Abstract
Background Severity of cerebral venous thrombosis (CVT) may require the transfer to intensive care unit (ICU). This report described the context for CVT transfer to ICU, the strategy of care and the outcome after 1 year.MethodsMonocentric cohort of 41 consecutive CVT admitted in a French ICU tertiary hospital (National Referent Center for CVT). Data collected are as follows: demographic data, clinical course, incidence of craniectomy and/or endovascular procedures and outcome in ICU, after 3 and 12 months.Results 47 years old (IQ 26–53), with 73.2 % were female, having a SAPS II 41 (32–45), GCS 7 (5–8), and at least one episode of mydriasis in 48.8 %. Thrombosis location was 80.5 % in lateral sinus and 53.7 % in superior sagittal sinus; intracranial hematoma was present in 78.0 %, signs of intracranial hypertension in 60.9 %, cerebral edema in 58.5 % and venous ischemia in 43.9 %. All patients received heparin therapy, and 9 cases had endovascular treatment (21.9 %); osmotherapy (53.7 %) and decompressive craniectomy (16 cases, 39 %) necessary to control intracranial hypertension. Ten patients/41 (24.4 %) died in ICU and 18/31 (58.1 %) were discharged from ICU with outcome 0–3 of mRS. After 12 months, 92 % of survivors (23/25) had a mRS between 0 and 3. The proportion of death was 31.7 % at 1 year.Conclusions The large proportion of acceptable outcome in survivors, which continue to functionally improve after 1 year, motivates the hospitalization in ICU for severe CVT. For similar CVT severity, craniectomy did not improve outcome in comparison with the absence of craniectomy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0135-7) contains supplementary material, which is available to authorized users.
Highlights
Severity of cerebral venous thrombosis (CVT) may require the transfer to intensive care unit (ICU)
This study reports the profile of severe CVT transferred to ICU, the monitoring used, the strategy of care with the observed complications and outcome in ICU and after 1 year
The diagnosis of CVT was usually established before ICU admission in all cases by computer‐ ized tomography (CT), venography, magnetic resonance imaging (MRI) or MRI combined with MR venography (MRV) and/or angiography
Summary
Severity of cerebral venous thrombosis (CVT) may require the transfer to intensive care unit (ICU). This report described the context for CVT transfer to ICU, the strategy of care and the outcome after 1 year. Cerebral venous thrombosis (CVT) is a difficult diagnosis of a rare brain vascular disease accounting for 0.5–1 % of all strokes [1, 2]. The authors mentioned 26 cases (4.1 %) with severe clinical presentations, but with elusive clinical information and care strategies and intensive care unit (ICU) hospitalization or not. There is no article on strategy of care and outcome of CVT patients requiring ICU admission. This study reports the profile of severe CVT transferred to ICU, the monitoring used, the strategy of care (supportive and instrumental interventions) with the observed complications and outcome in ICU and after 1 year
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