Objective
The data regarding diagnosis, prognosis, management, and outcome of patients with
cerebral venous thrombosis are limited from the United States.
Methods
Patients with diagnosis of cerebral venous thrombosis were identified by International Classification of Diseases, Ninth Revision coding system at 10 centers in the United States during a 10-year period by retrospective
chart review (1991-1997) or prospective enrollment (1997-2001). In all, 232 patients
were screened for study inclusion and 182 of these patients were included in the study.
Results
The age range was 13 to 82 years (mean 38 years). Hypercoagulable state was the most
common predisposing factor followed by pregnancy, malignancy, and homocystinemia.
Neurologic examination revealed normal findings in 69 patients (38%); 37 (20%) were
comatose, 59 (32%) had papilledema, and 71 (39%) had hemiparesis. In all, 61 patients
(33%) had evidence of hemorrhage by computed tomography/magnetic resonance imaging.
A total of 27 patients (15%) were treated with thrombolysis and 124 (68%) with anticoagulation.
Overall mortality was 13% (n = 24). One-year follow up was available for 96 patients
(53%). Of these, 26 (27%) were healthy, 43 (45%) were ambulatory with assistance,
and 27 (28%) were still bedridden. On multivariate analysis, the best predictors of
a poor outcome were coma at presentation (odds ratio 15.2 [95% confidence interval;
1.5-66]) and intracerebral hemorrhage (odds ratio 8.7 [95% confidence interval; 1.3-34.5]).
Conclusion
Clinical and radiologic presentation of cerebral venous thrombosis in the United States
is not much different from other parts of world but spectrum and frequency of predisposing
factors are different. Number of patients treated with thrombolysis is higher as compared
with other reported series of such patients. Coma at presentation and intracerebral
hemorrhage were the strongest predictors of poor outcome, which is comparable with
other series.
Key Words
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Article info
Publication history
Accepted:
October 12,
2007
Received in revised form:
October 9,
2007
Received:
September 10,
2007
Footnotes
Supported in part by a seed money grant from Aga Khan University.
Presented in preliminary form at World Congress of Neurology December 2005 in Sydney, Australia, and at the American Academy of Neurology Meeting, in Toronto, Ontario, Canada, in April 1999.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2007.10.001
Copyright
© 2008 National Stroke Association. Published by Elsevier Inc. All rights reserved.
