Abstract
Patients with cerebral venous sinus thrombosis (CVST) occasionally present with intracerebral hemorrhage (ICH). In this study, we aimed to identify predictors for ICH in CVST patients. Prospective CVST databases from three academic centers were retrospectively analyzed. CVST patients with and without ICH upon presentation were compared. Among the 404 included patients (mean age 41.8 years, 33% male), 74 (18.3%) had an ICH. The patients with ICH were older (45 ± 20.6 vs. 41.1 ± 18 years, p = 0.045), and were more often pregnant or postpartum women (15% vs. 6%, p = 0.011), or chronically hypertensive (15% vs. 5%, p = 0.001). The ICH patients had higher rates of seizures (60% vs. 15%, p < 0.001), and focal neurological deficits (53% vs. 23%, p < 0.001). The ICH group had lower rates of excellent outcome measured by 90-day mRS 0 (56.7% vs. 80.3%, p < 0.001) and higher rates of 90-day mortality (8% vs. 3%, p = 0.041). Radiological variables associated with ICH included superior sagittal sinus (SSS) thrombosis (63% vs. 36%), isolated cortical vein thrombosis (38% vs. 8%), and presence of venous infarction (34% vs. 7%) (p < 0.001 for all). Upon multivariate analysis, chronic hypertension (OR 3.7, p = 0.027), being either pregnant or postpartum (OR 4.3, p = 0.006), isolated cortical thrombosis (OR 3.5, p = 0.007), and SSS involvement (OR 3.4, p < 0.001) were independently associated with ICH upon admission. In conclusion, among CVST patients, the following present higher for ICH: pregnant or postpartum women, and individuals with chronic hypertension, cortical vein, or SSS involvement.
Highlights
Up to 40% of patients with cerebral venous sinus thrombosis (CVST) present with an intracranial hemorrhage (ICH) [1,2], which presents a challenge to anticoagulation therapy [3]
We identified all patients with CVST aged 18 and above but excluded from this analysis patients diagnosed with CVST younger than 18, or secondary to head trauma, otolaryngeal, or neurosurgical procedures (n = 157)
Pregnancy and the peripartum period were significantly associated with ICH (15% vs. 6%, p = 0.011)
Summary
Up to 40% of patients with cerebral venous sinus thrombosis (CVST) present with an intracranial hemorrhage (ICH) [1,2], which presents a challenge to anticoagulation therapy [3]. In the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT), the presence of ICH was implicated as a poor prognostic factor [4,5]. Patients presenting with ICH in the study were older and had a more severe clinical presentation with either seizures, coma, or focal neurological deficits. The ISCVT was performed over 20 years ago; since awareness has increased, and improved diagnostic measures have been introduced. We aimed to update our understanding of the frequency of ICH in CVST patients and develop a profile of their clinical and radiological characteristics
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