Abstract T MP96: Factors Associated with Neurological Worsening in Hospitalized Patients with Cerebral Venous Thrombosis
Background and purpose: A significant proportion of patients with cerebral venous thrombosis (CVT) present neurological deterioration within the following days after arriving to hospital without significant altered consciousness. This has been a poorly studied issue. We aimed to determine factors associated with neurological worsening in hospitalized patients with CVT.
Methods: We analyzed a collaborative database on patients with autopsy or neuroimaging confirmed CVT who were hospitalized from 1980 to 2014 in two third-level referral hospitals. For the present analysis we excluded cases arriving to hospital with profound altered consciousness. Neurological worsening was defined as the progression to stupor or coma in patients initially presenting alert or with somnolence. Bivariate analyses were performed to identify variables associated with neurological worsening. A multivariate analysis by logistic regression was performed to determine independent variables associated with this study outcome.
Results: A total of 426 patients were here analyzed (94% aseptic CVT, 81.2% women, median age: 29 years, interquartile range: 22-38 years), of whom 51 (12%) presented neurological worsening at least 24 h after hospital arrival (median time to deterioration: 8 days, interquartile range: 5-13 days). Among patients with neurological worsening, 28 (54.9%) deteriorated after the first week upon arrival, 21 (41.2%) died during their hospital stay, and 36 (70.6%) attained a modified Rankin scale >3 at hospital discharge. Independent predictors of neurological worsening were age >40 years (OR: 5.79, 95% CI: 2.53-13.24), parenchymal lesion >6 cm in its greater diameter (OR: 11.27, 95% CI: 5.00-25.41) and bilateral pyramidal syndrome at arrival (OR: 15.40, 95% CI: 6.90-34.40). Etiological factors, anticoagulant vs antiplatelet therapy, seizures, presence of extracranial venous thrombosis or CVT topography were not independent predictors for neurological worsening after adjustment.
Conclusion: Worsening in CVT patients arriving stable is not uncommon. More than half of cases of neurological deterioration occur after the first week of hospitalization, nonetheless, its determinants can be easily anticipated upon hospital arrival.
Author Disclosures: E. Chiquete: None. C. Cantú-Brito: None. M. Barboza: None. A. Quiroz: None. C. Jonathan: None. M. Merlos: None. A. Arauz: None.
- © 2015 by American Heart Association, Inc.