Association of admission clinical predictors and functional outcome in patients with Cerebral Venous and Dural Sinus Thrombosis

Ortega‐Gutiérrez, Santiago; Holcombe, Andrea; Aksan, Nazan; Dai, Biyue; Shaban, Amir; Lazarre, Lara; Zheng-Lin, Binbin; Sager, Lauren; Siddiqui, Fazeel M.; Mohr, Nicholas M.

doi:10.1016/j.clineuro.2019.105563

Cited by 13 publications

(12 citation statements)

References 18 publications

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“…Both intracranial hemorrhage and GCS score < 9 on admission were associated with death and dependency [22]. In the present study, it was also observed that increased local brain lesions and impaired consciousness were associated with unfavorable outcome, consistent with previous findings [22][23][24].…”

Section: Discussionsupporting

confidence: 92%

Association of neutrophil to lymphocyte ratio and D-dimer with functional outcome in patients with cerebral venous sinus thrombosis

Sun

Huang²,

et al. 2023

BMC Neurol

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Background Investigations on the risk factors for the prognosis of cerebral venous sinus thrombosis (CVST) are limited. This study aimed to explore whether specific inflammatory factors and coagulation indictors are associated with functional outcome in patients treated for CVST. Methods This retrospective study included 137 patients admitted to our hospital between January 2010 and October 2021. The functional outcome was assessed with the modified Rankin Scale (mRS) score at discharge. Patients were divided into two groups, 102 patients with favorable outcomes (mRS 0-1) and 35 patients with poor outcomes (mRS 2-6). The clinical indexes were compared between two groups. Multivariable logistic regression was performed to identify the independent influencing factors for poor outcomes of CVST patients. The prognostic indicators were analyzed using the receiver operating characteristic (ROC) curve. Results Compared with the favorable outcome group, the incidence of impaired consciousness and brain lesion, the levels of D-dimer, RDW, neutrophil count, neutrophil to lymphocyte ratio (NLR) and red blood cell distribution width to platelet ratio (%) on admission were significantly higher in the poor outcome group, while the level of lymphocyte count was significantly lower. After multivariable logistic regression analysis, baseline D-dimer level (odds ratio (OR), 1.180; 95% confidence interval (CI), 1.019-1.366, P = 0.027) and NLR (OR, 1.903; 95%CI, 1.232-2.938, P = 0.004) were significantly associated with unfavorable outcome at discharge. The ROC curve analysis showed that the areas under the curve of D-dimer, NLR and their combined detection for predicting worse outcome were 0.719, 0.707 and 0.786, respectively. Conclusions Elevated D-dimer level and NLR on admission were associated with an increased risk of poor functional outcome in patients with CVST.

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Section: Discussionsupporting

confidence: 92%

Association of neutrophil to lymphocyte ratio and D-dimer with functional outcome in patients with cerebral venous sinus thrombosis

Sun

Huang²,

et al. 2023

BMC Neurol

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“…12À30 Age, abnormal level of consciousness, and focal motor deficits on admission may be harbingers of poorer outcome in CVST patients. 31 Here, we present a case series of 8 patients and review the literature to characterize the presentation, management, and outcomes related to CVST events in COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature

Abdalkader

Shaikh

Siegler

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

100

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Background: COVID-19 infection has been known to predispose patients to both arterial and venous thromboembolic events such as deep venous thrombosis, pulmonary embolism, myocardial infarction, and stroke. A few reports from the literature suggest that Cerebral Venous Sinus Thrombosis (CVSTs) may be a direct complication of COVID-19. Objective: To review the clinical and radiological presentation of COVID-19 positive patients diagnosed with CVST. Methods: This was a multicenter, cross-sectional, retrospective study of patients diagnosed with CVST and COVID-19 reviewed from March 1, 2020 to November 8, 2020. We evaluated their clinical presentations, risk factors, clinical management, and outcome. We reviewed all published cases of CVST in patients with COVID-19 infection from January 1, 2020 to November 13, 2020. Results: There were 8 patients diagnosed with CVST and COVID-19 during the study period at 7 out of 31 participating centers. Patients in our case series were mostly female (7/8, 87.5%). Most patients presented with non-specific symptoms such as headache (50%), fever (50%), and gastrointestinal symptoms (75%). Several patients presented with focal neurologic deficits (2/8, 25%) or decreased consciousness (2/8, 25%). D-dimer and inflammatory biomarkers were significantly elevated relative to reference ranges in patients with available laboratory data. The superior sagittal and transverse sinuses were the most common sites for acute CVST formation (6/8, 75%). Median time to onset of focal neurologic deficit from initial COVID-19 diagnosis was 3 days (interquartile range 0.75À3 days). Median time from onset of COVID-19 symptoms to CVST radiologic diagnosis was 11 days (interquartile range 6À16.75 days). Mortality was low in this cohort (1/8 or 12.5%). Conclusions: Clinicians should consider the risk of acute CVST in patients positive for COVID-19, especially if neurological symptoms develop.

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“…Based on previous studies on predictors of mortality in CVT in general and in VITT‐CVT, we adjusted for the following variables: age, coma, ICH at presentation, and baseline platelet count. 12 , 13 , 16 Primary outcome was in‐hospital mortality. As a sensitivity analysis, we performed the same unadjusted and adjusted binary logistic regression including only definite VITT‐CVT cases.…”

Section: Methodsmentioning

confidence: 99%

“…Odds ratios (ORs) for mortality per different treatment modality were calculated using binary logistic regression. Based on previous studies on predictors of mortality in CVT in general and in VITT‐CVT, we adjusted for the following variables: age, coma, ICH at presentation, and baseline platelet count 12,13,16 . Primary outcome was in‐hospital mortality.…”

Section: Methodsmentioning

confidence: 99%

Management of Cerebral Venous Thrombosis Due to Adenoviral COVID‐19 Vaccination

Scutelnic

Krzywicka

Mbroh

et al. 2022

Annals of Neurology

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Objective Cerebral venous thrombosis (CVT) caused by vaccine‐induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus‐based severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non‐heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods We used data from an international prospective registry of patients with CVT after the adenovirus‐based SARS‐CoV‐2 vaccination. We analyzed possible, probable, or definite VITT‐CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results Ninety‐nine patients with VITT‐CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in‐line with VITT recommendations ( p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16–1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06–0.58). Treatment with non‐heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24–2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74–6.54). Conclusions In patients with VITT‐CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT‐CVT. ANN NEUROL 2022

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Association of admission clinical predictors and functional outcome in patients with Cerebral Venous and Dural Sinus Thrombosis

Cited by 13 publications

References 18 publications

Association of neutrophil to lymphocyte ratio and D-dimer with functional outcome in patients with cerebral venous sinus thrombosis

Association of neutrophil to lymphocyte ratio and D-dimer with functional outcome in patients with cerebral venous sinus thrombosis

Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature

Management of Cerebral Venous Thrombosis Due to Adenoviral COVID‐19 Vaccination

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