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

Kowoll CM, Kaminski J, Weiss V, Boesel J, Dietrich W, Juettler E, Flechsenhar J, Guenther A, Huttner H, Niesen WD, Pfefferkorn T, Schirotzek I, Schneider H, Liebig T, Dohmen C (2016)

Publication Type: Journal article

Publication year: 2016

Journal

Neurocritical Care Humana Press

Book Volume: 25

Pages Range: 392-399

Journal Issue: 3

DOI: 10.1007/s12028-016-0256-8

Abstract

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.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.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).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.

Authors with CRIS profile

Hagen Huttner Medizinische Fakultät

Involved external institutions

Charité - Universitätsmedizin Berlin DE Germany (DE) Universitätsklinikum Köln DE Germany (DE) Universität zu Köln DE Germany (DE) Universitätsklinikum Heidelberg DE Germany (DE) Klinikum Nürnberg DE Germany (DE) Universitätsklinikum Jena DE Germany (DE) Ostalb-Klinikum Aalen DE Germany (DE) Universitätsklinikum Freiburg DE Germany (DE) Klinikum der Universität München (Großhadern und Innenstadt) DE Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) DE Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden DE Germany (DE)

How to cite

APA:

Kowoll, C.M., Kaminski, J., Weiss, V., Boesel, J., Dietrich, W., Juettler, E.,... Dohmen, C. (2016). Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis. Neurocritical Care, 25(3), 392-399. https://doi.org/10.1007/s12028-016-0256-8

MLA:

Kowoll, Christina M., et al. "Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis." Neurocritical Care 25.3 (2016): 392-399.

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