Cerebral Venous Thrombosis Presenting Research Articles

Prevalence, clinical presentation, and treatment-management of cerebral venous thrombosis associated with spontaneous intracranial hypotension: A combined case-series and systematic literature review approach.

Cerebral venous thrombosis (CVT) is a rare complication of spontaneous intracranial hypotension (SIH). Therefore, its correct diagnosis and the corresponding optimal treatment-management identification remains challenging. Over the last 10 years, 300 patients received a definite SIH diagnosis at our stroke center. Through thorough review of the database, we identified all patients with SIH-related CVT. In addition, we performed a systematic literature review including all publications on SIH-related CVT. Five out of our 300 SIH patients showed CVT (F/M:2/3, mean age: 51.8 ± 15.7). Through the literature search, 72 additional cases were identified. Overall, the prevalence was 1.3% and main clinical presentations were orthostatic headache, nausea, and vomiting. The CVT was predominantly located at the superior sagittal sinus. Treatment strategies included anticoagulants (ACs) (43%), epidural blood patch (EBP) (19.4%), and combined AC + EBP (33.3%). In our cohort, all but one patient received combined EBP and AC. The mean clinical and radiological follow-up were 2 years and 1.5 years, respectively. Complete clinical recovery was reported in 96% of the cases, whereas 56% showed complete radiological CVT resolution. Among patients without radiological resolution (26.4%), 57% received AC-only, while 43% received combined AC + EBP. Of our five cases, all but one patient received combined AC + EBP. The overall prevalence of SIH-related CVT was 1.3%. AC and combined AC + EBP were the most used treatment-management strategies. CVT resolution was more commonly achieved after the combined strategy. Overall, the rate of complete clinical recovery was 96%.

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association.

Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.

Presentation and Management of Cerebral Venous Sinus Thrombosis After Supratentorial Craniotomy.

Cerebral venous sinus thrombosis (CVST) after supratentorial craniotomy is a poorly studied complication, for which there are no management guidelines. This study assessed the incidence, associated risk factors, and management of postoperative CVST after awake craniotomy. This is an observational, retrospective, monocentric analysis of patients who underwent a supratentorial awake craniotomy. Postoperative CVST was defined as a flow defect on the postoperative contrast-enhanced 3D T1-weighted sequence and/or as a T2* hypointensity within the sinus. In 401 supratentorial awake craniotomies (87.3% of diffuse glioma), the incidence of postoperative CVST was 4.0% (95% CI 2.5-6.4): 14/16 thromboses located in the superior sagittal sinus and 12/16 located in the transverse sinus. A venous sinus was exposed during craniotomy in 45.4% of cases, and no intraoperative injury to a cerebral venous sinus was reported. All thromboses were asymptomatic, and only two cases were diagnosed at the time of the first postoperative imaging (0.5%). Postoperative complications, early postoperative Karnofsky Performance Status score, and duration of hospital stay did not significantly differ between patients with and without postoperative CVST. Adjusted independent risk factors of postoperative CVST were female sex (adjusted Odds Ratio 4.00, 95% CI 1.24-12.91, P = .021) and a lesion ≤1 cm to a venous sinus (adjusted Odds Ratio 10.58, 95% CI 2.93-38.20, P < .001). All patients received standard prophylactic-dose anticoagulant therapy, and none received treatment-dose anticoagulant therapy. No thrombosis-related adverse event was reported. All thromboses presented spontaneous sinus recanalization radiologically at a mean of 89 ± 41 days (range, 7-171). CVST after supratentorial awake craniotomy is a rare event with satisfactory clinical outcomes and spontaneous sinus recanalization under conservative management without treatment-dose anticoagulant therapy. These findings are comforting to neurosurgeons confronted with postoperative MRI reports suggesting CVST.

S27 A Rare Presentation of Cerebral Venous Thrombosis as a Complication of Infantile Inflammatory Bowel Disease in a 17-Month-Old Infant

S27 A Rare Presentation of Cerebral Venous Thrombosis as a Complication of Infantile Inflammatory Bowel Disease in a 17-Month-Old Infant

Good outcome in a rare presentation of simultaneous cerebral superficial and deep venous thrombosis with cortical vein thrombosis post thrombectomy: A case report

Good outcome in a rare presentation of simultaneous cerebral superficial and deep venous thrombosis with cortical vein thrombosis post thrombectomy: A case report

Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension.

A 38-year-old woman with untreated Graves' disease was admitted to our hospital because of headache and diplopia for 3 months. A neuro-ophthalmic examination showed bilateral papilledema and abducens nerve paralysis. The cerebrospinal fluid pressure was extremely high. Brain magnetic resonance imaging showed cerebral venous thrombosis in the superior sagittal and right transverse and sigmoid sinuses. Laboratory investigations revealed elevated factor VIII and von Willebrand factor levels. The patient recovered after propylthiouracil and anticoagulation therapy. We herein report a rare case of cerebral venous thrombosis with hyperthyroidism presenting as chronic isolated intracranial hypertension. Hyperthyroidism can induce a hypercoagulable state and lead to venous thromboembolism.

Prognostic factors in patients with cerebral sinus venous thrombosis presenting with hemorrhage and papilledema

ObjectiveThe thromboinflammatory process is considered to play a role in the pathogenesis and prognosis of cerebral sinus vein thrombosis (CSVT). The purpose of the study was to compare the thromboinflammatory parameters between individuals with CSVT and healty controls. Additionally, the study sought to compare these parameters among CSVT subgroups with and without haemorrhage, as well as with and without papilledema. Furthermore, the investigation also aimed to identify which parameters had a more significant impact on the risk of hemorrhage and the development of papilledema in CSVT. MethodsThromboinflammatory parameters were compared retrospectively between the CSVT group of 88 patients and 80 age- and sex-matched healthy controls, and in the CSVT subgroups with (n = 35) /without hemorrhage (n = 53) and with (n = 52) /without papilledema (n = 36) after ethics committee approval. In both groups, parameters contributing to the risk of hemorrhage and papilledema development were determined by univariate and multivariate analyses. ResultsRegarding the risk of hemorrhage in CSVT patients, the most significant factors included hematocrit of <30.2 (%), mean platelet volume of ≤8.9 fL, neutrophil count of >5600, and hsCRP of >9 mg/L. Regarding the risk of papilledema development, the most important risk factors were age of ≤49, presence of vomiting, presence of blurred vision, HDL of >47 mg/dL, and D-dimer of >178 ng/mL. ConclusionIt was suggested that evaluating serum thromboinflammatory parameters, as well as demographic characteristics and neurological examination findings, had a critical role regarding prognosis and predictive factors in CSVT.

Interventions in cerebrovascular emergencies among patients with Paroxysmal nocturnal haemoglobinuria - A word of caution

IntroductionParoxysmal nocturnal haemoglobinuria (PNH) is a clonal hematopoietic disorder, where there is deficiency of glycosylphosphatidylinositol (GPI) anchored proteins in the cell membrane, leading to increased complement sensitivity of red blood cells, intravascular hemolysis and vascular inflammation. Arterial and venous strokes in patients with PNH are a rarity posing significant diagnostic and therapeutic challenges. We report our experience with management of PNH patients with cerebrovascular emergencies. MethodsWe report 2 patients with PNH, one who was previously diagnosed with PNH and had arterial stroke, the other had an index presentation of cerebral venous sinus thrombosis (CVT) and was subsequently diagnosed with PNH. We also present the systematic review of literature reporting similar cases, highlighting the challenges in management. ResultsBoth patients presented to our centre with cerebrovascular emergency. The first patient was a diagnosed with PNH, and presented with left hemispheric infarction caused by thrombosis of middle cerebral artery. He was thrombolysed and underwent mechanical thrombectomy, which was unsuccessful in view of repeated re – thrombosis of the vessel. The patient survived with significant disability. The second patient had severe cerebral venous sinus thrombosis with large right hemispheric hemorrhagic venous infarction. She underwent emergency decompressive hemicraniectomy complicated by massive blood loss and disseminated intravascular coagulation. She subsequently had recurrent life threatening intracranial bleed secondary to platelet transfusions, thrombocytopenia, and use of contrast agents. She progressed to develop Budd Chiari syndrome and was initiated on Eculuzimab. She became transfusion independent, however remained in minimally conscious state and succumbed to sepsis. ConclusionsManagement of arterial and venous strokes is complex in patients with PNH. Invasive procedures and platelet transfusions are to be avoided in acute thrombosis, till robust evidence is available establishing the safety of the same in patients with PNH. Eculuzimab is a promising option, but far from reach for patients in developing countries.

Neurological manifestations of cerebral venous thrombosis: experience from a tertiary care center

Background and Objective: &#x0D; Cerebral venous thrombosis (CVT) is a common cause of cerebrovascular accident (stroke). CVT is caused due to blockage in blood flow either in cerebral veins or in dural sinuses. The objective of this study was to determine prevalence of various clinical and imaging characteristics in patients with cerebral venous thrombosis.&#x0D; Methods:&#x0D; A descriptive retrospective cross-sectional patient data was collected from November 2019 to February 2021. This study was conducted in Neurology Department in Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. This study contains patient medical histories of 60 patients who were admitted in two and a half year time. Monitoring for any seizure occurrence was carried out for all the patients included in this study. Patient medical histories were examined and CT, MRI and MRV Brain were performed.&#x0D; Results:&#x0D; Superior sagittal sinus was spotted as a hot spot location for CVT. Mean age calculated was 30 while more frequency was recorded in female patients.&#x0D; Conclusion:&#x0D; CVT is a condition with more prevalence in younger population with more affected females than males. Most common presentation of CVT is headache. Superior sagittal sinuses involved in majority of cases reported. Specificity of modalities used and neurological manifestations needs a validation through a larger cohort study.

Surgical Management of Vision Loss in Cerebral Venous Thrombosis: Case Series from a Tertiary Care Stroke Center.

Cerebral venous thrombosis (CVT) presenting as vision loss is uncommon. Raised intracranial tension in CVT is proposed as one of the mechanisms (13.2%). There are still unknown underlying mechanisms to explain vision loss in CVT. The safety and outcome of the surgery (optic nerve sheath fenestration [ONSF] or theco-peritoneal shunt [TPS]) to reduce intracranial hypertension and prevent vision loss has not been studied. A retrospective case record review of CVT patients with impending vision loss who underwent ONSF/TPS from 2007 to 2019 was performed from the stroke registry. All patients had formal neuro-ophthalmological evaluation and documentation of visual acuity, supplemented by visual field assessments by perimetry in a subset of patients. Safety and outcomes were assessed based on vision improvement and adverse effects after the surgery. Among approximately 1400 patients with CVT admitted in the stroke ward over 12 years, surgery for rescuing vision was done in 18. Among these, the males were 6, and the females were 12. The mean age of presentation was 24 (range 18-52 years). All of them had headaches and progressive blurring of vision with papilledema. The number of patients who underwent TPS was 13, ONSF was 1, and both were 4. In the TPS group (26 eyes), vision improved in 15 eyes (57.7%), remained status-quo in 8 eyes (30.7%), and worsened in 3 eyes (11.5%). Four patients underwent both surgeries; three eyes improved, two remained status quo, and three worsened. One patient underwent ONSF, and his vision remained status quo (no perception of light). Three patients (17.6%) of the TPS group had minor complications (low-pressure headache, subdural hygroma), and five (29.4%) had major complications like subdural hemorrhage, abdominal wound infection, and meningitis. In patients with CVT, adequate vision monitoring is mandatory. Shunt surgeries (especially TPS) may help in stabilizing/improving vision in CVT patients with impending vision loss, despite adequate anti-edema measures (53.8% improved). Early diagnosis and precise decisions in referring for surgery are crucial.

Post COVID‐19 Cerebral Venous Thrombosis presenting as Acute Dementia

AbstractBackgroundCoronavirus disease (COVID‐19) is an infectious disease caused by SARS‐CoV‐2 virus which may lead to various neurological complications as reported in the literature. One important complication is CVT (Cerebral Venous Thrombosis) which classically presents as acute headache, seizures and focal neurological deficits. We report an interesting and rare case presentation of CVT here.MethodA 32 year old female presented to ER with history of progressive forgetfulness since 4 days. She had difficulty in remembering recent activities and names of close associates. This was followed by holocranial headache after 2 days. She had history of COVID‐19 infection 20 days before the symptom onset. With the suspicion of acute vascular event, she was subjected to brain imaging.ResultMRI brain with MR venogram showed left temporal venous infarct along with left transverse sinus and superior sagittal sinus thrombosis. She was treated with heparin and acenocoumarol subsequently along with supportive care with full relief in her symptoms.ConclusionCVT is now a known complication of COVID‐19 infection. It is generally an acute condition presenting with its classical features. However, it can also rarely present with other manifestations like acute cognitive decline or rapidly progressive dementia. Careful approach towards clinical presentation with appropriate diagnostic testing can quickly identify this condition for proper and timely treatment.

Young patient with thunderclap headache, seizure activity, and fixed eye deviation.

A 39-year-old female with a history of iron deficiency anemia presented to the emergency department (ED) with a 3-hour history of severe headache followed by acute-onset projectile non-bilious, non-bloody vomiting, acute mental status change, and seizure-like activity. The onset of the headache was spontaneous and described as the worst headache of her life. Vomiting and seizure-like activity began several hours after the onset of headache, and emergency medical services (EMS) were called at that time. The patient was found to be unresponsive by EMS. Upon arrival to the ED, the physical examination was notable for fixed left eye deviation, intermittent withdrawal from noxious stimuli, and spells of sustained clonus in the lower extremities greater on the left than the right. The patient was given 2-mg intravenous lorazepam with minimal improvement in the tonic–clonic activity. The patient was hemodynamically stable and had an oxygen saturation of 98% on room air. Initial laboratory test results were significant for anemia (hemoglobin = 5.2 g/dL, hematocrit = 21%) and elevated platelets (426.5). Computed tomography (CT) of the head, CT angiogram of the head and neck, CT venogram of the head, and urgent neurology consult were obtained immediately after arrival to the ED. The patient continued to decline after CT and was intubated for airway protection. Imaging was suggestive of acute venous sinus thrombosis extending from the superior sagittal sinus to the right cranial jugular vein with no definite intracranial hemorrhage (Figures 1 and 2) and bilateral segmental and subsegmental pulmonary emboli (Figure 3). This case describes a typical presentation of cerebral venous sinus thrombosis (CVST). CVSTs are more commonly seen in women aged 30–50 years.1 Commonly, sinus thrombosis can lead to subarachnoid hemorrhage with a subsequent “thunderclap” headache that can lead to neurological symptoms.3 Neurology evaluated the patient in the ED, and the patient was taken to the operating room for an aspiration thrombectomy and started on a continuous heparin infusion. The patient had gradual improvement of symptoms after 1 week of inpatient care in the neurology intensive care unit. At discharge, she was started on indefinite anticoagulation and levetiracetam for seizure prophylaxis. Further workup showed no evidence of hypercoagulability, no recent trauma, and no oral contraceptive use. CVST is defined as occlusion of dural sinuses leading to decreased venous flow, an increase in intracranial pressure, decreased cerebral perfusion pressures, and dilation of the cerebral veins. Continued hypoperfusion can result in ischemic tissue damage, resulting in acute neurologic symptoms such as seizures, headaches, altered mental status, and increased intracranial pressure. Without treatment, the thrombus can damage vessel walls, increasing the chances of vessel rupture, leading to subarachnoid hemorrhages and decreased cerebrospinal fluid outflow.1 Common risk factors for CVSTs include recent trauma, malignancy, thrombophilia, infection, obesity, oral contraceptive use, and increased estrogen states such as pregnancy.2

A Rare Presentation of CVT

Cerebral Venous Thrombosis (CVT) is an uncommon condition presenting with varying clinical symptoms, posing difficulty in diagnosis. Patients present with headaches, focal neurological deficits, seizures, and altered consciousness. CVT does not have a single clinical presentation, and it is important to consider CVT in all brain syndromes, especially young patients, and confirm it through imaging studies. Other uncommon presentations of CVT include single or multiple cranial nerve palsies.

Cerebral Venous Thrombosis Presenting as Cortical Subarachnoid HaemorrhageA Case Report and Review

In the presence of Subarachnoid Haemorrhage (SAH), diagnosis of underlying Cerebral Venous Thrombosis (CVT) is challenging as there is no difference in clinical presentation and therapeutically it is important because CVT need to be treated with anticoagulant unlike SAH. This article is about a 50-year-old male presenting with headache, right hemiparesis, and recurrent seizures. The Computed Tomography (CT) head was suggestive of SAH in right posterior parietal region. But Magnetic Resonance Imaging (MRI) venogram showed cerebral venous sinus thrombosis. Hence, he was treated with anticoagulants. The patient showed significant clinical improvement. SAH secondary to underlying CVT is relatively rare entity. After reviewing medical literature of such cases, 42 case reports and case series forming 95 cases of SAH secondary to CVT were found.

Unilateral Cerebral Venous Thrombosis Presenting with Asymmetric Papillary Edema in Optic Nerve

Unilateral Cerebral Venous Thrombosis Presenting with Asymmetric Papillary Edema in Optic Nerve

The Novel Oral Anticoagulants (NOACs) for the Treatment of Cerebral Venous Thrombosis: A Case Study of 32 Vietnamese Patients

Background and Purpose: Cerebral venous thrombosis (CVT) is a rare cause of cerebral infarction with diverse clinical presentations and outcomes. Novel oral anticoagulants (NOACs) provide an alternative option of systemic anticoagulation in various thromboembolic conditions, but uncertainty exists over the use of NOACs among patients with CVT. We present our initial experience with the use of NOACs for CVT in Vietnam. Methods: We included consecutive patients diagnosed with CVT presenting to 115 People’s Hospital in Vietnam between May 2016 and July 2017 and who were treated with NOACs. Data on patient demographics, vascular risk factors, clinical presentations, and outcomes at 180 days follow-up were obtained and analyzed. Modified Rankin scale (mRS) scores on admission, at discharge, and 180 days were assessed. Recanalization was assessed using magnetic resonance venography at 180 days follow-up. Venous thrombo-embolism events were defined as primary outcome, while bleeding complications were defined as safety outcome. Results: Among 32 patients with CVT (72% females; mean age: 40 ± 9.7 years), 15 were treated with rivaroxaban and 17 with dabigatran. A common risk factor was the usage of oral contraception (70%) on presentation. The mean mRS score on admission was 3.1 points (± 1.4). At FUP (median 8.5 months, IQR 5.5-9.5), clinical outcome (mRS ≤ 1) was excellent in most patients. All patients had at least partial recanalization and half of them achieved complete recanalization at 180 days follow-up. There were no bleeding complications. Conclusion: NOACs may offer clinical benefits with minimal complications in the treatment of CVT. Further prospective assessment with randomized controlled studies is warranted.

Predictors of mortality in thrombotic thrombocytopenia after adenoviral COVID-19 vaccination: the FAPIC score.

AimsThe clinical manifestation and outcomes of thrombosis with thrombocytopenia syndrome (TTS) after adenoviral COVID-19 vaccine administration are largely unknown due to the rare nature of the disease. We aimed to analyse the clinical presentation, treatment modalities, outcomes, and prognostic factors of adenoviral TTS, as well as identify predictors for mortality.Methods and ResultsPubMed, Scopus, Embase, and Web of Science databases were searched and the resulting articles were reviewed. A total of 6 case series and 13 case reports (64 patients) of TTS after ChAdOx1 nCoV-19 vaccination were included. We performed a pooled analysis and developed a novel scoring system to predict mortality. The overall mortality of TTS after ChAdOx1 nCoV-19 vaccination was 35.9% (23/64). In our analysis, age ≤60 years, platelet count <25 × 103/µL, fibrinogen <150 mg/dL, the presence of intracerebral haemorrhage (ICH), and the presence of cerebral venous thrombosis (CVT) were significantly associated with death and were selected as predictors for mortality (1 point each). We named this novel scoring system FAPIC (fibrinogen, age, platelet count, ICH, and CVT), and the C-statistic for the FAPIC score was 0.837 (95% CI 0.732–0.942). Expected mortality increased with each point increase in the FAPIC score, at 2.08, 6.66, 19.31, 44.54, 72.94, and 90.05% with FAPIC scores 0, 1, 2, 3, 4, and 5, respectively. The FAPIC scoring model was internally validated through cross-validation and bootstrapping, then externally validated on a panel of TTS patients after Ad26.COV2.S administration.ConclusionsFibrinogen levels, age, platelet count, and the presence of ICH and CVT were significantly associated with mortality in patients with TTS, and the FAPIC score comprising these risk factors could predict mortality. The FAPIC score could be used in the clinical setting to recognize TTS patients at high risk of adverse outcomes and provide early intensive interventions including intravenous immunoglobulins and non-heparin anticoagulants.

Eye-Neck Integrated Ultrasound in Idiopathic Intracranial Hypertension and Cerebral Venous Sinus Thrombosis.

Background: The clinical presentation of cerebral venous sinus thrombosis (CVST) overlaps with that of idiopathic intracranial hypertension (IIH), but no screening tool exists. We investigated the role of eye-neck integrated ultrasound in the diagnosis and differentiation of IIH and CVST.Methods: Twenty IIH patients, 30 CVST patients, and 40 healthy controls were retrospectively analyzed. The ultrasonographic optic nerve sheath diameter (ONSD) and hemodynamic characteristics of the internal jugular veins (IJVs) were recorded. The cerebrospinal fluid opening pressure was measured after ultrasonic examination.Results: The ONSD was significantly larger in IIH patients than in controls (4.71 ± 0.41 vs. 3.93 ± 0.24 mm, p < 0.001). The ONSD cut-off for IIH diagnosis was 4.25 mm (AUC = 0.978; 95% CI: 0.95–1.0, p < 0.001, sensitivity: 90%, specificity: 93%). In the CVST group, 22 (73.3%) patients had elevated intracranial pressure (ICP); the mean ONSD was significantly higher in patients with increased ICP than in those without (4.43 ± 0.33 vs. 3.95 ± 0.17 mm, p < 0.001). The mean blood flow volume (BFV) was significantly reduced in CVST patients (425.17 ± 349.83 mL/min) compared to that in controls (680.37 ± 233.03 mL/min, p < 0.001) and IIH patients (617.67 ± 282.96 mL/min, p = 0.008). The optimal BFV cut-off for predicting CVST was 527.28 mL/min (AUC = 0.804, 95% CI: 0.68–0.93, p < 0.001, sensitivity: 80%, specificity: 78%). The velocity of the unilateral IJVs-J3 segment decreased or remained constant during deep inspiration (abnormal respiratory modulate blood flow test, ARMT) in 32.5% of controls, with no bilateral ARMT. The prevalence of bilateral ARMT was 25% in IIH patients (χ2 = 12.9, p = 0.005) and 27% in CVST patients (χ2 = 17.6, p = 0.001).Conclusion: Eye-neck integrated ultrasound is an easily available bedside technique to assess ICP and hemodynamic characteristics of IJVs. ONSD measurement can identify patients with increased ICP, and reduced IJV BFV may aid the differentiation of CVST and IIH.

Cerebral Venous Thrombosis Presenting As Subarachnoid Hemorrhage: Clinical Case

Subarachnoid hemorrhage is typically due to an aneurysmal rupture. Cerebral venous thrombosis is a rare cause, especially if the clinical presentation is atypical. We report a patient with unusual acute headaches, with an entirely normal physical examination. His cerebral MRI, and cerebral venous angio-MRI documented a cerebral venous thrombosis associated with subarachnoid hemorrhage. The outcome was favorable with anticoagulant treatment.

Abstract P243: Identifying Cerebral Venous Thrombosis Through Administrative Data: Icd-10 Case Ascertainment Depends on Clinical Context

Background: Recent reported population-based rates of cerebral venous thrombosis (CVT) are higher than in older studies, though the context of these diagnoses is not well-defined. To better understand these trends, we examined the accuracy of administrative codes ( ICD-10 ) for CVT in different clinical scenarios. Methods: Cases of CVT presenting to a tertiary center between 2008-2018 were identified in two ways: free text search through all hospital electronic radiology reports regardless of modality and body part and any ICD-10 discharge codes (see Table 1). Electronic medical records were reviewed to verify diagnoses of CVT and their clinical context (Figure 1) to calculated Positive Predictive Value (PPV) of ICD-10 codes. Additionally, sensitivities of ICD-10 codes were calculated against all CVTs identified using either searches that were verified on chart review as the gold standard. Results: There were 289 confirmed cases: 239 new diagnoses, 204 of which were acute events. Only 75 cases (37%) were new, symptomatic CVTs not provoked by trauma or structural processes. Sensitivity and PPV for ICD-10 codes depending on clinical context is reported in Table 1. Conclusion: The majority of CVT identified at our institution were incidentally diagnosed in context of intracranial processes such as trauma, surgery, infection, or masses; 37% were symptomatic, non-structural incident diagnoses. Our findings have implications in interpreting CVT rates identified through administrative data, as the management and prognosis of CVT may differ based on clinical context.