cerebral venous - sinus thrombosis ( cvst ) is a potential life - threatening condition that requires rapid diagnosis and urgent treatment . its epidemiology has changed over past few decades . its increasing prevalence may be attributed to not only increased ease of diagnosis by modern imaging tools such as magnetic resonance imaging ( mri ) , but also to the increment of underlying causes including use of oral contraceptive pills ( ocps ) . cerebral venous - sinus thrombosis seems relatively more frequent in south asia and middle east . this study aims to report demographic , etiologic , radiological and prognostic characteristics of patients with cvst in fars province in the south of iran . the study is a retrospective analysis of medical records of 124 patients with cvst , who referred to nemazee hospital , a teaching hospital affiliated with shiraz university of medical sciences , from january 2000 to march 2008 . patients with related cvst manifestations underwent cerebral mri and magnetic resonance venography ( mrv ) . patients whose presentations could be explained better by any other neurological diseases or those whose imaging revealed congenital hypoplasia of dural sinuses were excluded . brain and paranasal sinuses mri , high resolution computer tomography ( ct ) scan of chest , abdominal and pelvic organs , bone scan , and tumor marker measurement were performed to evaluate infections and malignancies . in addition to routine laboratory evaluations , sickle cell and sucrose lysis tests were done . also , plasma concentrations of proteins c and s , and antibodies such as anticardiolipin , antinuclear , anti - double - stranded dna and anti - beta2-glycoprotein were measured . pathergy skin test and hla - b51 antigen were evaluated in patients suspected to have behcet 's disease ( bd ) . all patients with non - septic cvst , even those with hemorrhage , received intravenous heparin followed by oral warfarin for a period of six months . thrombosis profile was recorded in all patients , and when a substantial cause of thrombophilia was found , warfarin was prescribed as a life - long treatment . the patients ' demographic characteristics , clinical manifestations , laboratory finding , neuro - imaging investigations , treatment options and prognosis were also studied . statistical analysis 
  findings were analyzed using statistical package for social sciences ( spss software version 11.5 ) . the data are reported as meansd for quantitative variables , and as count and percent for qualitative variables . eleven ( 8.87% ) had septic cvst and 113 ( 91.12% ) had non - septic cerebral venous thrombosis ( cvt ) . the most frequent clinical manifestations were headache in 116 ( 93.54% ) , papilledema in 48 ( 62.3% ) , seizures in 28 ( 36.4% ) , neurological deficit in 44 ( 35.48% ) , and decreased level of consciousness in 31 patients ( 25% ) . common findings in 124 patients with cerebral venous sinus thrombosis ocp : oral contraceptive pill , bd : behcet 's disease , apls : antiphospholipid antibody syndrome , sle : systemic lupus erythematosus 
 table 1 shows the most common findings in 124 patients with cvst . twenty out of 57 women ( 35.08% ) took ocps to prevent menstruation to be able to perform ramadan fasting and hajj ceremony . poor prognostic factors at the time of admission were stupor or coma ( p=0.001 ) and parenchymal with or without subarachnoid hemorrhage in first ct scan ( p=0.005 ) . recurrent thrombosis developed in 12 patients ( 9.67% ) and consisted of recurrent cvst in one patient ( 0.80% ) , lower extremity deep vein thrombosis ( dvt ) in 10 patients ( 8.06% ) and hepatic vein thrombosis in one patient ( 0.80% ) . such an increased profile prompted us to investigate the underlying causes of cvst in iranian peoples . the present study is similar to some previous ones in terms of female predominance , clinical manifestations , and the involved sinus of cvst . the use of ocps might be the main factor associated with cvst in our study . the combined ocps increase the risk of cvst , and odds ratio increases to 30.0 , 79.3 and 19.5 in the presence of v leiden factor , prothrombin mutation or hyperhomocysteinemia , respectively . twenty women ( 35.08% ) took ocp for a duration longer than one month to prevent menstruation during religious ceremonies such as ramadan fasting or hajj , and developed cvst during the period of the drug use . a similar finding has been reported in other parts of iran , but not in other countries . dehydration during ramadan fasting and immobilization during long journey of hajj pilgrims are other factors in these situations . it results from low socioeconomic conditions secondary to deficient nutritional status , low plasma folate and vitamin b12 levels , which are associated with an increased risk of cvst in some developing countries . a small percentage ( 5.64% ) of our patients borhanihaghighi et al , reported that 22% of patients with neuro - behcet 's disease developed cvst . this might justify the high frequency of the disease as an underlying cause of cvst in iran . some patients of this study had primary antiphospholipid antibody syndrome ( apls ) and systemic lupus erythematosus ( sle ) . the role of antiphospholipid antibodies and other lupus anticoagulants in the evolution of cvst has been previously reported . thrombophilia conditions including deficiency of proteins c and s appeared in 6.5% of the patients . one of our patients , who was also reported by borhanihaghighi et al , had a rare sporadic combined hyperhomocysteinemia and protein c deficiency . the mortality rate was 14.51% in the present study , whereas that of patients with cvst in an international study on cerebral vein and dural sinus thrombosis ( iscvt ) was 8.3% . higher mortality in the present study might be due to the referral nature of our center , which excluded patients with milder course as well as the lack of neuro - intensive care units . presence of coma or stupor ( p=0.001 ) , parenchymal hemorrhage ( p=0.005 ) at the time of admission , and cancer were common predictors of high mortality rate in this study and other previous studies . increased morbidity in the present study ( 35.48% ) compared to that of iscvt ( 26.92% ) may be attributed to retrospective nature of our study in a clinic - based follow - up . headache , optic atrophy and focal neurological deficits were major sequels , which were similar to those reported in azin et al . and extracranial venous thrombosis in our study was approximately two times more than what was reported in a study by ferro et al . predisposing factors for recurrent thrombosis were malignancy , postpartum state , ocp , bd , sle , and apls . this study sheds new light on the subject , and suggests using important methods including organ mobilization and prophylactic anti - coagulative drugs in patients with cerebral venous - sinus thrombosis . it also emphasizes prompt diagnosis and treatment of thrombophilic conditions to prevent thrombosis formation more than before . the findings of the study indicate that the use of ocps was a main factor associated with cvst . clinical manifestations , prognostic factors , involved sinuses and imaging findings of our study were similar to those of other studies . mortality and morbidity rates were high in our patients ( 14.51 % and 35.48 % , respectively ) . moreover , the findings may suggest that health care policy makers should design a plan to warn susceptible women of the risk of cvst and educate them the ways to prevent it .
background : cerebral venous - sinus thrombosis is an uncommon form but important cause of stroke , especially in young - aged women . 
 methods : we performed a retrospective descriptive - analytical study in which 124 patients with cerebral venous - sinus thrombosis , who referred to nemazee hospital , shiraz university of medical sciences from january 2000 to march 2008 , were included , and their demographic , etiologic , radiological and prognostic characteristics were evaluated . 
 results : the patients ' mean age was 34.0110.25 
 . eighty seven ( 70.16% ) were women and 37 ( 29.83% ) were men . 
 the most frequent clinical manifestations were headache , papilledema and seizures . 
 fifty seven ( 65.51% ) women took oral contraceptive pills . 
 twenty of 57 women ( 35.08% ) took the pill longer than one month to be able to fast in ramadan or perform the hajj ceremonies . in the mean time they developed cerebral venous - sinus thrombosis . 
 superior sagital sinus , with or without lateral sinuses , was the most involved area ( 70.96% ) . 
 high mortality and morbidity rates ( 14.51% and 35.48% , respectively ) were found in patients . 
 poor prognostic factors at the time of admission were stupor and coma ( p=0.001 ) and evidence of hemorrhage in primary ct scan ( p=0.005 ) . 
 conclusion : taking oral contraceptive pills was a main factor associated with cerebral venous - sinus thrombosis . 
 clinical manifestations , prognostic factors , common involved sinuses and image findings of this study were similar to those of other studies . 
 health care policy makers should design a plan to warn susceptible women of the risk of cerebral venous - sinus thrombosis , and to educate them the ways to prevent it .