Published Online
on August 11, 2005

A more recent version of this article appeared on September 1, 2005

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Submitted on May 18, 2005
Accepted on June 27, 2005

Cerebral Vein and Dural Sinus Thrombosis in Elderly Patients

José M. Ferro MD, PhD^*; Patrícia Canhão MD; Marie-Germaine Bousser MD; Jan Stam MD; Fernando Barinagarrementeria MD; for the ISCVT Investigators

From the Department of Neurosciences and Mental Health (J.M.F., P.C.), Hospital Santa Maria, Lisboa, Portugal; Department of Neurology (M.-G.B.), Hôpital Lariboisière Paris, France; Department of Neurology (J.S.), Academic Medical Centre Amsterdam, The Netherlands; and Department of Neurology (F.B.), Instituto Nacional de Neurologia y Neurocirurgia, México City, México.

^* To whom correspondence should be addressed. E-mail: jmferro{at}fm.ul.pt.

Backgound and Purpose--The clinical features and prognosis of cerebral vein and dural sinus thrombosis (CVT) in elderly patients have not been previously described.

Methods--In a multicenter prospective observational study, we compared clinical and imaging features, risk factors, and outcome of adult patients aged <65 (young and middle-aged patients) and 65 years (elderly patients).

Results--A total of 624 adult patients with CVT were registered and followed-up for a median of 16 months. Fifty-one (8.2%) were aged 65 years. Presentation as an isolated intracranial hypertension syndrome was less frequent in elderly patients (4/51 versus 139/573, P=0.008), whereas depressed consciousness (17 versus 97, P=0.005), and mental status changes (22 versus 115, P=0.001) were more frequent in the elderly. The prognosis of elderly patients was considerably worse than that of younger patients, as only 49% of elderly patients made a complete recovery (versus 82% in younger patients), whereas 27% died and 22% were dependent at the end of follow-up (versus 7 and 2% respectively in younger patients). Carcinoma (5 cases) was more frequent as a risk factor for CVT in elderly patients (P=0.017). During follow-up, elderly patients were more likely to experience thrombotic events (HR=4.8, 95% CI=1.9 to 11.9) and were less likely to experience severe headaches (HR=0.2, 95% CI=0.02, 0.97).

Conclusions--Elderly patients with CVT have a distinctive clinical presentation: isolated intracranial hypertension is uncommon, whereas mental status and alertness disturbances are common. The prognosis of CVT is worse in elderly patients.

Key words: aged • cerebral veins • dural sinus • elderly • malignancy • outcome • prognosis • thrombosis

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