Causes and Predictors of Death in Cerebral Venous Thrombosis

Abstract

Background and Purpose— The causes of death of patients with cerebral venous thrombosis (CVT) have not been systematically addressed in previous studies. We aimed to analyze the causes and predictors of death during the acute phase of CVT in the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) to identify preventable or treatable causes. Methods— ISCVT is a multinational, prospective, observational study including 624 patients with CVT occurring between May 1998 and May 2001, in which 27 patients (4.3%) died during the acute phase, 21 (3.4%) within 30 days from symptom onset. Inclusion forms and a questionnaire assessing the causes of death were analyzed. A logistic regression analysis was performed to identify the predictors of death within 30 days from symptom onset of CVT. Results— Median time between onset of symptoms and death was 13 days and between diagnosis and death, 5 days. Causes of death were mainly transtentorial herniation due to a unilateral focal mass effect (10 patients) or to diffuse edema and multiple parenchymal lesions (10 patients). Independent predictors of death were coma (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.8 to 27.7), mental disturbance (OR, 2.5; 95% CI 0.9 to 7.3), deep CVT thrombosis (OR, 8.5; 95% CI, 2.6 to 27.8), right intracerebral hemorrhage (OR, 3.4; 95% CI, 1.1 to 10.6), and posterior fossa lesion (OR, 6.5; 95% CI, 1.3 to 31.7). Worsening of previous focal or de novo focal deficits increased the risk of death. Conclusions— The main causes of acute death were neurologic, the most frequent mechanism being transtentorial herniation.

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

“…10,52,60,62,67 Each of these theories separately or in some cases simultaneously may be implicated in the development of CVST. 10,52,60,62,67 The entire underlying pathophysiological mechanism has not been experimentally proven due to insufficient experimental animal research data, but parts of the 2 proposed theories have been decoded and have been experimentally demonstrated.…”

“…10,32 The presence of any of the above factors with CVST predisposes one to increased morbidity and mortality. On the other hand, the presence of isolated intracranial hypertension was a predictor of favorable outcome.…”

“…Additionally, maneuvers that may directly or indirectly alter the cerebral venous circulation, such as lumbar punctures, cranial trauma, jugular catheter occlusion, and neurosurgical interventions, have been identified as common risk factors of CVST in primary or hospital care. 8,10,29,32,62 Three large multicenter clinical studies representing different regions of the world revealed important differences among the CVST-associated risk factors and predisposing conditions, which require further consideration for developing more efficacious prophylaxis strategies. The ISCVT study by Ferro et al 32 mainly included patients from Europe and South America.…”

Cerebral Vein Thrombosis Post Cabg Precipitated by Malposition of Subclavian Central Catheter in Protein C & S Deficiency Patient

“…SVT has been often a multi factorial disease, i.e the identification of a risk factor or even of a cause should not deter a search for other causes (5,6). Several studies, have described some of the well-established risk factors for SVT that include inherited thrombophilia such as factor V Leiden mutation, protein C and S deficiency, acquired prothrombotic state (pregnancy, purperium and postsurgical period), hepatic dysfunction ,autoimmune disease (Behçet syndrome, systemic lupus erythematosus), malignancy (lung cancer, blood dyscrasia, systemic carcinoma), systemic infectious disease, local infection of the skull (e. (7)(8)(9)(10)(11)(12)(13)(14). Nagesh Kumar reported a case of a 35 years old male who presented to the emergency center with drowsiness and focal seizures leading to grand seizures and loss of consciousness.…”

Trombosis de senos venoso cerebrales: características epidemiológicas, clínicas imaginológicas y pronóstico

“…La presencia de infarto venoso, hemorragia parenquimatosa y hemorragia subaracnoidea, detectados por neuroimágenes, fue el rasgo común en los dos pacientes fallecidos. Ninguno de ellos presentaba alteración de la conciencia ni convulsiones en el momento de su ingreso al centro, a diferencia de lo reportado en otros estudios en los que estas dos condiciones se relacionaron con un pronóstico desfavorable (15,17,18).…”