Cerebral Venous Thrombosis with Nonhemorrhagic Lesions: Clinical Correlates and Prognosis

Abstract

Background and Purpose: Brain imaging of patients with acute cerebral venous thrombosis often shows parenchymal hemorrhagic and nonhemorrhagic lesions. The clinical relevance of nonhemorrhagic lesions is poorly known. Method: In the International Study on Cerebral Vein and Dural Sinus Thrombosis cohort, demographic, clinical, risk factor, prognosis and imaging findings were compared between patients with parenchymal nonhemorrhagic lesions and no hemorrhagic lesions (NHL) and (1) patients with parenchymal hemorrhagic lesions (HL) and (2) patients without brain lesions. Predictors of prognosis at the end of follow-up in the NHL group were analyzed by bivariate and Cox regression methods. Results: We identified 147 patients (23.6%) with NHL. When compared to patients without brain lesions (n = 309), those with NHL more often presented mental status disturbances, aphasia, decreased alertness, motor deficits, seizures, occlusions of the straight sinus, deep venous system and cortical veins. Patients with NHL had a better prognosis in the acute phase and at the end of follow-up than those with HL, but a worse one than patients without brain lesions, as more NHL patients were dead or dependent (modified Rankin Scale score = 3–6) at discharge (19.7 vs. 6.5%, p < 0.001) and final follow-up (14.3 vs. 7.4%, p = 0.03). In Cox regression analysis, coma (HR = 13.7; 95% CI = 4.3–43.7) and thrombosis of the deep venous system (HR = 3.5; 95% CI = 1.4–8.7) were associated with death or dependency at the end of follow-up. Conclusion: Cerebral venous thrombosis patients with NHL are intermediate between patients without brain lesions and those with HL, both in initial clinical picture and prognosis.

The clinical spectrum of intracerebral hematoma, hemorrhagic infarct, non‐hemorrhagic infarct, and non‐lesional venous stroke in patients with cerebral sinus–venous thrombosis

“…Approximately, two‐thirds of the patients having ICH were dependent, which could be a predictor of an unfavorable outcome in these patients. The ISCVT trial [9,22] reported that 3.4% of patients died within 30 days from symptom onset, and risk factors were depressed consciousness, altered mental status, transtentorial herniation secondary to a large hemorrhagic lesion, and diffuse brain edema, supporting the findings found in our series. Another recent study showed that patients with non‐hemorrhagic lesion had a better prognosis in the acute phase and at the end of follow‐up than those with hemorrhagic lesion [22].…”

Decompressive craniectomy in hemorrhagic cerebral venous thrombosis: clinicoradiological features and risk factors

“…4,8 However, some patients can develop refractory intracranial hypertension and experience poor outcomes, especially patients with hemorrhagic lesions. 4,7,10,23 The major hazard of severe CVT is herniation attributable to the mass effect produced by hemorrhagic venous infarctions. Different from large ischemic infarctions, the venous infarctions in CVT are caused by venous congestion.…”

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

“…Two studies were subsequently excluded because they presented an overlapping population with another study. 102,103 Although several of these cohorts evaluated the recurrence rates of CVT and other thrombotic venous events, all have important limitations. Also, there have been no randomised controlled trials, prospective controlled studies or cases control studies assessing optimal duration of oral anticoagulation for the prevention of recurrent CVT and other VTE.…”