Original Article
Cerebral Venous Thrombosis: Analysis of a Multicenter Cohort From the United States

https://doi.org/10.1016/j.jstrokecerebrovasdis.2007.10.001Get rights and content

Objective

The data regarding diagnosis, prognosis, management, and outcome of patients with cerebral venous thrombosis are limited from the United States.

Methods

Patients with diagnosis of cerebral venous thrombosis were identified by International Classification of Diseases, Ninth Revision coding system at 10 centers in the United States during a 10-year period by retrospective chart review (1991-1997) or prospective enrollment (1997-2001). In all, 232 patients were screened for study inclusion and 182 of these patients were included in the study.

Results

The age range was 13 to 82 years (mean 38 years). Hypercoagulable state was the most common predisposing factor followed by pregnancy, malignancy, and homocystinemia. Neurologic examination revealed normal findings in 69 patients (38%); 37 (20%) were comatose, 59 (32%) had papilledema, and 71 (39%) had hemiparesis. In all, 61 patients (33%) had evidence of hemorrhage by computed tomography/magnetic resonance imaging. A total of 27 patients (15%) were treated with thrombolysis and 124 (68%) with anticoagulation. Overall mortality was 13% (n = 24). One-year follow up was available for 96 patients (53%). Of these, 26 (27%) were healthy, 43 (45%) were ambulatory with assistance, and 27 (28%) were still bedridden. On multivariate analysis, the best predictors of a poor outcome were coma at presentation (odds ratio 15.2 [95% confidence interval; 1.5-66]) and intracerebral hemorrhage (odds ratio 8.7 [95% confidence interval; 1.3-34.5]).

Conclusion

Clinical and radiologic presentation of cerebral venous thrombosis in the United States is not much different from other parts of world but spectrum and frequency of predisposing factors are different. Number of patients treated with thrombolysis is higher as compared with other reported series of such patients. Coma at presentation and intracerebral hemorrhage were the strongest predictors of poor outcome, which is comparable with other series.

Section snippets

Methods

Patients with diagnosis of CVT were identified by International Classification of Diseases, Ninth Revision coding system (325, phlebitis and thrombophlebitis of intracranial venous sinuses; 671.5, CVT in pregnancy and puerperium; and 437.6, nonpyogenic thrombosis of intracranial venous sinus) at 10 centers in the United States during a 10-year period by retrospective chart review (1991-1997) or prospective enrollment (1997-2001). The investigators screened 232 patients for study inclusion by

Results

The study included 182 patients. The age range was 13 to 82 years (mean 38 years). In all, 109 individuals (60%) were women. In 103 patients (57%), one or more predisposing factors were identified (Table 1). A homocysteine level was checked in 89 patients (49%) and was elevated (>20 μmol/L) in 9 patients (10%). The range of homocysteine level was 20 to 37 μmol/L (median 25 μmol/L) in this 10% of patients. Two or more risk factors were identified in 19 patients (10%).

Headache (76%) was the most

Discussion

This study represents the second largest registry of patients with CVT after the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)6 and the largest cohort of these patients from the United States. Clinical and radiologic features, predisposing factors, outcome, and predictors of outcome are not much different from ISCVT or other European studies. The major strength of the study is it being the largest US-based multicenter cohort with the largest number (n = 27; 15% of all

Acknowledgment

The authors are grateful to Dr Steve Roach, Ohio State University, for manuscript review and valuable suggestions.

References (26)

  • J.E. Cavazos et al.

    Sumatriptan-induced stroke in sagittal sinus thrombosis

    Lancet

    (1994)
  • W.R. Gowers

    Manual of diseases of the nervous system

    (1888)
  • A. Daif et al.

    Cerebral venous thrombosis in adults: A study of 40 cases from Saudi Arabia

    Stroke

    (1995)
  • A. Lleo et al.

    Cerebral venous thrombosis: Study of 17 cases

    Med Clin (Barc)

    (1999)
  • J.M. Ferro et al.

    Cerebral Venous Thrombosis Portuguese Collaborative Study Group (Venoport). Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998

    Cerebrovasc Dis

    (2001)
  • S.F. de Bruijn et al.

    for The Cerebral Venous Sinus Thrombosis Study Group. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients

    J Neurol Neurosurg Psychiatry

    (2001)
  • J.M. Ferro et al.

    ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: Results of the international study on cerebral vein and dural sinus thrombosis (ISCVT)

    Stroke

    (2004)
  • C. Benesch et al.

    Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease

    Neurology

    (1997)
  • L.B. Goldstein

    Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke: Effect of modifier codes

    Stroke

    (1998)
  • M.R. Golomb et al.

    Accuracy of ICD-9 codes for identifying children with cerebral sinovenous thrombosis

    J Child Neurol

    (2007)
  • P.J. Kelly et al.

    Stroke in young patients with hyperhomocysteinemia due to cystathionine beta-synthase deficiency

    Neurology

    (2003)
  • J.B. Caress et al.

    The clinical features of 16 cases of stroke associated with administration of IVIg

    Neurology

    (2003)
  • N. Evangelou et al.

    Transverse sinus thrombosis and IVIg treatment: A case report and discussion of risk-benefit assessment for immunoglobulin treatment

    J Clin Pathol

    (2003)
  • Cited by (0)

    Supported in part by a seed money grant from Aga Khan University.

    Presented in preliminary form at World Congress of Neurology December 2005 in Sydney, Australia, and at the American Academy of Neurology Meeting, in Toronto, Ontario, Canada, in April 1999.

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