Non-contrast CT image characteristics on admission predict the 3-month outcome of cerebral venous sinus thrombosis: an observational study in a single institution

Abstract

Background: Various computed tomography (CT) appearances of cerebral venous sinus thrombosis (CVST) were associated with different prognosis and the patients with large intracranial hematoma will have adverse outcomes, but no in-depth study of non-contrast CT image appearances was carried out. We aimed to test the hypothesis that non-contrast CT image characteristics on admission are associated with and predict the outcome of CVST at 3 months. Methods: Three hundred and six patients with CVST between 2008 and 2017 were collected. Age, sex, onset of CVST(acute, subacute, or chronic), etiology, clinical manifestations, midline shift, occluded venous sinus, location of infarction, non-contrast CT image characteristics, and the 3-month outcome were recorded. In addition, we established a non-contrast CT image-based classification and grading system to test the hypothesis; the CVST patients were classified into four grades (namely non-contrast CT image-based classification): grade I, no obvious abnormality; grade II, simple vein infarction without hemorrhage or with subarachnoid hemorrhage; grade III, cerebral venous infarction with subarachnoid hemorrhage; and grade IV, cerebral vein infarction with hematoma. All enrolled patients had received subcutaneous injections of low molecular weight heparin subcutaneous injection for 14 days. Thereafter, oral anticoagulant therapy with warfarin was continued. Patients with epilepsy were given antiepileptic drugs, and patients with cerebral herniation received decompressive craniotomy. Results: Our observational findings revealed that midline shift (> 5 mm), location of lesion (frontal lobe and temporal lobe), and cerebral venous infarction with subarachnoid or hematoma (grade III and IV) were associated with 3-month poor outcome (p < 0.05); the respective increased risks were 12.730 [risk ratio (RR) 12.730, 95% confidence interval (CI) 1.680-96.490, p = 0.014], 46.538 (RR 146.538, 95% CI 6.222-348.079, p = 0.000), 32.549 (RR 32.549, 95% CI 2.180-486.104, p = 0.012), 37.725 (RR 37.725, 95% CI 2.051-693.778, p = 0.015), and 93.164-fold (RR 93.164, 95% CI 11.137-779.328, p = 0.000). However, seizure, hemiplegia, location of occluded venous sinus (super sagittal sinus and deep venous systems), location of infarction (parietal lobe), and non-contrast CT image-based classification (I) were not correlated with the adverse outcome (p > 0.05). Conclusions: Our findings suggested that non-contrast CT image characteristics on admission were associated with and predict the 3-month outcome of CVST. However, the ultimate conclusions need to be confirmed by a large sample of CVST patients at multiple institutions.

Non-fasting Glucose Level at Admission Associated with Outcomes in Cerebral Venous Thrombosis

“…In our study, demographic characteristics, signs and symptoms, radiological findings, treatment, and outcomes were similar to those reported previously. [2][3][4][5][6][7][8][9][10][11] However, our results showed that 68.5% of the patients with CVT had protein S deficiency, which was higher than that previously reported by Karsy et al 8 (10.7%) and Pan et al 9 (55.5%). We provide two explanations for the difference in the percentage of patients with a protein S deficiency: (a) differences in genetic predispositions, or (b) the protein S level was obtained at the time of CVT diagnosis, before the initiation of anticoagulant treatment; therefore, the lower protein S level might be attributed to the effects of acute thrombosis.…”

“…11 Further, OCP use induced thrombosis by increasing factor VII, factor X, and fibrinogen levels, which might be associated with the good outcome observed in our study since it is a precipitating factor that can be reversed by stopping OCP use, unlike some kinds of malignancies or genetic prothrombotic factors. Most prognostic factors related to poor outcomes have been described in previous reports, [2][3][4][5][6][7][8][9][10][11]16 except for the duration of the symptoms. We found that the duration of presenting symptoms of < 24 hours was associated with poor outcomes.…”

“…4 Recent studies have found various prognostic factors related to outcomes in CVT, which include sex, age, impaired consciousness, neurological deficit, seizure, ICH, brain herniation, and intra-and paracranial infection. [2][3][4][5][6][7][8][9][10][11] However, some results of these studies were inconclusive. In 2004, Ferro et al found that central nervous system (CNS) infection was associated with poor outcomes, whereas Shakibajahromi et al found no such association.…”