Risk Score to Predict the Outcome of Patients with Cerebral Vein and Dural Sinus Thrombosis

Abstract

Background: Around 15% of patients die or become dependent after cerebral vein and dural sinus thrombosis (CVT). Method: We used the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) sample (624 patients, with a median follow-up time of 478 days) to develop a Cox proportional hazards regression model to predict outcome, dichotomised by a modified Rankin Scale score >2. From the model hazard ratios, a risk score was derived and a cut-off point selected. The model and the score were tested in 2 validation samples: (1) the prospective Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT) sample with 91 patients; (2) a sample of 169 consecutive CVT patients admitted to 5 ISCVT centres after the end of the ISCVT recruitment period. Sensitivity, specificity, c statistics and overall efficiency to predict outcome at 6 months were calculated. Results: The model (hazard ratios: malignancy 4.53; coma 4.19; thrombosis of the deep venous system 3.03; mental status disturbance 2.18; male gender 1.60; intracranial haemorrhage 1.42) had overall efficiencies of 85.1, 84.4 and 90.0%, in the derivation sample and validation samples 1 and 2, respectively. Using the risk score (range from 0 to 9) with a cut-off of ≥3 points, overall efficiency was 85.4, 84.4 and 90.1% in the derivation sample and validation samples 1 and 2, respectively. Sensitivity and specificity in the combined samples were 96.1 and 13.6%, respectively. Conclusions: The CVT risk score has a good estimated overall rate of correct classifications in both validation samples, but its specificity is low. It can be used to avoid unnecessary or dangerous interventions in low-risk patients, and may help to identify high-risk CVT patients.

Clinical, Etiological and Prognostic Factors of Cerebral Venous Sinus Thrombosis in Kashmir-North India

“…Douglas et al reported that frequency of peripartum intracranial venous thrombosis is 8.9 to 11.6 cases per 100 000 deliveries (23,24) . In our cohort 33.33% of the females were in the postpartum state as opposed to 15% reported from the west (21,25) . The plausible reason for this difference include home deliveries in unhygienic environments and certain rites like water deprivation during immediate postpartum period.…”

“…Clinical presentation of our cohort is almost identical to what has been reported from the west. 88.88% percent of our patients had mental status changes including drowsiness, confusion, and agitation, as compared to 22% reported in International Study on Cerebral Venous and Dural Sinus Thrombosis (ISCVT) (21,22) . We noted a median duration from symptom onset to hospital presentation as 5days, as compared to 4 days in other reports (21,22) .…”

“…88.88% percent of our patients had mental status changes including drowsiness, confusion, and agitation, as compared to 22% reported in International Study on Cerebral Venous and Dural Sinus Thrombosis (ISCVT) (21,22) . We noted a median duration from symptom onset to hospital presentation as 5days, as compared to 4 days in other reports (21,22) . Douglas et al reported that frequency of peripartum intracranial venous thrombosis is 8.9 to 11.6 cases per 100 000 deliveries (23,24) .…”

Diagnosis and Management of Cerebral Venous Thrombosis

“…6,10,89 Table 6 summarizes demographic, imaging, and clinical variables associated with poor prognosis. 281,282 A Glasgow Coma Scale score of 14 to 15 on admission, a complete or partial intracranial hypertension syndrome (including isolated headache) as the only manifestation of CVT, and absence of aphasia were variables associated with a favorable outcome. 117,177 …”

Field Synopsis of the Role of Sex in Stroke Prediction Models

“…Sex was included in only 6% (1/16) of models predicting any outcome among patients with hemorrhagic stroke, as compared to 24% (6/25) of such models among ischemic stroke patients. Study‐ and model‐level characteristics of the 30 stroke‐related CPMs that included sex are presented in Table 2 25, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54…”