictors of unfavorable prognosis. Additionally, age above 50 years and symptom duration beyond one month were associated with delayed recanalization and incomplete recovery. In contrast, all patients in our series survived, and most showed good functional outcomes with significant clinical improvement at discharge. The variation in recovery and hospital stay among our patients was primarily influenced by age, comorbidities, and the extent of cerebral involvement. The oldest patient (78 years) had the longest hospital stay (38 days) and the poorest outcome, complicated by status epilepticus, septic shock, and deep vein thrombosis\u0026mdash;findings consistent with predictors of poor outcome noted in previous literature. In contrast, younger patients with isolated sinus thrombosis and no parenchymal changes (Patients 5 and 7) recovered rapidly within 4\u0026ndash;6 days, underscoring how early diagnosis and preserved venous drainage contribute to favorable outcomes. Intermediate recoveries were noted in patients with systemic illnesses such as COVID-19 pneumonia, pregnancy-related hypercoagulability, and systemic lupus erythematosus, where underlying inflammatory and thrombotic states prolonged hospitalization (18\u0026ndash;23 days) and delayed recovery. Patient 4, despite being older (59 years) with COPD and hypertension, had a brief admission (5 days) and favorable recovery, likely due to limited neurological involvement and stable systemic status. Overall, our findings indicate that advanced age, comorbid diseases, and extensive parenchymal infarction are associated with prolonged hospital stay and poorer outcomes, whereas younger patients with limited sinus thrombosis and early management experience shorter admissions and complete recovery. The absence of mortality in our cohort further highlights the effectiveness of timely anticoagulation and multidisciplinary care in optimizing recovery among CVT patients.\u003c/p\u003e\u003cp\u003eOur study has certain limitations that should be acknowledged. Being a retrospective single-center case series with a small number of patients, the findings may not be fully generalizable to the broader population. The incomplete thrombophilia work-up in some cases might have led to an underestimation of underlying genetic or acquired prothrombotic conditions. Moreover, variations in referral timing, prior treatment, and lack of uniform long-term follow-up imaging limited our ability to assess complete recanalization and long-term functional recovery. Despite these limitations, this study provides valuable initial insights into the clinical and radiological characteristics of cerebral venous thrombosis (CVT) in the Nepalese population, serving as an important reference for future multicenter studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur case series highlights diverse presentations of cerebral venous thrombosis with multiple underlying risk factors, including autoimmune disorders such as systemic lupus erythematosus, pregnancy-related hypercoagulability, infections, and lifestyle factors. This represents the first documented CVT case series from Nepal, demonstrating the effectiveness of MRI and MRV for diagnosis and the favorable outcomes achieved with timely anticoagulation and supportive care. Based on our findings, we suggest that patients with CVT in Nepal exhibit similar risk factors to those reported globally, but with variable clinical outcomes influenced by age, comorbidities, and extent of venous involvement. These observations are consistent with existing literature and underscore the importance of early recognition and multidisciplinary management to optimize recovery in CVT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest statement\u003c/h2\u003e\u003cp\u003eThere were no conflicts of interest among all authors.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent\u003c/h2\u003e\u003cp\u003e Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eDeclarations\u003c/h2\u003e\u003cp\u003eAll the authors declare that the information provided here is accurate to the best of our knowledge.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study received no funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAbhishek Kumar Shah and Nishant Neupane collected clinical data, performed data analysis, and drafted the manuscript.Dinesh Od contributed to data interpretation, literature review, and manuscript editing.Rajeev Ojha supervised the study, provided critical revisions, and approved the final version of the manuscript.All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGaillard F, Agazzi GM, Le L. Cerebral venous thrombosis. In: Radiopaedia.org [Internet]. Radiopaedia.org; 2008. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.53347/rid-4449\u003c/span\u003e\u003cspan address=\"10.53347/rid-4449\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med [Internet]. 2005;352(17):1791\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1056/NEJMra042354\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra042354\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRanjan R, Ken-Dror G, Sharma P. Pathophysiology, diagnosis and management of cerebral venous thrombosis: A comprehensive review. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ahajournals.org/doi/10.1161/STR.0000000000000456#supplementary-materials\u003c/span\u003e\u003cspan address=\"https://www.ahajournals.org/doi/10.1161/STR.0000000000000456#supplementary-materials\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShahid R, Zafar A. Functional outcome predictors and recanalization in cerebral venous thrombosis: A single-center cross-sectional study. Turk J Emerg Med [Internet]. 2024 [cited 2025 Oct 20];24(4):218\u0026ndash;25. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://turkjemergmed.com/full-text-pdf/892\u003c/span\u003e\u003cspan address=\"https://turkjemergmed.com/full-text-pdf/892\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cerebral venous thrombosis, MRI, MRV, anticoagulation, Nepal, case series, stroke, COVID-19, postpartum","lastPublishedDoi":"10.21203/rs.3.rs-7917843/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7917843/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eCerebral venous thrombosis (CVT) is an uncommon but potentially reversible cause of stroke, primarily affecting young adults and women. Despite global data, information from Nepal is limited. This study presents the first documented case series describing the clinical presentation, radiological characteristics, risk factors, management, and outcomes of CVT in a tertiary hospital setting in Nepal.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA retrospective descriptive study was conducted at the Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, from September 2020 to August 2021. Seven patients with radiologically confirmed CVT were included. Demographic, clinical, radiological, and treatment data were extracted from hospital records and analyzed descriptively.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe mean age of the patients was 41.7 years (range: 20\u0026ndash;78 years), with a female predominance (5 females, 2 males). The most common presenting symptom was headache (85.7%), followed by seizures and focal neurological deficits (each in 71.4%). MRI and MRV were the primary diagnostic modalities, revealing the superior sagittal sinus as the most frequently involved site (71.4%). Parenchymal changes, mainly venous or hemorrhagic infarctions, were seen in 71.4% of cases. Major risk factors included infections, autoimmune diseases, pregnancy/postpartum state, and COVID-19 infection. All patients received anticoagulation, with LMWH transitioned to warfarin or direct oral anticoagulants. At discharge, all patients improved clinically, with one achieving complete recovery and no recorded mortality.\u003c/p\u003e\u003ch2\u003eDiscussion:\u003c/h2\u003e\u003cp\u003eThe findings align with global literature highlighting CVT as a condition with diverse clinical manifestations and generally favorable prognosis when promptly recognized. The high frequency of headache and seizures corresponds to patterns observed in international cohorts. MRI and MRV continue to be indispensable for diagnosis, especially in atypical stroke presentations. The identification of postpartum, autoimmune, and COVID-19\u0026ndash;related cases reflects evolving risk profiles in developing countries. The good recovery rates in this series reinforce the effectiveness of early anticoagulation and multidisciplinary management.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003eThis first Nepalese case series underscores that cerebral venous thrombosis presents with variable symptoms but favorable outcomes when diagnosed early and treated with anticoagulation. Risk factors mirror global patterns, including autoimmune and pregnancy-related conditions. MRI and MRV remain the diagnostic gold standards. Early recognition and multidisciplinary management are key to optimizing outcomes\u003c/p\u003e","manuscriptTitle":"Clinical and Radiological Profile of Seven Patients with Cerebral Venous Thrombosis: A Case Series from Nepal","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 08:20:12","doi":"10.21203/rs.3.rs-7917843/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-06T20:36:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-23T05:17:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-23T05:17:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2025-10-21T15:22:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a658ce85-f7d1-4192-883e-dd070011030c","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T14:23:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 08:20:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7917843","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7917843","identity":"rs-7917843","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}