Clinicoradiological Profile and Functional Outcome of Acute Cerebral Venous Thrombosis: A Hospital-Based Cohort Study

Abstract

Introduction Acute cerebral venous thrombosis (CVT) may result in a variety of clinical presentations, with headache being the most common. The relationship between clinical and neuroradiological characteristics in acute CVT patients is still not univocally characterized. Materials and methods We enrolled 32 consecutive acute CVT patients admitted to our emergency department from January 1, 2012, to June 30, 2019. Clinicoradiological associations and their relationship with the functional outcome at the discharge were tested. Results Headache was the presenting symptom in 85% of patients, more frequently subacute (82%), new-onset (67%), with unusual features in respect to prior headache episodes (100%), and associated with concomitant neurological symptoms/signs (74%). Patients with holocranial headache showed more frequent venous ischemia (VI) compared to those with bilateral and unilateral headache (50% vs. 20% vs. 0%, respectively; p=0.027). Patients with concomitant neurological defects had a higher prevalence of VI (50.0% vs. 15.0%; p=0.049) and superior sagittal sinus thrombosis (67% vs. 30%; p=0.043) than those without. Vomit was more frequently observed in patients with straight sinus thrombosis (67% vs. 8%; p=0.005). Increasing age and VI were independently associated with poor (modified Rankin scale (mRS) 2-5) functional outcome (odds ratio (OR) = 1.081, 95% confidence interval (CI) 1.004-1.165; p=0.038 and OR = 12.089, 95% CI 1.141-128.104; p=0.039, respectively). Conclusions Our study confirms and enriches available data on the clinicoradiological profile of patients with acute CVT and suggests that increasing age and venous ischemia are independently associated with poor outcomes.

Clinical Characteristics and Prognostic Factors of Non-Infectious Cerebral Venous Sinus Thrombosis

“…Consistent with other studies [ 5 , 13 , 17 , 18 , 19 , 20 ], our results show that a headache is the most common presentation of CVT [ 18 ]. The characteristics of a headache are mostly subacute onset and diffuse pain and may be aggravated by the Valsalva maneuver, but the patterns are mostly variable.…”

“…In a recent French study [ 19 ], the most frequently occluded sinuses were the transverse sinus, followed by superior sagittal sinus. Transverse, superior sagittal, and sigmoid sinuses are the most commonly involved sinus of CVT in Chinese and Italian populations [ 17 , 20 ].…”

“…In Portuguese and Dutch populations, older age and cerebral hemorrhage are predictors of death or dependence in cerebral venous thrombosis patients [ 13 ]. Older age and venous infarction are associated with poor clinical outcomes (defined by mRS ≥ 2) in Italians [ 20 ]. However, the associations between poor clinical outcome and cerebral infarction or hemorrhage are not seen in our study.…”

Venous stroke–a stroke subtype that should not be ignored

“…The most common clinical manifestation of CVT is cranial hypertension, as represented by headache and visual impairment ( 146 ). Headache is associated with CVT in at least 85% of patients ( 147 ). It usually presents as acute or pulsating pain in the holocranial, forehead, or vertex, which may be isolated or accompanied by other signs or symptoms ( 148 ).…”