Early, delayed, and expanded intracranial hemorrhage in cerebral venous thrombosis

Abstract

Objectives One of the most important prognostic factors of cerebral venous sinus thrombosis (CVST) is intracranial hemorrhage (ICH). We studied the risk factors, clinical, and radiologic characteristics of early, delayed, and expanded ICH in Iranian patients with CVST. Materials and Methods In a retrospective study, from August 2012 to September 2016, all adult patients with a confirmed diagnosis of CVST were recruited. Demographic, clinical, and radiologic characteristics of the patients were recorded. The predictors of early, delayed, and expanded ICH were assessed through logistic regression analysis. Results Among 174 eligible patients, 35.1% of the patients had early ICH. Delayed and expanded hemorrhage occurred in 5% and 7.4% of the patients, respectively. Higher age was a risk factor (odds ratio [OR] = 1.038, 95% confidence interval [CI] = 1.008‐1.069), and involvement of multiple sinuses/veins was associated with lower risk of early ICH (OR = 0.432, CI = 0.226‐0.827). The risk of delayed ICH was higher in the patients with early hemorrhage (OR = 4.44, CI: 0.990‐19.94), men (OR = 4.18, CI: 0.919‐19.05), and those with a focal neurologic deficit on admission (OR = 16.05, CI: 1.82‐141.39). Acute onset was the predictor of the expansion of early ICH (OR = 8.92, CI: 1.81‐43.77), whereas female gender‐related conditions were associated with a lower risk of hemorrhage expansion (OR = 0.138, CI: 0.025‐0.770). Administration of anticoagulants was associated with neither delayed (P value = .140) nor expanded hemorrhage (P‐value = .623). Conclusions Male gender, early hemorrhages, acute onset, and presence of focal neurologic deficit are the risk factors for delayed and/or expanded hemorrhages in the patients with CVST.

Cerebral venous sinus thrombosis associated with SARS-CoV-2; a multinational case series

“…Hemorrhagic lesions (IPH) were detected in the initial brain imaging in four patients (30.7%). Brain hemorrhagic lesions have been found in up to 35% of CVST patients [ 30 ]. Thus, in SARS-CoV-2 infected patients who present with brain hemorrhagic lesions, CVST should be considered as a potential underlying cause.…”

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

“…The presence of intracranial hemorrhage at the time of CVT diagnosis was not an infrequent finding, reported in 20-39% of patients [2,3,16,25] and was a negative prognostic factor [16,25,26].…”

Cerebral venous sinus thrombosis might be under-diagnosed in the COVID-19 era

“…It is also worth emphasizing that patients with CVST and COVID-19 might present with hemorrhagic infarction as the first imaging manifestation of CVST. [ 9 , 16 , 19 ] Given the high rate of early hemorrhagic infarction in CVST patients (up to 35%) [ 20 ], the presence of any unexplained and atypical hemorrhagic lesion in the initial brain CT of these patients should raise the suspicion to CVST.…”