Outcomes in adults with cerebral venous sinus thrombosis: A retrospective cohort study

Karsy, Michael; Harmer, Joshua R.; Guan, Jian; Brock, Andrea A.; Ravindra, Vijay M.; Chung, Lee; Tkach, Aleksander; Majersik, Jennifer J.; Park, Min; Schmidt, Richard H.

doi:10.1016/j.jocn.2018.03.004

Cited by 18 publications

(25 citation statements)

References 14 publications

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“…Eight children who developed nephritis or nephrotic syndrome (hormone therapy) were already in the pre-thrombus state and the occurrence of CVST was attributed to insufficient water intake due to vomiting. These findings are in accordance with those of several other studies in that infection, nephritis, or nephrotic syndrome may be important etiologies of CVST (8, 9). In this study, 63.3% (19/30) of the children presented with obvious cases of the disease, which is far lower than the 85% reported in international studies (10).…”

Section: Discussionsupporting

confidence: 93%

Clinical Characteristics and Outcomes of Pediatric Cerebral Venous Sinus Thrombosis: An Analysis of 30 Cases in China

et al. 2019

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Background: Cerebral venous sinus thrombosis (CVST) in children is rare in a clinical setting. The aim of this study was to summarize the etiological, clinical, and imaging characteristics of CVST in children.Methods: We retrospectively analyzed the data of 30 patients with a diagnosis of CVST who were admitted to Children's Hospital of Fudan University from 2008 to 2018. The medical records, including clinical manifestations, laboratory data, neurological findings, treatment, and short-term prognosis were analyzed.Results: Etiologically, the causes of CVST were infection (7/30), tumor (3/30), nephritis or nephrotic syndrome (8/30), traumatic brain injury (1/30), and undefined disease (11/30). All 30 cases were diagnosed with CVST after a neuroimaging examination using brain magnetic resonance imaging (MRI) combined with magnetic angiography venography (MRV). With regard to short-term prognosis, all the patients were treated with anticoagulants, after which 26 cases improved.Conclusions: CVST patients do not typically present with specific clinical manifestations, which leads to a high rate of misdiagnosis and delayed therapy. Increased consideration and prompt MRV checkup plays a key role in achieving an accurate diagnosis. Overall, anticoagulation is a safe and effective treatment for CVST.

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Section: Discussionsupporting

confidence: 93%

Clinical Characteristics and Outcomes of Pediatric Cerebral Venous Sinus Thrombosis: An Analysis of 30 Cases in China

et al. 2019

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“…Therefore, our scale achieves its best performance in predicting acute fatality. Another reason to establish our primary goal as the evaluation of functional bad outcome in the acute period is related to the lack of statistical significance in the mid- and long-term functional outcome (3 and 6 months, respectively), with a tendency for a good prognosis (mRS 0–2) in those who overcome the 30-day initial period ( 13 , 15 – 24 ). However, our score model must be evaluated in another prospective study to test its performance in these follow-up periods as well.…”

Section: Discussionmentioning

confidence: 99%

A Practical Score for Prediction of Outcome After Cerebral Venous Thrombosis

et al. 2018

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Background: Most patients with cerebral venous thrombosis (CVT) have independent survival in the short term. However, identification of high-risk individuals with an unfavorable outcome is a challenging task. We aimed to develop a CVT grading scale (CVT-GS) to aid in the short-term clinical decision-making.Methods: We included 467 consecutive patients with CVT who were hospitalized from 1981 to 2015 in two third-level referral hospitals. Factors associated with 30-day mortality were selected with bivariate analyses to integrate a Cox proportional-hazards model to determine components of the final scoring. After the scale was configured, the prognostic performance was tested for prediction of short-term death or moderately impaired to death [modified Rankin scale (mRS) > 2]. CVT-GS was categorized as mild, moderate or severe for the prediction of 30-day fatality rate and a probability of mRS > 2.Results: The 30-day case fatality rate was 9.0%. The CVT-GS (0–13 points; more points predicting poorer outcomes) was composed of parenchymal lesion size > 6 cm (3 points), bilateral Babinski signs (3 points), male sex (2 points), parenchymal hemorrhage (2 points), and level of consciousness (coma: 3 points, stupor: 2, somnolence: 1, and alert: 0). CVT was categorized as mild (0–2 points, 0.4% fatality rate), moderate (3–7 points, 9.9% fatality rate), or severe (8–13 points, 61.4% fatality rate). The CVT-GS had an accuracy of 91.6% for the prediction of 30-day mortality and 85.3% for mRS > 2.Conclusions: CVT-GS is a practical clinical tool for prediction of outcome after CVT. This score may aid in clinical decision-making and could serve to stratify patients enrolled in clinical trials.

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“…The basis of sinus venous thrombosis can be linked to Virchow’s triad, which includes injury to the vessel walls, a hypercoagulable state and stasis 22. Up to now, recognised predisposing risk factors for thrombosis are known to include inflammation,23 and infection likely adds additional patient risk in addition to the risk of CVST 24. Pathophysiological mechanisms that specifically drive thrombosis during infection have not yet been fully elucidated, but inflammation has been regarded as one of the causes of the hypercoagulable state 25 26.…”

Section: Discussionmentioning

confidence: 99%

Lower lymphocyte to monocyte ratio is a potential predictor of poor outcome in patients with cerebral venous sinus thrombosis

Shen¹,

Li²,

Zhang³

et al. 2018

Stroke Vasc Neurol

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BackgroundLymphocyte to monocyte ratio (LMR) is associated with functional outcome in patients with stroke. But the relationship between the LMR value and the prognosis of cerebral venous sinus thrombosis (CVST) has not been investigated.MethodsCVST patients, admitted to the First Affiliated Hospital of Zhengzhou University, were retrospectively identified from November 2010 to January 2017. Functional outcomes of patients were evaluated with the modified Rankin Scale (mRS). Patients were divided into good (mRS 0–2) and poor (mRS 3–6) outcomes groups. Univariate and multivariate Cox regression analyses were used to assess the relationship between LMR and the poor survival outcome.ResultsA total of 228 patients were included of which 41 had poor outcomes (18.0%). The duration of follow-up was 22 months (6–66 months). LMR (2.3±1.2 vs 3.2±1.8, p<0.01) was significantly lower in the poor outcome group. Multivariate Cox regression analysis showed that LMR (HR 0.726, 95% CI 0.546 to 0.964, p=0.027) was a independent predictor of poor prognosis.ConclusionsLMR may be a predictor of poor prognosis in CVST patients.

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Outcomes in adults with cerebral venous sinus thrombosis: A retrospective cohort study

Cited by 18 publications

References 14 publications

Clinical Characteristics and Outcomes of Pediatric Cerebral Venous Sinus Thrombosis: An Analysis of 30 Cases in China

Clinical Characteristics and Outcomes of Pediatric Cerebral Venous Sinus Thrombosis: An Analysis of 30 Cases in China

A Practical Score for Prediction of Outcome After Cerebral Venous Thrombosis

Lower lymphocyte to monocyte ratio is a potential predictor of poor outcome in patients with cerebral venous sinus thrombosis

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