on January 4, 2007
Published online before print January 4, 2007, doi: 10.1161/01.STR.0000254579.16319.35
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Submitted on June 17, 2006
From Department of Neurology (M.G., D.L.), Lille University Hospital (EA2691), Lille, France; Department of Neurology (J.M.F., P.C.), Santa Maria Hospital, Lisbon, Portugal; Department of Neurology (J.S.), Academic Medical Center Amsterdam, Amsterdam, The Netherlands; Department of Neurology (M.-G.B.), Lariboisière Hospital, Paris, France; Department of Neurology (F.B.), National Institute of Neurology and Neurosurgery, Mexico City, Mexico. * To whom correspondence should be addressed. E-mail: dleys{at}chru-lille.fr.
Background and Purpose--Although intracerebral hemorrhages are frequent in patients with cerebral venous thrombosis, and lead to worse outcome, predictors of outcome in cerebral venous thrombosis patients with intracerebral hemorrhages have never been evaluated in adequately powered studies. Methods--This study was conducted as a part of the International Study on Cerebral Vein and Dural Sinus Thrombosis. We evaluated predictors of outcome in cerebral venous thrombosis patients who had an "early intracerebral hemorrhage," ie, intracerebral hemorrhages already present at time of diagnosis of cerebral venous thrombosis by a logistic regression analysis, with a modified Rankin scale 3 to 6 at month 6 as dependent variable. The same analysis was performed with "delayed intracerebral hemorrhages," ie, intracerebral hemorrhages that occurred after the diagnosis of cerebral venous thrombosis, as dependent variable. Results--Of 624 patients recruited in International Study on Cerebral Vein and Dural Sinus Thrombosis, 245 (39%) had an early intracerebral hemorrhage: at month 6, 51 (21%) of them had a modified Rankin Scale 3 to 6. Independent predictors of having modified Rankin scale 3 to 6 at month 6 were older age (adjusted odds ratio for 1-year increase in age, 1.05; 95% CI, 1.02 to 1.08); male gender (adjusted odds ratio, 3.25; 95% CI, 1.29 to 8.16); having a deep cerebral venous system thrombosis (adjusted odds ratio, 5.43; 95% CI, 1.67 to 17.61) or a right lateral sinus thrombosis (adjusted odds ratio, 2.56; 95% CI, 1.03 to 6.40); and having a motor deficit (adjusted odds ratio, 2.94; 95% CI, 1.21 to 7.10). Of the 36 patients who had a delayed intracerebral hemorrhage, those who had a modified Rankin scale 3 to 6 at month 6 were less likely to have received heparin at the acute stage, and more likely to have had early intracerebral hemorrhage. Conclusion--Among patients with early intracerebral hemorrhage, those who were older, men, had a thrombosis of the deep cerebral venous system or of the right lateral sinus, and a motor deficit were at higher risk for death or dependency at month 6. This subgroup of patients with predictors of poor outcome can be the target for new therapeutic strategies.
Revised on September 8, 2006
Accepted on September 15, 2006
Predictors of Outcome in Patients With Cerebral Venous Thrombosis and Intracerebral Hemorrhage
Marie Girot MD;
Key words: acute stroke • cerebral venous thrombosis • intracerebral hemorrhage
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Stroke 2007 38: 395-397.