A hypofibrinolytic state in overweight patients with cerebral venous thrombosis and isolated intracranial hypertension

Evidence suggests that isolated intracranial hypertension (ilH) is often as sociated with cerebral venous thrombosis (CVT). In eight patients referred to our Institution for iIH who were later shown to harbor CVT we have perfo rmed a comprehensive coagulation work-up, including genetic tests for inher ited predisposition to thrombophilia, to clarify the etiology of sinus veno us thrombosis. All subjects were women. All but one were overweight. There were high, plasma concentrations of D dimer, thrombin-antithrombin complexe s or prothrombin fragments I and 2, further supporting the neuroimaging dia gnosis of CVT. Importantly, seven of eight cases had a raised level of plas minogen activator inhibitor I, a well known inhibitor of fibrinolysis relat ed to obesity: Tissue plasminogen activator levels were elevated accordingl y. Factor V gene mutation was present in one subject, and the 20210 prothro mbin gene mutation was found in another individual. Three patients had elev ated plasmatic levels of homocysteine. In conclusion, the present study pro vides solid evidence that impaired fibrinolysis probably related to overwei ght, acting in concert with other prothrombotic abnormalities, is involved in the pathogenesis of CVT presenting as iIH.