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Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis

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Abstract

Background

Severe cerebral venous-sinus thrombosis (CVT) is a rare disease, and its clinical course, imaging correlates, as well as long-term prognosis have not yet been investigated systematically.

Methods

Multicenter retrospective study. Inclusion criteria were CVT, Glasgow coma scale ≤9, and treatment in the intensive care unit. Primary outcome was death or dependency, assessed by a modified Rankin Score (mRS) >2 at last follow-up.

Results

114 patients were included. At last follow-up (median 2.5 years), 38 patients (33.3 %) showed no or minor residual symptoms (mRS = 0 or 1), 12 (10.5 %) had a mild (mRS = 2), 13 (11.4 %) a moderate (mRS = 3), 12 (10.5 %) a severe disability (mRS = 4 or 5), and 39 (34.2 %) had died. In bivariate analysis, predictors of poor outcome were any signs of mass effect on imaging, clinical deterioration after admission, and age. In contrast, clinical symptoms on admission and parenchymal lesions per se, such as edema, infarction, or hemorrhage were not predictive. Multivariate predictors of poor outcome were an increase in National Institutes of Health Stroke Scale ≥3 after admission [odds ratio (OR) 6.7], bilateral motor signs in the further course (OR 9.2), and midline shift (OR 5.1).

Conclusion

The outcome of severe CVT is almost equally divided between severe impairment or death and survival with no or only mild handicap. Specifically, space-occupying mass effect and associated neurologic deterioration seem to determine a poor outcome. Therefore, early detection and treatment of mass effect should be the focus of critical care.

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Author information

Authors and Affiliations

  1. Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Christina M. Kowoll & Christian Dohmen

  2. Department of Radiology and Neuroradiology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Julia Kaminski & Thomas Liebig

  3. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Verena Weiß

  4. Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Julian Bösel

  5. Department of Neurology, Nuremburg Hospital, Breslauer Str. 201, 90471, Nuremberg, Germany

    Wenke Dietrich

  6. Department of Neurology, Ostalb Hospital, Im Kälblesrain 1, 73430, Aalen, Germany

    Eric Jüttler

  7. Department of Neurology, University Hospital Charité, Center for Stroke Research, Charitéplatz 1, 10117, Berlin, Germany

    Eric Jüttler & Julia Flechsenhar

  8. Department of Neurology, University Hospital Jena, Erlanger Allee 101, 07747, Jena, Germany

    Albrecht Guenther

  9. Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

    Hagen B. Huttner

  10. Department of Neurology, University Hospital Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany

    Wolf-Dirk Niesen

  11. Department of Neurology, University Hospital Munich (LMU), Marchioninistraße 15, 81377, Munich, Germany

    Thomas Pfefferkorn

  12. Department of Neurology, University Hospital Giessen, Klinikstr. 33, 35385, Giessen, Germany

    Ingo Schirotzek

  13. Department of Neurology, University Hospital Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Hauke Schneider

  14. Institute of Neuroradiology, University Hospital Charité, Berlin, Germany

    Thomas Liebig

  15. Max Planck Institute for Metabolism Research, Cologne, Germany

    Christian Dohmen

Authors
  1. Christina M. Kowoll
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  2. Julia Kaminski
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  3. Verena Weiß
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  4. Julian Bösel
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  5. Wenke Dietrich
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  6. Eric Jüttler
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  7. Julia Flechsenhar
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  8. Albrecht Guenther
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  9. Hagen B. Huttner
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  10. Wolf-Dirk Niesen
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  11. Thomas Pfefferkorn
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  12. Ingo Schirotzek
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  13. Hauke Schneider
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  14. Thomas Liebig
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  15. Christian Dohmen
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Corresponding author

Correspondence to Christian Dohmen.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from individual participants if they were contacted in order to obtain follow up information especially for this study. For retrospective data acquisition formal consent is not required.

Additional information

On behalf of IGNITE (Initiative of German Neurointensive Trial Engagement)

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Cite this article

Kowoll, C.M., Kaminski, J., Weiß, V. et al. Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis. Neurocrit Care 25, 392–399 (2016). https://doi.org/10.1007/s12028-016-0256-8

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  • DOI: https://doi.org/10.1007/s12028-016-0256-8

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