No abstract

Cerebral venous and sinus thrombosis (CVST) can present with a variety of clinical symptoms ranging from isolated headache to deep coma. Prognosis is better than previously thought and prospective studies have reported an independent survival of more than 80% of patients. Although it may be difficult to predict recovery in an individual patient, clinical presentation on hospital admission and the results of neuroimaging investigations are--apart from the underlying condition--the most important prognostic factors. Comatose patients with intracranial haemorrhage (ICH) on admission brain scan carry the highest risk of a fatal outcome. Available treatment data from controlled trials favour the use of anticoagulation (AC) as the first-line therapy of CVST because it may reduce the risk of a fatal outcome and severe disability and does not promote ICH. A few patients deteriorate despise adequate AC which may warrant the use of more aggressive treatment modalities such as local thrombolysis. The risk of recurrence is low (< 10%) and most relapses occur within the first 12 months. Analogous to patients with extracerebral venous thrombosis, oral AC is usually continued for 3 months after idiopathic CVST and for 6-12 months in patients with inherited or acquired thrombophilia but controlled data proving the benefit of long-term AC in patients with CVST are not available.

We assessed the risk and determined predictors of early epileptic seizures (ES) in patients with acute cerebral venous and sinus thrombosis (CVST). A prospective series of 194 consecutive patients with acute CVST admitted to neurological wards in two German university hospitals was analysed for frequency of ES and in-hospital mortality. Demographic, clinical and radiological characteristics during the acute stage were retrospectively analysed for significant association with ES in univariate and multivariate analyses. During the acute stage, 19 patients (9.8%) died. Early symptomatic seizures were found in 86 patients (44.3%). Status epilepticus occurred in 11 patients (12.8%) of whom four died. Amongst patients with epileptic seizures, mortality was three times higher in those with status than in those without (36.4% and 12%, respectively). In multivariate logistic regression analysis, motor deficit [odds ratio (OR) 5.8; 95% CI 2.98-11.42; P < 0.001], intracranial haemorrhage (OR 2.8; 95% CI 1.46-5.56; P = 0.002) and cortical vein thrombosis (OR 2.9; 95% CI 1.43-5.96; P = 0.003) were independent predictors of early epileptic seizures. Status epilepticus was an important source of morbidity and early mortality in patients with CVST in this study. Patients with focal motor deficits, cortical vein thrombosis and intracranial haemorrhage carried the highest risk for ES. Prophylactic antiepileptic treatment may be an option for these patients.

Objective: To assess the risk of recurrence of cerebral venous and sinus thrombosis (CVST) during subsequent pregnancy and puerperium in women with previous cerebral venous occlusive disease. Methods: The authors retrospectively studied the relapse rate of CVST and the incidence of extracerebral venous thrombosis during subsequent pregnancies in 39 women (from 125 patients with CVST) who suffered a CVST at childbearing age. Results: Mean follow up was 10.25 years (range 1 to 20). Twenty two pregnancies and 19 births were observed in 14 women without evidence of either recurrence of CVST or extracerebral venous thrombosis. One pregnancy occurred during oral anticoagulation and was interrupted and two pregnancies ended with spontaneous abortions. Low dose heparin had been given during five pregnancies. Conclusions: The risk of recurrence for CVST during pregnancy seems to be low and these data do not justify a negative advice on pregnancy in women with previous CVST. Further studies are needed to evaluate the need for a prophylactic anticoagulation during pregnancy and puerperium.H ormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism (VTE) including cerebral venous and sinus thrombosis (CVST).1-3 Very little is known about the relapse rate during pregnancy and puerperium in women with a history of CVST. As CVST is nowadays largely a disease of younger women and hormonal factors such as the intake of oral contraceptives 4 5 or pregnancy are important risk factors in a large proportion of female patients, counselling of such women regarding future pregnancies remains a problem in clinical practice. We studied the course and complications of further pregnancies as well as the relapse rate in women with previous CVST at childbearing age. PATIENTS AND METHODSA total of 125 consecutive patients with CVST treated between 1976 and 1996 were identified from hospital charts. Diagnosis had been confirmed by conventional angiography or magnetic resonance angiography in all patients. Eighteen patients (14.6%) had died during the acute stage and 12 had died during the follow up period. Additional 10 patients were lost to follow up and three refused to participate in the study. The remaining 82 patients were eligible for the study. Of these, 39 (47.5%) were women and had been at childbearing age (18-40 years) when the CVST occurred.Data were obtained by phone interviews using a standardised questionnaire. It contained questions on the CVST relapse rate and the long term outcome and was sent to all 82 patients. One part of the questionnaire focused on subsequent pregnancies asking for (1) recurrence of CVST (and its delay to the previous CVST and how the diagnosis was established) (2) incidence of other venous thrombotic events (3) incidence of other pregnancy related complications, and (4) the use and duration of anticoagulation with heparin. Patients who declined a telephone interview were sent the questionnaire by mail. If questions were not or equivocally answered in the mailed...