JOURNAL READING CEREBROVASCULAR

SEPTEMBER 7TH 2017

Predictors of Hospital Outcome in Patients
with Cerebral Venous Thrombosis
(Pat Korathanakhun,. et al, 2014)

dr. Ade Mayashita

Moderator : dr. Abdul Gofir, M.Sc., Sp.S(K)
Examiner : Dr. dr. Ismail S, Sp.S (K)
Dr. Kusumo Dananjoyo, M.Sc. Sp.S
 Background

serious neurologic condition disability and death.

1

3 to 4 cases / million people in the western countries.

2
obstruction of cerebral venous circulation = both focal cerebral

CVT 3
venous infarction and diffuse brain edema severe
intracranial hypertension.

The clinical presentations were variable.

4
The studies regarding epidemiology, clinical presentations, risk
factors, managements, and outcomes of CVT in Thai people
5 are scarce
 Objective

This study aims to identify predictors of hospital

outcomes among the Thai patients with CVT.
 Methods
Retrospective case control study

January 2002 - December 2013 in Songklanagarind Hospital

Enrolled all patients diagnosed with CVT by ICD 10 codes of I636 (cerebral infarction
due to CVT), I676 (nonpyogenic thrombosis of intracranial venous system), O225 (CVT
in pregnancy), and G08 (intracranial and intraspinal phlebitis and thrombophlebitis).

All of the patients = at least one : computed tomography (CT) scan, magnetic resonance
imaging (MRI), magnetic resonance venography (MRV), or cerebral angiography.

Patients demographic data, clinical presentations, associated factors of CVT, methods

of neuroimaging studies and their results, treatments, and hospital outcomes
(univariate and multivariate logistic regression analysis) were demonstrated and
analyzed.
 Methods

Level of consciousness ->GCS scale.

Hospital outcomes : mRS; nondependency (mRS, 0-2) & dependency or death (mRS, 3-6).

The clinical presentations were classified into 5 separate neurologic syndromes :

(1) focal neurologic deficits
(2) isolated intracranial hypertension
(3) cavernous sinus syndrome
(4) isolated headache
(5) seizure

Cause of death : CVT-related death (brain herniation) and non-CVTrelated death

 Results
Ninety patients = 41
males (45.6%) & 49
females (54.4%) ; mean
age 41.22 years
(standard deviation,
17.13; range, 15-80
years).
The most common clinical
presentations = focal
neurologic deficits (33
patients), seizure (30 patients),
cavernous sinus syndrome (29
patients), GCS 13 or less (16
patients), isolated headache
(10 patients), isolated
intracranial hypertension (9
patients).
Fifty-six patients had a single
clinical presentation.
Twenty-six patients had 2
clinical presentations. Seven
patients had more than 2
clinical presentations. One
patient asymptomatic with
accidentally found CVT by a
CT scan for evaluation of
chronic otitis media.
The sites of cerebral venous
occlusions were
demonstrated by a CT scan
in 73 patients (81.1%), an
MRI in 68 patients (75.6%),
an MRV in 37 patients
(41.1%), and a cerebral
angiography in 14 patients
(15.6%).
 Results

CT scan plus MRI and MRV in 26 patients (28.9%)

The common combination of CT scan and MRI in 22 patients (22.2%)
neuroimaging studies MRI and MRV in 7 patients (7.9%)

1 site in 44 patients (48.9%)

The numbers of sites of 2 sites in 24 patients (26.7%)
CVT More than 2 sites in 22 patients (24.4%)

superior sagittal sinus in 45 cases (50.0%)

The common sites of transverse sinus in 39 cases (43.3%)
CVT cavernous sinus in 30 cases (33.3%)
sigmoid sinus in 20 cases (22.2%).

superficial cortical vein in 13 patients (14.4%)

The uncommon site of straight sinus in 9 patients (10.0%)
CVT internal jugular vein in 8 patients (8.9%)
deep cerebral vein in 5 patients (5.6%).
 Results

43 patients (47.8%) were

nondependent (mRS, 0-2)
47 patients (52.2%) were
dependency or death (mRS, 3-
On discharge : 6).
Eleven patients (12.2%) were
dead; CVT-related death was
found in 7 patients (7.78%)

The statistically significant difference in clinical neurologic

presentation were seizure (9 of 30 patients [30.0%] treated
within 24 hours subgroup and 12 of 19 patients [63.2%]
treated after 24 hours subgroup; c2 5 5.22; P 5.022) and
isolated intracranial hypertension (7 of 30 patients [23.3%]
treated within 24 hours subgroup and 0 patients [.0%] treated
after 24 hours subgroup; c2 55.17; P 5 .023).
Results
 Discussion

The incidence of CVT was higher in female

A lower incidence of isolated headache (11.1%) compared with the study of
Breteau et al (30.9%) and a lower incidence of isolated intracranial
hypertension (10.0%) compared with the report of International Study on
Cerebral Vein and Dural Sinus Thrombosis (22.9%).
The common sites of CVT in the present study were superior sagittal sinus,
transverse sinus, carvernous sinus, and sigmoid sinus, respectively.
In contrast to the previous reports, the authors found that contraceptive
hormonal therapy, pregnancy or puerperium, and blood coagulation disorders
were not significantly associated with CVT.
 Discussion

The higher proportion of dependency on admission was because of the tertiary

and referral medical service of the center.
The statistically significant independent predictor for dependency or death was
the presence of focal neurologic deficits
The mRS score of 3-5 on admission was another independent predictor for
dependency or death.
Seizure predicted the lower incidence of dependency or death. The authors
hypothesized that the presence of seizure facilitated an earlier diagnosis and
treatment of CVT.
 Conclusion

Focal neurologic deficit was the most common clinical presentation and together
with high mRS score on presentation were significant predictors for dependency
or death in patients with CVT in the present study.
Seizure early diagnostic neuroimaging study followed by early treatments.
Higher incidence of CVT rhinosinal or intracranial infections.
Limitation = retrospective study design, selection bias of including more severe
cases would occur.