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Neurocrit Care. 2016 Dec;25(3):392-399.

Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis.

Author information

1
Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
2
Department of Radiology and Neuroradiology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
3
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
4
Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
5
Department of Neurology, Nuremburg Hospital, Breslauer Str. 201, 90471, Nuremberg, Germany.
6
Department of Neurology, Ostalb Hospital, Im Kälblesrain 1, 73430, Aalen, Germany.
7
Department of Neurology, University Hospital Charité, Center for Stroke Research, Charitéplatz 1, 10117, Berlin, Germany.
8
Department of Neurology, University Hospital Jena, Erlanger Allee 101, 07747, Jena, Germany.
9
Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
10
Department of Neurology, University Hospital Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
11
Department of Neurology, University Hospital Munich (LMU), Marchioninistraße 15, 81377, Munich, Germany.
12
Department of Neurology, University Hospital Giessen, Klinikstr. 33, 35385, Giessen, Germany.
13
Department of Neurology, University Hospital Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
14
Institute of Neuroradiology, University Hospital Charité, Berlin, Germany.
15
Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany. christian.dohmen@uk-koeln.de.
16
Max Planck Institute for Metabolism Research, Cologne, Germany. christian.dohmen@uk-koeln.de.

Abstract

BACKGROUND:

Severe cerebral venous-sinus thrombosis (CVT) is a rare disease, and its clinical course, imaging correlates, as well as long-term prognosis have not yet been investigated systematically.

METHODS:

Multicenter retrospective study. Inclusion criteria were CVT, Glasgow coma scale ≤9, and treatment in the intensive care unit. Primary outcome was death or dependency, assessed by a modified Rankin Score (mRS) >2 at last follow-up.

RESULTS:

114 patients were included. At last follow-up (median 2.5 years), 38 patients (33.3 %) showed no or minor residual symptoms (mRS = 0 or 1), 12 (10.5 %) had a mild (mRS = 2), 13 (11.4 %) a moderate (mRS = 3), 12 (10.5 %) a severe disability (mRS = 4 or 5), and 39 (34.2 %) had died. In bivariate analysis, predictors of poor outcome were any signs of mass effect on imaging, clinical deterioration after admission, and age. In contrast, clinical symptoms on admission and parenchymal lesions per se, such as edema, infarction, or hemorrhage were not predictive. Multivariate predictors of poor outcome were an increase in National Institutes of Health Stroke Scale ≥3 after admission [odds ratio (OR) 6.7], bilateral motor signs in the further course (OR 9.2), and midline shift (OR 5.1).

CONCLUSION:

The outcome of severe CVT is almost equally divided between severe impairment or death and survival with no or only mild handicap. Specifically, space-occupying mass effect and associated neurologic deterioration seem to determine a poor outcome. Therefore, early detection and treatment of mass effect should be the focus of critical care.

KEYWORDS:

Cerebral venous thrombosis; Intensive care; Neurocritical care; Prognosis; Stroke

PMID:
27000641
DOI:
10.1007/s12028-016-0256-8
[Indexed for MEDLINE]

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