Cerebral Venous Thrombosis Patients Research Articles

Prediction of Long-Term Poor Clinical Outcomes in Cerebral Venous Thrombosis Using Neural Networks Model: The BEAST Study.

Risk prediction models are commonly performed with logistic regression analysis but are limited by skewed datasets. We utilised neural networks (NNs) model to identify independent predictors of poor outcomes in cerebral venous thrombosis (CVT) due to the limitations of logistic regression (LR) analysis with complex datasets. We evaluated 1309 adult CVT patients from the prospective BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. The area under the receiver operating characteristic (AUROC) curve confirmed the goodness-of-fit of prediction models. The normalised importance (NI) of the NNs determines the significance of independent predictors. The stepwise logistic regression model found thrombolysis (OR 32.1; 95% CI 3.6-287.0; P=0.002), craniotomy (OR 6.9; 95% CI 1.3-36.8; P=0.02), and cerebral haemorrhage (OR 4.5; 95% CI 1.3-15.4; P=0.01) as predictors of poor clinical outcome with the AUROC of 0.71. Conversely, the NNs model identified major independent predictors of long-term poor clinical outcomes as cerebral haemorrhage (NI 100%) and thrombolysis (NI 98%), as well as trivial predictors of age (NI 2.8%) and altered mental status (NI 3.5%). The accuracy of the NNs model was 95.1% and 94.1% for self-learned randomly selected training and testing samples with an AUROC of 0.82. Positive and negative predictive values for poor outcomes were 13.2% and 97.1% for the LR model, compared with the NNs model of 18.8% and 98.7%, respectively. Cerebral haemorrhage and thrombolysis was a strong independent predictor, whereas age merely impacts the long-term poor clinical outcome in adult CVT. Integrating unorthodox neural networks risk prediction model can improve decision-making as it outperforms conventional logistic regression with complex datasets.

Health Care Encounters Prior to Hospitalization for Cerebral Venous Thrombosis Patients.

Unlike other causes of stroke, symptoms in cerebral venous thrombosis (CVT) can be nonspecific at onset with gradual worsening over time. To explore potential opportunities for earlier diagnosis, we analyzed healthcare interactions in the week prior to hospitalization for patients admitted with incident CVT in British Columbia (BC). We constructed a population-based cohort (2000-2017) using linked patient-level administrative data to identify patients aged ≥18 diagnosed with CVT in BC. We used descriptive analysis to describe the frequency and types of healthcare encounters within the 7 and 3 days prior to hospitalization. Multivariable logistic regression modeling was performed to examine risk factors associated with prior encounters. The cohort included 554 patients (mean age 50.9 years, 55.4% female). Within the 7 days prior to CVT hospitalization, 57.9% of patients had ≥1 outpatient encounter and 5.6% had ≥1 inpatient encounter. In the 3 days prior to hospitalization, 46.8% of patients had ≥1 outpatient encounter and 2.0% had ≥1 inpatient encounter. Women more frequently had outpatient interactions within 7 days (64.8% women vs. 35.2% men, p < 0.001) and 3 days (51.8% vs. 48.2%, p = 0.01) before admission. Common provider specialties for outpatient encounters were general practice (58.0%), emergency (8.3%) and neurology (5.7%). Females had higher odds (OR = 1.79) of having ≥1 outpatient encounter after adjusting for confounding. Within our Canadian cohort, over half of patients had a healthcare encounter within 7 days before their hospitalization with incident CVT. Women more commonly had an outpatient encounter preceding hospital admission.

Reducing the global burden of cerebral venous thrombosis: An international research agenda.

Due to the rarity of cerebral venous thrombosis (CVT), performing high-quality scientific research in this field is challenging. Providing answers to unresolved research questions will improve prevention, diagnosis, and treatment, and ultimately translate to a better outcome of patients with CVT. We present an international research agenda, in which the most important research questions in the field of CVT are prioritized. This research agenda has three distinct goals: (1) to provide inspiration and focus to research on CVT for the coming years, (2) to reinforce international collaboration, and (3) to facilitate the acquisition of research funding. This international research agenda is the result of a research summit organized by the International Cerebral Venous Thrombosis Consortium in Amsterdam, the Netherlands, in June 2023. The summit brought together 45 participants from 15 countries including clinical researchers from various disciplines, patients who previously suffered from CVT, and delegates from industry and non-profit funding organizations. The research agenda is categorized into six pre-specified themes: (1) epidemiology and clinical features, (2) life after CVT, (3) neuroimaging and diagnosis, (4) pathophysiology, (5) medical treatment, and (6) endovascular treatment. For each theme, we present two to four research questions, followed by a brief substantiation per question. The research questions were prioritized by the participants of the summit through consensus discussion. This international research agenda provides an overview of the most burning research questions on CVT. Answering these questions will advance our understanding and management of CVT, which will ultimately lead to improved outcomes for CVT patients worldwide.

A Study of the Correlation of Pulsatility Index by Transcranial Doppler in the Clinical Outcome of Patients with Cerebral Venous Sinus Thrombosis

Background Cerebral Venous Thrombosis (CVT), accounting for 3% of strokes, can be assessed using non-invasive Transcranial Doppler (TCD) ultrasound to measure cerebrovascular function in real-time. The TCD-derived pulsatility index (PI), highly correlates with intracranial pressure (ICP) and serves as a reliable non-invasive monitoring tool. Aim This study aims to correlate PI by TCD with clinical outcomes in CVT patients. Methods A prospective observational study of 41 CVT patients admitted between June 2022 to December 2022 was conducted in the Department of Neurology of MBS Hospital. Each patient was subjected to TCD and the PI was also recorded. The results were analysed with SPSS. Results Out of the 41 patients, two patients died and 39 patients were discharged. The PI at admission in the left middle cerebral artery (MCA) was 1.19 ± 0.20 amongst discharged and 1.64 ± 0.10 amongst those who died ( p = .003). Similarly, the PI at admission in the right MCA was 1.23 ± 0.21 amongst those discharged and 1.63 ± 0.20 amongst those who died ( p = .02). Also, PI in both left and right MCA positively and significantly correlated with CVT GS score at admission (r = 0.70, p &lt; .05; r = 0.64, p &lt; .05). Conclusion PI at admission is both right and left MCA was found to be significantly higher in patients who died during the hospital stay. Also, PI significantly correlated with the CVT GS score at the presentation. Thus, PI at admission by TCD can predict the clinical outcome of patients with CVT.

Acute management of cerebral venous thrombosis: Indications, technique, and outcome of endovascular treatment in two high-volume centers.

After several uncontrolled studies and one randomized clinical trial, there is still uncertainty regarding the role of endovascular treatment (EVT) in cerebral venous thrombosis (CVT). This study aims to describe and assess different acute management strategies in the treatment of CVT. We performed a retrospective analysis of an international two-center registry of CVT patients admitted since 2019. Good outcome was defined as a return to baseline modified Rankin scale at three months. We described and compared EVT versus no-EVT patients. We included 61 patients. Only one did not receive systemic anticoagulation. EVT was performed in 13/61 (20%) of the cases, with a median time from diagnosis to puncture of 4.5 h (1.25-28.5). EVT patients had a higher median baseline NIHSS [6 (IQR 2-17) vs 0 (0-2.7), p = 0.002)] and a higher incidence of intracerebral hemorrhage (53.8% vs 20.3%, p = 0.03). Recanalization was achieved in 10/13 (77%) patients. Thrombectomy was performed in every case with angioplasty in 7 out of 12 patients and stenting in 3 cases. No postprocedural complication was reported. An improvement of the median NIHSS from baseline to discharge [6 (2-17) vs 1(0-3.75); p < 0.001] was observed in EVT group. A total of 31/60 patients (50.8%) had good outcomes. Adjusting to NIHSS and ICH, EVT had a non-significant increase in the odds of a good outcome [aOR 1.42 (95%CI 0.73-2.8, p = 0.307)]. EVT in combination with anticoagulation was safe in acute treatment of CVT as suggested by NIHSS improvement. Selected patients may benefit from this treatment.

Cerebral Venous Thrombosis in Patients With Traumatic Brain Injury: Epidemiology and Outcome.

The natural history and epidemiological aspects of traumatic cerebral venous thrombosis (CVT) are not fully understood. Due to the concomitant occurrence with intracranial hemorrhages, guidelines for medical treatment have been highly controversial.In this study, our objective was to carry out an analysis description of the population and to conduct a literature review. A prospectively gathered radiology registry data of patients hospitalized at the tertiary hospital of Centro Hospitalar Universitário do São João, Porto, Portugal, between 2016 and 2021 was carried out. All patients with traumatic brain injury (TBI) and concomitant CVT were identified. CVT was confirmed by CT venogram. Demographic, clinical, and radiological data and their medical management were reported. In-hospital complications and treatment outcomes were compared between patients measured by the Glasgow Outcome Score Extended (GOSE) at discharge and GOSE at three months. There were 41 patients with traumatic CVT admitted to this study. The majority (45.2%) had a hyperdense signal near the lateral sinus at admission, and only 26.2% presented with skull fractures. Of this cohort, 95% had experienced lateral sinus thrombosis. Twenty-five patients (60%) had occlusive venous thrombosis. Venous infarct was the main complication following CVT.Thirty-two patients (78%) were anticoagulated after CVT and four developed complications. At the three-month follow-up after discharge, 28.2% had good recovery (GOSE > 6). This study revealed a higher incidence of CVT in severe TBI and a mild association with skull fractures. There is a higher incidence of CVT in the lateral sinus. Management was inconsistent, with no difference in outcome without or with anticoagulation. Larger, prospective cohort studies are required to better comprehend this condition and determine evidence-based guidelines.

Non-fasting Glucose Level at Admission Associated with Outcomes in Cerebral Venous Thrombosis

Background and Purpose Cerebral venous thrombosis (CVT) is a rare form of stroke. The objective of this study was to investigate the characteristics, outcomes, and prognostic factors of CVT patients. Methods This is a five-year retrospective study of CVT patients admitted to our Hospital from April 2016 to April 2021. Medical records were accessed to confirm the diagnosis and obtain the clinical, imaging, laboratory, and treatment data. Further, outcomes of the patients at three months were collected. Binary logistic regression was used to analyse the prognostic factors. Results Seventy-three patients with CVT were analysed (35.6% male; mean age, 44.3 years). A poor outcome (modified Rankin scale score, 3–6) was 17.8% of patients, and mortality was 10.9%. Factors associated with poor outcomes in all patients with CVT included the duration of presenting symptoms &lt;24 hours (OR: 3.95, 95% CI: 1.13–13.82), age ≥ 50 years (OR: 8.12, 95% CI: 2.16–30.71), a non-fasting glucose level of ≥ 200 mg/dL (OR: 9.58, 95% CI: 1.90–48.25), impaired consciousness (Glasgow coma scale score, 3–8) (OR: 5.63, 95% CI: 1.39–22.81), male sex (OR: 3.73, 95% CI: 1.07–12.98), and brain herniation (midline shift ≥ 5 mm) (OR: 8.75, 95% CI: 1.94–39.57). Headache and use of an oral contraceptive pill were associated with good outcomes in all of the patients. Conclusion The non-fasting glucose level, a modifiable prognostic factor, exhibited the highest correlation with poor outcomes in CVT patients.

Abstract WMP49: Outcomes of Patients With Cerebral Venous Thrombosiswith and Without COVID-19 Infection

Introduction: COVID-19 infection has thus emerged to be a new risk factor for Cerebral Venous Thrombosis (CVT). Our study aimed to compare outcomes of patients diagnosed with CVT within 2 weeks of COVID infection compared to those without COVID-19. Methods: Adult patients with CVT diagnosis from 2020-2022 in TriNetX COVID research network were included in the study. Patients diagnosed with COVID within 2 weeks of CVT diagnosis were defined as CVT with COVID. CVT without COVID group included those without COVID diagnosis any time before and up to three months after diagnosis of CVT. All-cause mortality was the primary outcome. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), epilepsy, deep vein thrombosis and pulmonary embolism were secondary outcomes. 1:1 propensity score matching was performed to control for age, sex, race, ethnicity, obesity, malignancy and medications. The two groups were compared with cox proportional hazard analysis and reported as hazard ratio (HR) and 95% confidence interval (CI). Results: A total of 424 patients with CVT and COVID-19 and 8,969 patients with CVT without COVID met the study criteria. After 1:1 propensity score matching, 422 patients were included in both cohorts. The group CVT with COVID-19 infection within two weeks of diagnosis of CVT had two times higher risk of all-cause mortality at one month [31 (7.3%) vs 16 (3.8%); HR=1.94; 95% CI=1.06-3.55] and three months [43 (10.2%) vs 17 (4.0%); HR=2.57; 95% CI=1.46-4.50] compared to CVT without COVID. CVT patients with COVID were two times more likely to have complications of ICH [1 month: 11.6% vs 5.5%; HR=2.16; 95% CI=1.23-3.64 and three months: 11.6% vs 6.3%; HR=1.90; 95% CI=1.15-3.13] and SAH [1 month: 8.3% vs 4.2%; HR=2.00; 95% CI=1.11-3.59 and three months: 8.3% vs 4.5%; HR=1.89; 95% CI=1.07-3.36]. CVT with COVID patients were more likely to develop deep vein thrombosis at one month (19.8% vs 13.6%; HR=1.51; 95% CI=1.04-2.20) but not at three months. There was no difference in diagnosis of AIS, epilepsy and pulmonary embolism at one and three months in the two groups. Conclusion: CVT patients with COVID-19 infection in the prior two weeks are two times more likely to die and have complications of ICH and SAH compared to CVT without COVID-19.

Abstract WP260: Higher Incidence of Cerebral Venous Thrombosis Seen During the First Year of the COVID-19 Pandemic: Insights From the National Inpatient Sample

Background: Cerebral venous thrombosis (CVT) is associated with significant risk of death and disability. Prior research has found patients with COVID-19 had higher incidences of system venous and arterial thrombosis, however, there has been little research into its impact on incidence of CVT. Objective: Determine whether the incidence of CVT was higher during the first year of the COVID-19 pandemic. Methods: A cross-sectional study utilizing data from the National Inpatient Sample (NIS) was performed. Adult patients in 2018 (n=6,051,974) were compared to those in 2020 (n=5,470,813), the first year of the COVID-19 pandemic. To prevent potential confounding by undiagnosed COVID-19, patients in 2019 were not utilized in the analysis. ICD-10 codes were utilized to identify patients with CVT along with additional diagnoses, including COVID-19 infection. Odds ratios and 95% confidence intervals were calculated and compared using t-tests. Rates of CVT were also calculated. Results: There were 731 (weighted estimate for the US population n=3,655, rate of 13.4 cases per 100,000 admissions) patients with CVT in 2020, compared to 641 patients in 2018 (weighted n=3,205, rate of 10.6 per 100,000 admissions; p-value 0.003; cOR=1.26, 95% CI=1.08-1.47). Female patients had a higher incidence of CVT in both years (58.6% versus 62.5%) with no significant between year difference. No age or race difference was identified. Hospital mortality rate among CVT patients admitted in 2020 was 5%. Twelve patients were diagnosed with concurrent COVID-19 infections. Length of stay among CVT patients admitted in 2018 and 2020 was similar (7.89 versus 8.06 days). However, CVT patients with concurrent COVID-19 had a longer hospital stay than those without COVID-19 (18 versus 8 days; p-value&lt;0.001). Conclusions: There was a significantly higher incidence of CVT among hospitalized patients during the first year of the COVID-19 pandemic compared to 2018. This finding is consistent with the previously described higher rates of thrombotic disorders during the COVID-19 pandemic and should prompt further study.

Abstract TP267: Cerebral Venous Thrombosis at High Altitude: A Comparison of Patients From Plateau and Plain in China

Introduction: Exposure to high altitude environment is a risk factor of cerebral venous thrombosis (CVT) probably due to the hypercoagulability. The study aims to explore the unique clinical, risk factors, and prognostic characteristics of CVT patients in high-altitude areas of China by comparing them with CVT patients in plain areas. Methods: We retrospectively included consecutive patients with CVT admitted to Tibet Autonomous Region People’s Hospital and Peking Union Medical College Hospital (PUMCH) between January 2015 and June 2022. The risk factors, clinical and radiological presentations, treatment, and outcomes were analyzed. Results: A total of 43 patients with CVT from Tibet and 111 patients from PUMCH were included. The median age was 31 and 35 years old, and women accounted for 65.1% and 54.1% respectively. Headache (90.7% vs. 71.2%, P=0.01) and altered consciousness (32.6% vs. 15.3%, P=0.017) were more common in patients from Tibet. Hemorrhage (44.2% vs. 19.8%, P=0.002) and venous infarction (51.2% vs. 25.2%, P=0.002) were more prevalent in Tibetan patients. The proportion of pregnant or postpartum patients in plateau areas was significantly higher than that in plains (27.9% vs. 5.4%, P=0.000). The levels of C-reactive protein (17.9 vs. 3.28 mg/L, P=0.011) and D-Dimer (2.15 vs. 1.1mg/L FEU, P=0.014) were greatly higher in patients from Tibet. The percentage of patients receiving anticoagulant therapy was lower in Tibet than that in PUMCH (67.4% vs. 92.8%, P=0.000). All three Tibet patients who died in hospital had recent infections, and two in-hospital deaths in PUMCH were attributed to severe pneumonia and cerebral hernia. Favorable outcome (modified Ranking Score, mRS 0-2) at follow-up was observed in 81.6% of patients in Tibet and 89.9% of those in PUMCH, with the median follow-up time of 396 days and 913 days respectively. Conclusions: The clinical and imaging manifestations are more severe in patients from Tibet. Pregnancy or puerperium is more common in patients from Tibet. The levels of inflammation and coagulation indexes in Tibetan patients are significantly higher than those in plain. Although the proportion of anticoagulant therapy in patients with high-altitude CVT is relatively low, the prognosis is good.

Safety of pregnancy after cerebral venous thrombosis: A case-control study.

Since pregnancy is considered one of the major risk factors of cerebral venous thrombosis (CVT), the safety of pregnancy in women of childbearing age and a previous history of CVT, is concerning in terms of prevention, family planning, and management. This study aims to estimate the prevalence of pregnancies among women of childbearing age with previous CVT, evaluate the pregnancy-associated risk of CVT recurrence, and explore the maternal and fetal outcomes among CVT women in comparison with pregnant women without a history of CVT. A retrospective, case-control study was conducted at the Obstetrics Departments of King Fahad Medical City Hospital, Saudi Arabia. It included all women with a history of CVT diagnosed in the last 5 years (cases), as well as CVT history-free pregnant women (control). The prevalence of pregnancy after CVT was estimated and the prepartum and postpartum parameters of the two groups were compared. Fifty women with CVT and 100 controls were included. Among the 50 CVT cases, 28 (56.0%) have been pregnant. The incidence of pre-eclampsia was significantly more frequent in CVT women (7.1% vs. 0.0%, p = 0.047); however, only one case of deep vein thrombosis (3.6%) was reported in CVT patients versus none in controls (p = 0.219). CVT women delivered at a lower gestational age (mean [SD] = 36.9 [3.5] weeks) compared with controls (38.3 [1.4] weeks) (p = 0.006). No significant differences in other pregnancy or delivery outcomes were observed between the two groups. More than half of women of childbearing age with a history of CVT opt for pregnancy after the CVT episode, with no major additional risk for pre or postpartum complications.

Fate of Papilledema in Cerebral Venous Thrombosis Patients and its Correlation to Affected Cerebral Venous Sinuses

Background: Cerebral venous thrombosis is an important cause of stroke in young and middle-aged adults with estimated (3-4) cases per million annual incidences. Papilledema is the most common sign detected in these patients that can end by blindness if not monitored and treated well. This research aims to assess development and prognosis of papilledema and its association with certain cerebral venous sinuses thrombosis. Evaluation of the optic nerve head has been done clinically and by using optical coherence tomography. Methods: A descriptive analytic hospital-based study was conducted in neurology unit at wad medani teaching hospital from December 2021 to July 2022. 20 patients were included in the study. Data including optical coherence tomography reports was collected at admission and after 2 months. Analysis was done using SPSS version 25 to report frequency of papilledema, 2months visual outcome, correlation of MRI\MRV findings with the development and outcome of papilledema. Results: This study include 20 cerebral venous thrombosis patients with mean age of 35.75 years. Papilledema present in 70% at initial presentation in whom the superior sagittal sinus was affected in 78.6%, after two months period papilledema regressed in80%, 10% developed optic atrophy and10% died. There is clear correlation between the sinus affected and the development of papilledema (P value=0.009); in contrast no relation between the sinus affected and the two months visual outcome of papilledema (P value=0.417). Conclusion: Papilledema regressed in most CVT patients while small number of them developed optic atrophy confirming the importance of regular ophthalmological follow up of CVT patients at frequent intervals using OCT in addition to other papilledema assessment tools in order to prevent irreversible blindness. Affection of certain cerebral venous sinus can predict development of papilledema in CVT patients, but not the outcome.

ABO blood group associated with cerebral venous thrombosis after Oxford-AstraZeneca COVID-19 vaccination: a case-control study.

To determine whether blood group influences development of cerebral venous thrombosis (CVT) after administration of the coronavirus disease 2019 (COVID-19) AstraZeneca ChAdOx1-S vaccine. A case-control study. Univariate and multivariate logistic regression was used to determine the association between blood type and COVID-19 vaccination status. Vaccinated and unvaccinated patients recruited from the international Bio-Repository to Establish the Aetiology of Sinovenous Thrombosis study and the Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group. All patients were of European descent and age and sex matched. Cases (n = 82) were patients ≥18 years old who suffered a CVT within 28 days of a first dose of ChAdOx1-S vaccine. Controls (n = 441) were unvaccinated CVT patients ≥18 years old. All patients were of European descent. Frequency of blood type and ABO allele distribution by vaccination status. Blood group O was found to be more prevalent among CVT patients with vaccine-induced thrombotic thrombocytopenia (VITT-CVT) after ChAdOx1-S vaccination compared with unvaccinated CVT cases (43% vs. 17%, respectively, p < 0.001). Blood group A was less prevalent, though still high, in the vaccinated group compared with the unvaccinated group (47% vs. 71%, respectively, p < 0.001). No significant differences were observed in the VITT-CVT non-ChAdOx1-S vaccine group and unvaccinated pre-COVID-19 CVT group for blood group. Blood group O is more prevalent among patients with VITT-CVT after ChAdOx1-S vaccination compared with unvaccinated cases, independent of well-established CVT risk factors. A larger dataset may be able to determine whether those of blood groups B and/or AB may be safely vaccinated with the low cost, readily available and easily transported ChAdOx1-S rather than adopting a complete ban.

Cerebral Venous Thrombosis Among Bangladeshi Population: A Systematic Review.

Cerebral venous thrombosis (CVT) is a rare cause of stroke which remains unsung among Bangladeshi physicians and the general population. Our objective was to provide a comprehensive review of published data on Bangladeshi CVT patients. We searched all-electronic databases for Bangladeshi studies on CVT until November 2023, including literature in all languages. This study reviews the age of onset, gender distribution, radiological characteristics, and outcomes of Bangladeshi CVT patients.We included 13 studies (two observational and 11 case reports) that evaluated102 CVT patients and found that women suffered CVT significantly higher than men (59.8% vs 40.2%; P =0.04), respectively. The overall age of the study population was 36.6±6.8, and men were significantly older than women (45.4±12.3 vs. 32.4±8.3; P<0.001). The most commonly affected sites were the superior sagittal sinus and transverse sinus thrombosis. Rivaroxaban was primarily used for long-term anticoagulation after initial low molecular weight heparin therapy. Furthermore, most studies observed an excellent clinical outcome with completed recanalisation on early follow-up angiography in three studies. In Bangladesh, women 1.5 times more commonly suffer from CVT and 13 years earlier than men. Although this review found that prompt diagnosis and anticoagulation therapy provides good clinical outcome, we recommended further studies to evaluate the long-term outcome, especially the safety and efficacy of oral anticoagulants, with recanalisation and recurrence rate.

Prognosis after cerebral venous thrombosis: Mortality during initial admission and at 30 days and one year after discharge in a large Canadian population-based cohort

BackgroundPrognosis following cerebral venous thrombosis (CVT) is more favorable than other stroke types, but longer-term literature is limited, and trends over time are under-explored. ObjectiveUsing administrative data, we examined factors associated with mortality in the inpatient setting, at 30 days and at one year following hospital discharge among a large consecutive cohort of Canadian patients with CVT. Design/methodsCVT patients from British Columbia (BC), Canada from 2000 to 2017 were identified using ICD diagnosis codes from the BC subset of the Canadian Institute for Health Information's Discharge Abstract Database. Logistic regression was used to investigate factors associated with inpatient mortality and survival analysis with Cox regression was used to explore factors associated with mortality at 30 days and one year. ResultsOf 554 incident CVT patients identified, 508 (92 %) survived their index admission. Older age (OR 1.04, 95 % CI 1.03–1.06, p < 0.01) and the presence of seizures (OR 2.31, 95 % CI 1.08–4.94, p = 0.03) or intracranial bleeding (OR 2.28, 95 % CI 1.08–4.85, p = 0.03) were associated with increased odds of inpatient mortality. Mortality after hospital discharge was 3.0 % at 30 days and 9.4 % at one year. Older age (HR 1.05, 95 % CI 1.02–1.08, p < 0.01 at 30 days; HR 1.05, 95 % CI 1.04–1.07, p < 0.01 at 1 year) and having recent or active malignancy (HR 4.17, 95 % CI 1.51–11.52, p < 0.01 at 30 days; HR 4.60, 95 % CI 2.60–8.11, p < 0.01 at 1 year) were significantly associated with higher risks of mortality at 30 days and one year after discharge. There were decreases in inpatient mortality over the study period, but this was offset by higher mortality within 30 days after discharge in the later study epochs. ConclusionsAmong patients discharged with a diagnosis of CVT, one-year mortality was high at 9.4 %. Older age and a history of cancer were associated with higher mortality after discharge.

Dural Arteriovenous Fistulas With or Without Cerebral Venous Thrombosis: A Cross-Sectional Analysis of 511 Patients.

Recent studies suggest a bidirectional relationship of dural arteriovenous fistula (DAVF) with cerebral venous thrombosis (CVT). We aimed to compare the characteristics of patients with DAVF with or without CVT and to analyze the risk factors for the coexistence of CVT in a DAVF population. A total of 511 adult patients with DAVF were enrolled consecutively in our hospital from February 2019 through November 2022. Demographic data, clinical manifestations, and imaging characteristics were reviewed in detail. The patients with DAVF were divided into two groups: DAVF with CVT (DAVF-CVT) group and without CVT (DAVF alone) group. Univariate logistic regression and multivariate logistic regression were used to analyze the risk factors for the coexistence of CVT and DAVF. CVT was found in 19.8% of patients with DAVF. In univariate analysis, compared with the DAVF-alone group, the DAVF-CVT group was more likely to have tinnitus ( P = .001), blurred vision ( P < .001), visual field loss ( P = .001), focal neurological deficits ( P = .002), seizures ( P = .008), and cognitive impairment ( P = .046) and less likely to have spinal cord/brain stem dysfunction ( P = .004). In addition, there were significant differences in age ( P = .009), sex ( P = .019), the occurrence of venous cerebral infarction ( P = .001), and DAVF location ( P < .001) between the two groups. Furthermore, multivariate analysis showed that blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF were risk factors for the coexistence of CVT in patients with DAVF, with the odds ratio of 2.416 (95% CI 1.267-4.606, P = .007), 6.018 (95% CI 1.289-28.100, P = .022), 5.801 (95% CI 2.494-13.496, P < .001), and 5.640 (95% CI 2.122-14.989, P = .001), respectively. CVT occurred in approximately one fifth of patients with DAVF. Blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF may be the risk factors for predicting the coexistence of CVT in patients with DAVF.

Radiographic Signs of Advanced Cerebral Venous Thrombosis Negatively Modulate the Effectiveness of Endovascular Treatments

Introduction: Endovascular treatment (EVT) is a therapeutic option for cerebral venous thrombosis (CVT); however, its benefit over conservative medical management has not been proven. Whether the current patient selection practices are appropriate for EVT is unclear. Methods: This was a nationwide study of the 2016–2020 National Inpatient Sample database. Adult CVT patients and EVT treatments were identified. Patient demographics, medical comorbidities, CVT risk factors, and CVT manifestations were identified. Presence of radiographic signs of advanced and severe CVT (venous infarction, cerebral edema, and intracranial hemorrhage) was recorded. Primary and secondary outcomes were good discharge outcomes and in-hospital mortality, respectively. Results: A total of 17,130 CVT patients were identified, and 56.7% had good discharge outcomes, while 4.6% died during hospitalization. 945 (5.5%) received EVT, and EVT patients were more likely to have cerebral infarction (35.4 vs. 21.8%, p p p p = 0.059) and resulted in zero deaths. However, with the increasing burden of radiographic signs of advanced CVT measured by the cumulative presence of infarction, edema, and hemorrhage, EVT was associated with decreasing odds of good outcomes and increasing odds of in-hospital mortality compared to medical management (interaction p = 0.046 and 0.029, respectively). Conclusions: EVT may lead to higher rates of favorable hospitalization outcomes in patients who have not yet developed overt parenchymal manifestations of backpressure changes; presence of infarction, edema, and hemorrhage may diminish the short-term effectiveness of EVT.

Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy.

Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.

Frequency of Clinical and Imaging Findings of Cerebral Venous Thrombosis in Patients Referred to Booali Hospital of Qazvin: A Case Series

Background and Aim: Cerebral venous thrombosis (CVT) is a rare type of stroke and usually occurs in young people. The most common early clinical sign is a headache and the most common finding on clinical examination is bilateral papillary edema. Results: Herewith, we have reported the frequency of clinical features, and imaging findings of cerebral venous thrombosis patients. A total of 17 patients with cerebral venous thrombosis with symptoms of stroke were evaluated, 64.7% of patients were female. The Mean±SD age of the patients was 40.41±12.08 years and the Mean±SD number of hospitalization days was 11.76±3.71 days. The most location of thrombosis and neurological symptoms were sigmoid headaches and blurred vision, respectively. Conclusion: Based on our study, we found that the most common clinical manifestation of CVT is a headache. Papilledema and seizure are also very common, and the most common site of thrombosis in these patients is the sigmoid sinus.

Risk and Prognosis of Cancer in Patients With Cerebral Venous Thrombosis Compared With the Danish General Population.

Whether cerebral venous thrombosis (CVT) is a marker of cancer in clinical practice remains unknown. Little is known about the prognosis of cancer detected subsequent to CVT. We used Danish nationwide registries (1996-2019) to identify patients with a first-time primary inpatient diagnosis of CVT without a history of cancer (N=811, 65% women, median age 42 years). We assessed the risk of an incident cancer diagnosis using standardized incidence ratios (SIRs). This measure contrasts the number of observed cancers among patients with CVT to the number of expected cancers where patients with CVT have the same cancer risk as the general population. We used Kaplan-Meier survival analysis and Cox regression to compare the survival of patients with both cancer and CVT with the survival of patients with cancer but without CVT, matched on cancer site, sex, age, and year of cancer diagnosis. Observing 43 incident cancer cases during follow-up, the overall SIR was unity (SIR, 1.04 [95% CI, 0.75-1.40]). However, the risk was ≈7-fold the expected level in the first 3 months following CVT diagnosis (SIR, 7.00 [95% CI, 3.02-13.80]) and ≈2-fold the expected level from 3 to 12 months following CVT diagnosis (SIR, 2.21 [95% CI, 0.89-4.56]). By 12 months following CVT diagnosis, the risk resembled the expected level (SIR, 0.76 [95% CI, 0.50-1.09]). Survival among cancer patients with prior CVT versus cancer patients without prior CVT was 91% versus 87% after 6 months and 65% versus 70% after 5 years. The adjusted hazard ratio of death was 0.78 (95% CI, 0.44-1.38). Patients with CVT were not at overall increased risk of a cancer diagnosis, except in the first 3 months after diagnosis during which period the risk was elevated ≈7-fold. The estimate from this early period, however, was based on only a few cancer diagnoses. Unlike other forms of venous thrombosis, a prior diagnosis of CVT did not negatively impact cancer survival.