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Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis.
- Source :
- Neurocritical Care; Dec2016, Vol. 25 Issue 3, p392-399, 8p
- Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- SINUS thrombosis
BRAIN imaging
INTENSIVE care units
STATISTICAL correlation
CLINICAL trials
PROGNOSIS
THERAPEUTICS
ANTICOAGULANTS
CEREBRAL angiography
CEREBRAL embolism & thrombosis
CEREBRAL veins
COMPARATIVE studies
LONGITUDINAL method
RESEARCH methodology
MEDICAL cooperation
HEALTH outcome assessment
RESEARCH
VENOUS thrombosis
VENOGRAPHY
EVALUATION research
RETROSPECTIVE studies
SEVERITY of illness index
DISEASE progression
DIAGNOSIS
Subjects
Details
- Language :
- English
- ISSN :
- 15416933
- Volume :
- 25
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- Neurocritical Care
- Publication Type :
- Academic Journal
- Accession number :
- 119973715
- Full Text :
- https://doi.org/10.1007/s12028-016-0256-8