Delay in Hospital Admission of Patients with Cerebral Vein and Dural Sinus Thrombosis

Abstract

Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41–14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00–0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97–7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61–13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome.

Delay in the Diagnosis of Cerebral Vein and Dural Sinus Thrombosis

“…Two previous studies 1,2 identified clinical variables associated with admission delay, but could not demonstrate an influence of admission delay on outcome. The purposes of this study were to describe the delay in the diagnosis of CVT and to analyze its predictors and its influence on the outcome of a large cohort of patients with CVT.…”

“…Median admission delay and predictors of admission delay were consistent with the findings of the 2 previous studies with smaller sample sizes. 1,2 Early diagnosis is more likely to have a favorable influence in outcome if an intervention has increased efficacy if applied earlier. There are no studies analyzing the influence on outcome of the delay on starting anticoagulation.…”

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

“…34 The clinical picture of CVST may be expressed as 4 distinct syndromes or combinations of them with significantly varied morbidity and mortality. 29 The severity of CVST and the presenting clinical symptomatology as well as its overall outcome are affected by the patient's age and general medical condition, the anatomical location of the involved sinus and the associated cerebral veins, the extent and the degree of thrombosis, and the involvement of the cerebral parenchyma.…”

Noncontrast CT in Deep Cerebral Venous Thrombosis and Sinus Thrombosis: Comparison of its Diagnostic Value for Both Entities

“…The clinical signs are highly variable with headaches, seizures, focal neurologic deficits, and an impaired level of consciousness representing the most common symptoms. [3][4][5] Besides the patient's age, 6,7 the presence of parenchymal involvement, the interval from symptom to diagnosis, 8 and the site and extent of the thrombosis are important in the clinical presentation of thrombosis. 5,9,10 The deep cerebral veins (ie, the internal cerebral veins [ICVs], the basal veins of Rosenthal [BVR] and their tributaries) are involved in approximately 10% of patients.…”