Abstract
BackgroundCerebral venous sinus thrombosis (CVST) can infrequently lead to chronical intracranial hypertension (IH) due to the altered venous drainage. The aim of this study was to ascertain the risk of IH after CVST and to stratify underlying risk factors.MethodsWe performed a retrospective cohort analysis of all cases treated for acute CVST at our department between 2013 and 2019. IH was diagnosed at follow-up according to the modified Dandy criteria. CVST-patients with and without IH were descriptively compared conforming to available clinical and radiological data as well as outcomes.ResultsOur study included 102 patients with acute CVST. In 70 cases complete follow-up data was available (68.6%). Seven of these patients developed symptomatic intracranial hypertension (10%; N = 7, n = 70) within a median follow-up of 6 months. Four of these patients (57.1% (N = 4, n = 7) vs. 3.2% (N = 2, n = 63); p < 0.001) presented recurrent sinus thrombosis in the further course. There were no significant differences between patients with or without IH concerning gender, age, risk factors, occluded vessels and treatment for their CVST. However the presence of visual deterioration at initial admission was higher in patients who developed IH afterwards (57.1% (N = 4, n = 7) vs. 20.6% (N = 13, n = 63); p = 0.03). Patients with chronic IH after CVST showed significantly less likely recanalization of the occluded vessel on follow-up MRI (no recanalization in 28.6% (N = 2, n = 7) vs. 4.8% (N = 3, n = 63); p = 0.02). All patients with IH had a good outcome (mRS 0–2) at discharge and follow-up.ConclusionIH occurred in around 10% after CVST. Insufficient recanalization status may facilitate IH. Patients with visual disturbances seem to develop more likely IH afterwards. Patients who present IH after CVST may develop recurrent cerebral venous thrombosis.
Highlights
Cerebral Venous Sinus Thrombosis (CVST) is a rare cause of stroke with an incidence from 1.3 to 1.6 per 100,000 persons [1] which often occurs in younger adults [2]
Three patients already died during the acute-phase of the Cerebral venous sinus thrombosis (CVST), 8 patients had a clinical follow-up without imaging information and 21 more patients were lost to follow-up
Seven CVST-patients developed symptomatic intracranial hypertension (10%; N = 7, n = 70) according to the modified Dandy criteria which led to a presentation at the emergency department or at the outpatient clinic
Summary
Cerebral Venous Sinus Thrombosis (CVST) is a rare cause of stroke with an incidence from 1.3 to 1.6 per 100,000 persons [1] which often occurs in younger adults [2]. An increased cerebral pressure can be measured by lumbar puncture without evidence of structural reasons as stenosis of a sinus or postthrombotic constrictions [8]. Most prone to this condition are fertile and obese women who can present with visual deteroriations, papilledema and headache [8,9,10]. CVST can lead to chronical intracranial hypertension (IH) as a consequence of the altered venous drainage and can affect the overall outcome and quality of life. Cerebral venous sinus thrombosis (CVST) can infrequently lead to chronical intracranial hypertension (IH) due to the altered venous drainage. The aim of this study was to ascertain the risk of IH after CVST and to stratify underlying risk factors
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