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Central nervous system venous thrombosis in cancer: Frequency and clinical characteristics in a prospective observational study of 339 patients.

e19597 Background: The aim of the present study was to analyze the epidemiology and clinical characteristics of cancer patients with central nervous system venous thrombosis (CNSVT), an uncommon manifestation of the hypercoagulable state in cancer patients.


METHODS
From May 2006 to April 2009 a prospective observational study including consecutive cancer patients with newly-diagnosed venous thrombosis was performed in our Medical Oncology Department.


RESULTS
In 3 out of 339 patients (1%) the venous thrombosis event presented with CNSVT. There were 2 women and 1 man with a median age of 59 years (range 54 to 63 years). Two patients were actively receiving platin-based chemotherapy schemes at the time of the thrombotic event (1 in the adjuvant setting for colon cancer and 1 while receiving palliative chemotherapy for metastatic lung cancer). The other one was receiving 5FU in the adjuvant setting for cholangiocarcinoma). The clinical CNSVT presentation consisted of sudden headache and seizures. CT scan was performed in the Emergency room to rule out brain metastasis. In two patients (66%) evidence for cerebral sinus thrombosis was diagnosed and in one case the thrombus extended to the internal jugular vein without carrying any venous catheter. In the remaining patient the CT scan was assessed as normal at first evaluation and the CNSVT diagnosis required a reassessment of the initial CT scan by an experienced neuroradiologist and further study by cerebral MRI. All patients were safely anticoagulated with low molecular weight heparin with a favourable outcome of the acute thrombotic event.


CONCLUSIONS
CNSVT must be taken into account in the differential diagnosis of acute neurological symptoms in cancer patients.