Neurological Predictors of Functional Outcome in Cortical Venous Sinus Thrombosis

Abstract

Objectives Cerebral venous sinus thrombosis (CVST) has a wide clinical spectrum. Despite favorable prognosis, identifying CVST patients with a possible poor functional outcome can be challenging. This study aims to establish the neurological predictors of outcome in CVST. Materials and Methods We analyzed 70 patients of CVST and categorized them into three groups: Group I with isolated intracranial hypertension; Group II—focal syndrome of neurological deficit; Group III—subacute encephalopathy. Demographic, disease characteristics, and radiological parameters were also analyzed for prediction of hospital course. Functional outcome was assessed by modified Rankin scale (mRS) dichotomized as good (mRS: 0–2) or poor outcome (mRS ≥ 3). Statistical Analysis Univariate and multivariate logistic regression analyses were performed to find out the independent effects of prognostic factors to be used for outcome prediction. Results The mean age was 36.71 ± 14.9 years with 40 (68.8%) males. Most common presenting complaints were headache 35 (50%), hemiparesis 14 (20%), and seizures 12 (17.4%). Group I included 44 (62.9%), group II 17 (24.3%) and group III 12 (12.9%) patients. During hospitalization 28 (40%) patients needed intensive care unit (ICU) care, among them 7 (10%) required ventilation. There were eight times more chances of ICU care (odds ratio [OR]: 7.4; 2.5–24.4) and 23 times more need for ventilation (OR: 23; 2.5–88.9) whenever patients were in group II or III. Good outcome (mRS < 2) was noted in 52 (74.2%) patients. Headache was associated with good functional outcome, whereas hemiparesis with poor outcome. Neurological grouping was the independent predictor of functional outcome; patients with focal neurological deficit (group II) were 20 times more likely to have dependent life at the time of discharge (p < 0.05) with the mortality rate of 2.9%. Conclusions Neurological grouping is a practical tool for prediction of function outcomes. Early anticipation of prognosis helps in decision-making in the clinical practice.

Clinical and laboratory characteristics and outcome predictors of cerebral venous sinus thrombosis in a referral neurology hospital in Bangladesh

“… 26 Hemiparesis was a predictive factor of CVT outcome in our study, which is consistent with the results of numerous studies. 12 , 21 , 25 , 27 , 28 Altered consciousness could predict poor CVT outcome, which is in line with previous reports. 12 , 20 , 22 However, Girot et al.…”

Non-fasting Glucose Level at Admission Associated with Outcomes in Cerebral Venous Thrombosis

“…In our study, demographic characteristics, signs and symptoms, radiological findings, treatment, and outcomes were similar to those reported previously. [2][3][4][5][6][7][8][9][10][11] However, our results showed that 68.5% of the patients with CVT had protein S deficiency, which was higher than that previously reported by Karsy et al 8 (10.7%) and Pan et al 9 (55.5%). We provide two explanations for the difference in the percentage of patients with a protein S deficiency: (a) differences in genetic predispositions, or (b) the protein S level was obtained at the time of CVT diagnosis, before the initiation of anticoagulant treatment; therefore, the lower protein S level might be attributed to the effects of acute thrombosis.…”

“…Patients with CVT with headaches usually did not have impaired consciousness, and according to the study by Aarju et al, headaches in CVT might be associated with isolated intracranial hypertension, which was associated with a good outcome. 11 Further, OCP use induced thrombosis by increasing factor VII, factor X, and fibrinogen levels, which might be associated with the good outcome observed in our study since it is a precipitating factor that can be reversed by stopping OCP use, unlike some kinds of malignancies or genetic prothrombotic factors. Most prognostic factors related to poor outcomes have been described in previous reports, [2][3][4][5][6][7][8][9][10][11]16 except for the duration of the symptoms.…”

“…11 Further, OCP use induced thrombosis by increasing factor VII, factor X, and fibrinogen levels, which might be associated with the good outcome observed in our study since it is a precipitating factor that can be reversed by stopping OCP use, unlike some kinds of malignancies or genetic prothrombotic factors. Most prognostic factors related to poor outcomes have been described in previous reports, [2][3][4][5][6][7][8][9][10][11]16 except for the duration of the symptoms. We found that the duration of presenting symptoms of < 24 hours was associated with poor outcomes.…”

“…4 Recent studies have found various prognostic factors related to outcomes in CVT, which include sex, age, impaired consciousness, neurological deficit, seizure, ICH, brain herniation, and intra-and paracranial infection. [2][3][4][5][6][7][8][9][10][11] However, some results of these studies were inconclusive. In 2004, Ferro et al found that central nervous system (CNS) infection was associated with poor outcomes, whereas Shakibajahromi et al found no such association.…”