Do the Risk Factors Determine the Severity and Outcome of Cerebral Venous Sinus Thrombosis?
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ORIGINAL ARTICLE
Do the Risk Factors Determine the Severity and Outcome of Cerebral Venous Sinus Thrombosis? Jayantee Kalita 1 & Usha K. Misra 1
&
Rajesh K. Singh 1
Received: 7 November 2017 / Revised: 27 December 2017 / Accepted: 28 December 2017 # Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract We report the burden of risk factors in cerebral venous sinus thrombosis (CVST) and its relationship with the clinical severity, extent of MRI and MRV abnormality, and outcome. One hundred and twenty-eight consecutive patients with CVST were included. Their demographic, presenting symptoms and neurological findings were noted and risk factors of CVST were evaluated. The outcomes were assessed using modified Rankin Scale (mRS). Based on the risk factors, the patients could be categorized as prothrombotic conditions only in 46 (35.9%), prothrombotic with other risk factors in 36 (28.1%), non-prothrombotic risk factors in 20 (15.6%), and no risk factors in 26 (20.3%). More than two risk factors were present in 33 (25.8%). Sixteen out of 22 (72.7%) patients with female gender-specific risk factors also had other prothrombotic conditions. On MRV, more than two sinuses were involved in 35 (27.3%) patients and 94 (73.4%) patients had parenchymal lesions on MRI. Thirty-one (24.2%) patients had poor outcome (mRS > 2) at discharge and 25/122 (20.5%) at 3 months. The number of risk factors was not related to clinical severity and extent of MRI or MRV abnormality. On multivariate analysis, age (OR 1.05, 95%CI 1.00–1.09, P = 0.03), GCS score (OR 5.30, 95%CI 1.25–22.24, P = 0.02), and mechanical ventilation (OR 196.17, 95%CI 16.05, P = 0.001) predicted the outcome at 3 months. Keywords Cerebral venous thrombosis . Stroke . Risk factors . MRI . Prothrombotic states . MR venography
Introduction Cerebral venous sinus thrombosis (CVST) constitutes 0.5–1% of total strokes with a difference in its etiology, demography, evaluation, clinical presentation, and outcome. Cerebral venous Highlights: ?• Prothrombotic state is the commonest cause of CVST (64%). • Twenty percent patients may not have risk factor. • Multiple risk factors were more frequent than single risk factor for occurrence of CVST. • Burden of risk factors does not determine clinico-radiological severity and outcome. • Need for mechanical ventilation, GCS score and elderly patients were independent predictors for poor clinical outcome. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12975-017-0607-6) contains supplementary material, which is available to authorized users. * Usha K. Misra [email protected]; [email protected] 1
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India
sinus thrombosis should be suspected in relevant clinical situation, because it is easy to diagnose and rewarding to treat. The prevalence of CVST has been reported to be higher in puerperium in the developing countries especially in I
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