Predictors of Outcome in Patients With Cerebral Venous Thrombosis and Intracerebral Hemorrhage

Abstract

Background and Purpose— Although intracerebral hemorrhages are frequent in patients with cerebral venous thrombosis, and lead to worse outcome, predictors of outcome in cerebral venous thrombosis patients with intracerebral hemorrhages have never been evaluated in adequately powered studies. Methods— This study was conducted as a part of the International Study on Cerebral Vein and Dural Sinus Thrombosis. We evaluated predictors of outcome in cerebral venous thrombosis patients who had an “early intracerebral hemorrhage,” ie, intracerebral hemorrhages already present at time of diagnosis of cerebral venous thrombosis by a logistic regression analysis, with a modified Rankin scale 3 to 6 at month 6 as dependent variable. The same analysis was performed with “delayed intracerebral hemorrhages,” ie, intracerebral hemorrhages that occurred after the diagnosis of cerebral venous thrombosis, as dependent variable. Results— Of 624 patients recruited in International Study on Cerebral Vein and Dural Sinus Thrombosis, 245 (39%) had an early intracerebral hemorrhage: at month 6, 51 (21%) of them had a modified Rankin Scale 3 to 6. Independent predictors of having modified Rankin scale 3 to 6 at month 6 were older age (adjusted odds ratio for 1-year increase in age, 1.05; 95% CI, 1.02 to 1.08); male gender (adjusted odds ratio, 3.25; 95% CI, 1.29 to 8.16); having a deep cerebral venous system thrombosis (adjusted odds ratio, 5.43; 95% CI, 1.67 to 17.61) or a right lateral sinus thrombosis (adjusted odds ratio, 2.56; 95% CI, 1.03 to 6.40); and having a motor deficit (adjusted odds ratio, 2.94; 95% CI, 1.21 to 7.10). Of the 36 patients who had a delayed intracerebral hemorrhage, those who had a modified Rankin scale 3 to 6 at month 6 were less likely to have received heparin at the acute stage, and more likely to have had early intracerebral hemorrhage. Conclusion— Among patients with early intracerebral hemorrhage, those who were older, men, had a thrombosis of the deep cerebral venous system or of the right lateral sinus, and a motor deficit were at higher risk for death or dependency at month 6. This subgroup of patients with predictors of poor outcome can be the target for new therapeutic strategies.

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

“…In the past, CVST had been associated with a dismal prognosis and high mortality rate, reaching 30-50%. 5,54 Recent studies, 6,32,37,64,65,68 and especially the ISCVT study, performed in the era of modern neuroimaging, LMWH administration, and endovascular intervention, reported much lower mortality rates (8-14%) and significantly better outcome. A meta-analysis of 19 studies conducted by Dentali et al 22 showed that the mortality rate during the perihospitalization period was about 5.6%, while at the end of the follow-up period, this percentage increased to 9.4%.…”

Cerebral sinus venous thrombosis in puerperium: Review of the literature in the light of two cases

“…CASE REPORT 2 A 29 year old right-handed woman presented to our outpatient neurology clinic with a new onset of severe, pulsatile headaches around the entire head following postoperative seventh day of caesarean section with spinal anesthesia. VAS score of her headaches were 8 . She had vertigo, photophobia accompanying headaches.…”

Cerebral Venous Sinus Thrombosis: Incidence and Hyperhomocysteinemia as a Risk Factor in Japanese Patients

“…A meta-analysis of 17 clinical studies showed that oral contraceptive use, Leiden mutation of Factor V, and hyperHcy were recognized as statistically significant risk factors 8). A multinational (21 countries), multicenter (89 centers) prospective observational study entitled the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) [9][10][11][12][13] examined 624 cases of CVT and reported that the prevalence of hyper-Hcy is 4.5%. However, Boncoraglio et al reported from Italy that 10 of 26 patients (38.5%) with CVT had hyper-Hcy7).…”