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(Stroke. 2009;40:3133.)
© 2009 American Heart Association, Inc.

Research Letters

Delay in the Diagnosis of Cerebral Vein and Dural Sinus Thrombosis

Influence on Outcome

José M. Ferro, MD, PhD; Patrícia Canhão, MD; Jan Stam, MD; Marie-Germaine Bousser, MD; Fernando Barinagarrementeria, MD; Ayrton Massaro, MD; Xavier Ducrocq, MD; Scott E. Kasner, MD for the ISCVT Investigators

From the Department of Neurology (J.M.F., P.C.), Hospital Santa Maria, University of Lisboa, Lisboa, Portugal; the Academic Medical Centre (J.S.), Amsterdam, The Netherlands; Hôpital Lariboisière (M.G.B.), Paris, France; Instituto Nacional de Neurologia y Neurocirurgia (F.B.), México City, México; Hospital das Clínicas (A.M.), Universidade de São Paulo, São Paulo, Brazil; Hôpital Central (X.D.), Nancy, France; and the University of Pennsylvania Medical Center (S.E.K.), Philadelphia, Pa.

Correspondence to José M. Ferro, MD, PhD, Department of Neurology, Hospital Santa Maria, 1649-035 Lisboa, Portugal. E-mail jmferro{at}fm.ul.pt

Background and Purpose— Diagnostic delay of cerebral vein and dural sinus thrombosis may have an impact on outcome.

Methods— In the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) cohort (624 patients with cerebral vein and dural sinus thrombosis), we analyzed the predictors and the impact on outcome of diagnostic delay. Primary outcome was a modified Rankin Scale score >2 at the end of follow-up. Secondary outcomes were modified Rankin Scale score 0 to 1 at the end of follow-up, death, and visual deficits (visual acuity or visual field).

Results— Median delay was 7 days (interquartile range, 3 to 16). Patients with disturbance of consciousness (P<0.001) and of mental status (P=0.042), seizure (<0.001), and with parenchymal lesions on admission CT/MR (P<0.001) were diagnosed earlier, whereas men (P=0.01) and those with isolated intracranial hypertension syndrome (P=0.04) were diagnosed later. Between patients diagnosed earlier and later than the median delay, no statistically significant differences were found in the primary (P=0.33) and in secondary outcomes: modified Rankin Scale score 0 to 1 (P=0.86) or deaths (P=0.53). Persistent visual deficits were more frequent in patients diagnosed later (P=0.05). In patients with isolated intracranial hypertension syndrome, modified Rankin Scale score >2 at the end of follow-up was more frequent in patients diagnosed later (P=0.02).

Conclusions— Diagnostic delay was considerable in this cohort and was associated with an increased risk of visual deficit. In patients with isolated intracranial hypertension syndrome, diagnostic delay was also associated with death or dependency.

Key Words: cerebral vein thrombosis • diagnostic delay • dural sinus thrombosis • medicolegal • outcome