Age and body-mass index account for part of the sex differences in cerebral venous thrombosis

Background. Women with cerebral venous thrombosis are younger than men and more often present with headache, but the cohorts reporting these differences did not account for age or body-mass index, both of which differ by sex. Methods. Single-center cohort of 219 consecutive adults with confirmed cerebral venous thrombosis admitted in Zurich in 2001-2021. Presentation, imaging and laboratory findings were compared between women and men, and every difference was re-estimated at equal age and body-mass index. Secondary analyses compared functional outcome, residual symptoms and return to work by sex, with an audit of incomplete follow-up. Results. Women (132, 60.3%) were younger (47.3 versus 54.9 years) and had a lower body-mass index (25.9 versus 27.8 kg/m 2 ) than men. Headache (72.0% versus 57.5%) and cortical vein thrombosis (14.4% versus 5.7%) were more frequent in women, but neither association persisted after adjustment (odds ratios, 1.17 [95% CI, 0.54-2.54] and 2.05 [95% CI, 0.59-7.06]). Higher platelet counts (+56 × 10 9 /L [95% CI, 26-86]) and elevated acute-phase markers without documented infection (59.1% versus 33.3%; odds ratio, 2.91 [95% CI, 1.44-5.87]) persisted after adjustment for age, body-mass index and calendar period. Among assessed patients (38% at 6 months), functional independence (86.3% versus 87.5%), residual headache, return to work and recanalization did not differ by sex. Conclusions. At equal age and body-mass index, the female excess of headache and cortical vein involvement was no longer apparent, whereas a higher platelet count and a non-specific acute-phase response remained. Neither translated into a difference in outcome among assessed patients.