Exploring Seizure Risks in Cerebral Venous Sinus Thrombosis Based on Thrombosis Site

Abstract

OBJECTIVES: Cerebral venous sinus thrombosis (CVST) often leads to seizures, potentially worsening prognosis. This study aimed to assess the relationship between specific occlusion sites and seizure occurrence. METHODS: We retrospectively analyzed 154 patients diagnosed with CVST in 3 major hospitals in Tehran. Medical records detailing sinus involvement, seizure occurrence, and baseline characteristics were reviewed. Statistical analyses included the χ 2 or the Fisher exact tests, followed by binomial logistic regression to identify independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) curves. RESULTS: The study included 102 women (66.2%) and 52 men (33.8%), with a mean age of 36.4±10.8 years. A total of 35 patients (22.7%) experienced seizures, predominantly generalized tonic-clonic (85.7%). Superior sagittal sinus (SSS) involvement was strongly associated with seizures (odds ratio=3.056, P =0.006), while left transverse sinus involvement showed a marginally significant inverse relationship in univariate analysis ( P =0.027), which became nonsignificant in the multivariate model ( P =0.056). Trolard vein thrombosis was rare but associated with a high seizure rate (3/4 cases). The ROC for the final model showed moderate predictive ability (AUC=0.676). CONCLUSION: SSS thrombosis significantly predicted seizures in Iranian CVST patients. Although rare, trolard vein involvement may carry a substantial seizure risk. These findings underscore the importance of precise imaging and individualized treatment plans for high-risk CVST patients. By illuminating the role of SSS and trolard vein, this study highlights the need for prospective trials to refine clinical decision-making. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.