Published online before print February 19, 2004, doi: 10.1161/01.STR.0000117571.76197.26
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(Stroke. 2004;35:664.)
© 2004 American Heart Association, Inc.
Original Contributions |
Prognosis of Cerebral Vein and Dural Sinus Thrombosis
Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)
From the Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (J.M.F., P.C.); Department of Neurology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands (J.S.); Department of Neurology, Hôpital Lariboisière Paris, Paris, France (M-G.B.); and Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, México (F.B.).
Correspondence to José M. Ferro, Neurology Department, Hospital Santa Maria, 1649-035 Lisbon, Portugal. E-mail jmferro{at}iscvt.com
Background and Purpose— The natural history and long-term prognosis of cerebral vein and dural sinus thrombosis (CVT) have not been examined previously by adequately powered prospective studies.
Methods— We performed a multinational (21 countries), multicenter (89 centers), prospective observational study. Patients were followed up at 6 months and yearly thereafter. Primary outcome was death or dependence as assessed by modified Rankin Scale (mRS) score >2 at the end of follow-up.
Results— From May 1998 to May 2001, 624 adult patients with CVT were registered. At the end of follow-up (median 16 months), 356 patients (57.1%) had no symptom or signs (mRS=0), 137 (22%) had minor residual symptoms (mRS=1), and 47 (7.5%) had mild impairments (mRS=2). Eighteen (2.9%) were moderately impaired (mRS=3), 14 (2.2%) were severely handicapped (mRS=4 or 5), and 52 (8.3%) had died. Multivariate predictors of death or dependence were age >37 years (hazard ratio [HR]=2.0), male sex (HR=1.6), coma (HR=2.7), mental status disorder (HR=2.0), hemorrhage on admission CT scan (HR=1.9), thrombosis of the deep cerebral venous system (HR=2.9), central nervous system infection (HR=3.3), and cancer (HR=2.9). Fourteen patients (2.2%) had a recurrent sinus thrombosis, 27 (4.3%) had other thrombotic events, and 66 (10.6%) had seizures.
Conclusions— The prognosis of CVT is better than reported previously. A subgroup (13%) of clinically identifiable CVT patients is at increased risk of bad outcome. These high-risk patients may benefit from more aggressive therapeutic interventions, to be studied in randomized clinical trials.
Key Words: cerebral veins • cranial sinuses • outcome • prognosis • thrombosis
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