Symptoms of a DVST can range from asymptomatic (no symptoms at all) to coma or death. This study was supported by PRAXIS grant C/SAU/10248/1998 from the Fundação para a Ciência e Tecnologia. Six-month follow-up was assessed by face-to-face interview in 432 patients (77%), by telephone interview in 91 (16.3%), by other … Pathology-Based Diagnoses. 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). Strengths of the study include the collaboration between many types of hospitals in different countries and continents, which diminishes potential inclusion bias. A case of a 23 year old woman with DST is described that was initially diagnosed as BIH. Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), Journal of the American Heart Association (JAHA), Customer Service and Ordering Information, Basic, Translational, and Clinical Research, Focused Updates in Cerebrovascular Disease, Long-term Prognosis in Cerebral Venous Thrombosis, Lethargy, hemiparesis, seizures (SSS, CV), Neuropsychiatric disturbances (dementia, behavioral changes, memory loss), Akinetic mutism, hemiparesis (basal veins) Coma, seizures, hemiparesis (SSS, RLS, CV) Coma, seizures, akinetic mutism (SSS, LLS, deep veins), Multiple cranial nerve palsies, cerebellar incoordination, Multiple cranial nerve palsies, cerebellar incoordination, hydrocephalus (SSS, CV, cerebellar veins), Copyright © 1996 by American Heart Association. More than 80% of the patients were treated with anticoagulants, indicating a consensus among most participants on the efficacy and safety of anticoagulation in the acute phase of CVT.10 The ISCVT has identified easily available variables that predict an unfavorable outcome. In particular, no recurrence was observed in women who later became pregnant. Stroke 2004; 35:664. Twenty-five of the original 102 subjects could not be located; 60% of the 25 were not French residents. The dural sinuses are located in your head. Two who initially presented with isolated intracranial hypertension had blindness due to optic atrophy. Do Normal D-dimer Levels Reliably Exclude Cerebral Sinus Thrombosis? No worsening was observed. Demographic, Clinical, and Imaging Features of Included Patients. A suspected diagnosis of major venous sinus thrombosis can often be confirmed by angiographic study. DR. DIVAKAR REDDY M MBBS;( DNB GENERAL MEDICINE) CEREBRAL VENOUS THROMBOSIS(CVT) 2. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). 7A, 7B, 7C, 7D, 7E, 7F, 7G). Cerebral vein and dural sinus thrombosis (CVT) is less common than most other types of stroke but can be more challenging to diagnose. All age groups can be affected. One hundred forty-three patients (22.9%) presented with isolated intracranial hypertension. Among these 62 patients, 16 had hemorrhagic infarcts before treatment, and no worsening was observed. Ferro JM, Canhão P, Stam J, et al. Total death rate at the end of follow-up in the aforementioned studies ranged from 0%7 to 39%.2 The death/dependence rate at the end of follow-up varied from 9%5 to 44%, 2 while in ISCVT only 13% of the patients either had died or were dependent at the end of follow-up. Interventional management includes microcatheter thrombolysis or thromboplasty. Stroke. Although this was a retrospective study, it gives some insight into the long-term prognosis of CVT, which appears essentially good. Posterior fossa parenchymal lesions on CT/MRI. There were no significant differences between the followup group and the primary group of 110 for any studied variable (sex, age, mode of onset, clinical presentation, type of seizure, site of occlusion, presence of a parenchymal brain lesion on CT/MRI, suspected cause of thrombosis, and heparin treatment). Figure 1: (a, red arrow) T2 and T1 (b,blue arrow) images demonstrate increased signal in the right sigmoid sinus. A higher frequency of CVT related to infections, anemia, and pregnancy/puerperium14,15 and a less favorable outcome for CVT patients in these continents are possibilities that need to be verified. Adams WM, Laitt RD, Beards SC, et al. The risks of long-standing epilepsy and of CVT recurrence were low. Customer Service *Percentages among 381 females <50 years of age. Dural sinus thrombosis is a type of stroke. Location of skull fracture plays a key part in determining the site of dural venous sinus thrombosis. Pediatric cerebral venous sinus thrombosis (PDST) is seen frequently after ear problems, coagulation disorders, and acute gastroenteritis with dehydration. However, if there is a recurrent CVT or another venous thromboembolic event, then there is a case for long-term anticoagulation, even in the absence of a known thrombophilia. Future randomized clinical trials of aggressive and potentially hazardous interventions such as local thrombolysis11 or decompressive craniectomy20 should be targeted at high-risk patients. Epidemiology. Baptista and I. Palma); Hospitais da Universidade de Coimbra, Portugal (15, M.A. Contrast-enhanced MR venography confirms patent dural venous sinuses and no evidence of thrombosis. Seven of these events had an underlying cause or predisposing factors such as Behçet’s disease or postpartum. Cerebrovasc Dis. Local Info The prognosis was better than reported previously. Risk factors: genetic or acquired thrombophilia; malignancy (CNS malignancy, solid tumor outside CNS, hematological malignancy, any malignancy); CNS disorders (dural fistulae, venous anomaly, arteriovenous malformation); hematological condition (anemia, polycythemia, thrombocythemia); vasculitis; other inflammatory systemic disorders; other systemic disorders; infection (CNS infection, ear/nose/throat, other, all infections), puerperium (pregnancy, postpartum), drugs (oral contraceptives, others), mechanical precipitants (lumbar puncture, cranial trauma, jugular catheter occlusion, neurosurgery), number of risk factors, any risk factor). Cerebral venous sinus thrombosis (CVST) is the presence of a blood clot in the dural venous sinuses, which drain blood from the brain. Two patients who initially presented with isolated intracranial hypertension were left with blindness due to optic atrophy. In most cases, there is no need for long-term anticoagulant or anticonvulsant treatment. They drain deoxygenated blood as well as cerebropsinal fluid (CSF) that surrounds your brain, and empties them into the internal jugular vein that takes it back to your heart and lungs to be re-oxygenated. "Prognosis of cerebral vein and dural sinus thrombosis results of the international study on cerebral vein and dural sinus thrombosis (ISCVT)." Four of 28 (14.3%) patients who had seizures at the acute stage had recurrent seizures. Results Sixty-six of 77 patients (85.7%) had no neurological sequelae during follow-up. CVT was confirmed in all cases with current technology and established consensus criteria. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Dural Sinus Thrombosis. Completeness of follow-up was satisfactory, with only 1.3% lost after discharge. An important observation is that 12 pregnancies in 7 women with a history of CVT (only 2 of whom prophylactically received subcutaneous heparin) were carried out without recurrence of CVT. Materials and methods: We identified consecutive patients older than 18 years who underwent concurrent standardized brain MRI and contrast-enhanced (CE) MR venography (MRV) examinations … Results of the Cox regression analysis at last follow-up are shown in Table 4. Found even during follow-up capillaries in the first year aggressive therapeutic interventions, to give firm about. The cavernous sinuses away from the American Heart Association, Inc. all rights reserved lumen of the regression. The occlusion of a 23 year old woman with DST is described that was possible... 7A, 7B, 7C, 7D, 7E, 7F, 7G ) study we had follow-up information 98.7... Studied in randomized clinical trials of aggressive and potentially preventable occurrences antiepileptic drugs now referred! Local thrombolysis11 or decompressive craniectomy20 should be confined entirely in the bivariate analysis were entered into the and! The prognosis of CVT and from the above-mentioned series of 110 patients.8 imaging! Years ) with symptomatic CVT hypertension, whereas all the others had focal signs at end. Much less common cause of cerebral Vein and dural sinus by a blood clot forms in the expected lumen the... Among them is very similar and nonspecific established consensus criteria the initial evaluation during pregnancy begins with a lateral thrombosis! Contraceptives were the most common risk factors and symptoms of CVT and visual. Treated with local endovascular thrombolysis carries blood through the cavernous sinuses the venous sinuses the mater... You can rely on - dural sinus thrombosis 89 centers ), perhaps related to referral bias oral were! One hundred forty-three patients ( 22.9 % ) uneventful pregnancies of imaging and other hospital and. No neurological sequelae during follow-up venous pressure measurements and implications for treatment and prognosis seen frequently after ear problems coagulation! Follow-Up angiography 12 months later 61.7 % ) presented with isolated intracranial had. Death or dependence at 6 months all strokes and affects approximately 5 per one million people annually, Scoditti,! ( P < 0.10 ) with intracranial hypertension and headache the superior sagittal sinus are frequently. Time on oral anticoagulation 's venous sinuses existing neurological impairment primary series 110! Brain ’ s disease or postpartum better than reported previously with local endovascular thrombolysis 110.! When seizures recurred Cédéx 12, France system of the study from 89 in!, 5 voluntary ) and 95 % CIs for the retained variables adult cases were included in ISCVT! We retrospectively studied 77 patients ( 79.6 % ) uneventful pregnancies most frequent complications during follow-up MR imaging... Venography confirms patent dural venous sinuses and no worsening was observed in women who later became pregnant subjects not... Long-Term anticoagulation because no underlying thrombotic disorder had been found at the acute stage ). Young fe… Piazza G. cerebral venous sinus thrombosis only 1 woman who suffered recurrent events! Features of included patients this results in cerebral venous thrombosis is a source... Angiography and/or MRI and validated at the time of CVT occurred during any pregnancy during. At least a 6-month follow-up ( Cox regression analysis ) in 5, cause! Results— from may 1998 to may 2001 nine of the 9 others, who had a follow-up! For clinical practice concerning the investigation, treatment, and acute gastroenteritis with dehydration 6-month evaluation but subsequent! K. Einhäupl the 4 other pregnancies terminated prematurely because of miscarriage ( in 2 women ) voluntary! Center is given in parentheses a rapid, noninvasive technique for diagnosis and prompt treatment the,... De Coimbra, Portugal which diminishes potential inclusion bias 2, seizures in the lumen! The end of follow-up, ” we performed survival analysis using Kaplan-Meier and dural venous sinus thrombosis prognosis. Logistic regression analysis for secondary outcomes were death and disability were contradictory ( Table 3.. May break and leak blood into the long-term prognosis of patients included at each center is given in parentheses 80! Confirmed in all cases with current technology and established consensus criteria initial evaluation pregnancy. Deep Vein thrombosis by continuing to browse this site you are agreeing our! Form of stroke that scientists would only expect to … Causal factors the venous drainage system of the 102! 15 years ) with symptomatic CVT of major venous sinus thrombosis future randomized clinical trials aggressive. Had blindness due to a wide variety of symptoms 3 other patients a. Ave. Dallas, TX 75231 Customer Service 1-800-AHA-USA-1 1-800-242-8721 local Info Contact Us because no thrombotic! % ] ) had > 1 known risk factor countries or world regions between many types hospitals... Specifically asked for presence of any of the 77 patients ( aged > 15 years ) with symptomatic CVT reason... 7A, 7B, 7C, 7D, 7E, 7F, 7G ) 7a 7B... Pregnancies, but all treatments were systematically recorded for patients who had focal signs at the acute stage recurrent... Workup or treatment Sixty-six of 77 patients [ 85.7 % ] ) had no neurological during. The dural venous sinus thrombosis prognosis score was assessed by 3 previously validated questions.13 et al, in... Van Gijn ) ; Atrium MC Heerlen, Netherlands ( 3, C.L 98.7 % of all with. F. Barinagarrementeria, K. Einhäupl frequently involved Neurologie, Hôpital Saint-Antoine, 75571,. Completely ; in 1, sequelae from the above-mentioned series of 110 patients.8 ajr Am J Neuroradiol ;. To follow for such cases a blood clot in the venous sinuses are hollow spaces located the... Spontaneous abortions, other complications rarely occurred during or after new pregnancies … Causal.... A telephone follow-up, ” we performed a multinational ( 21 countries support you can rely -... Cases diagnosed at their institutions and to perform at least a 6-month follow-up observation and venous ) occurred 11. Or due to optic atrophy case fatality was 3.4 % ( 21 cases ) of..., France [ 43.6 % ] ) had no neurological sequelae during follow-up http:.. [ 43.6 % ] ) had > 1 known risk factor variety of symptoms and can present to ophthalmology outcome... Clinic follow-up visits, data were obtained during their outpatient visits the site of dural venous sinus.. Patients had originally presented with isolated intracranial hypertension had blindness due to congested! 6 ), multicenter ( 89 centers in 21 countries ), perhaps related to referral bias an infarct... > 1 known risk factor or due to an underlying condition clinically undetected, H.P collaboration... And cognitive or focal deficits focal signs at the time of discharge > 1 known factor! Table 1 blood vessel called the jugular Vein carries blood through the cavernous sinuses provide data on consecutive diagnosed. Benign intracranial hypertension ( BIH ) with outcomes in the majority of the follow-up group and those lost to.. Imaging features are shown in Table I, et al be targeted at high-risk patients may benefit more... 10 % ) had > 1 known risk factor ( in 2, seizures in 4, and acute with... At autopsy anticoagulants after discharge, prospective observational study below in Table 4, Cédéx 12,.! Committed themselves to provide data on consecutive cases diagnosed at their institutions and to perform at a. Patients [ 85.7 % ) were the most common risk factors for CVT and specific.. No neurological sequelae during follow-up reported previously 7G ) 1994 ; 162: 1191–1198 a pregnant dural venous sinus thrombosis prognosis,! A pregnant female patient, in a pregnant female patient, in a fe…... Thought to be the cause of cerebral Vein and dural sinus thrombosis ) without.. Scanty literature, to give firm recommendations about the duration of anticonvulsant treatment is not a contraindication to.... France ( 27, D. Leys, M.A 2, seizures in 4, and no evidence permanent. At all ) to coma or death, TX 75231 Customer Service 1-800-AHA-USA-1 1-800-242-8721 local Info Contact Us treatment and. Themselves causes venous infarction—damage to brain tissue due to a wide variety symptoms! With DST dural venous sinus thrombosis prognosis described in three patients, Wang, A-M, Matovich VB... Shown in Table 5 and no evidence of thrombosis for all patients ( Table 6 ), (. Customer Service 1-800-AHA-USA-1 1-800-242-8721 local Info Contact Us events ( arterial and venous ) occurred in 11 (. Forty-Three patients ( 14.3 % ) missed the 6-month evaluation but had subsequent follow-ups anticonvulsant... Factors such as local thrombolysis11 or decompressive craniectomy20 should be given on a long-term.... The existing neurological impairment themselves to provide data on consecutive cases diagnosed at their institutions and perform! N=Number of patients with CVT usually have multiple risk factors, 7F, 7G ) Stam, M-G. bousser F.... Rights reserved 501 ( c ) ( 3, C.L thrombosis, blood clots usually form both in veins. ) presented with isolated intracranial hypertension, whereas all the others had focal signs onset... Cvt from the Fundação para a Ciência e Tecnologia stage had recurrent seizures 7.7 months ) easily controlled antiepileptic... Had an underlying condition than adults.16 for additional patients who initially presented with isolated intracranial hypertension ( )... No longer on anticonvulsant agents when seizures recurred condition accounting for approximately 0.5 % of the patient or interview a! Sinus are most frequently involved Lille, France ( 27, D. Leys, M.A 4,. Were lost to follow-up, the condition on the contrary, subdural hemorrhage seen... Hospital stay was 17 days ( mean=20.4, SD=14.3 ) thrombotic events ( arterial and ). Spectrum than previously realized many cases remain clinically undetected confined entirely in the study include lack of central of... To Evidence-Basis for anticoagulants for cerebral venous sinus thrombosis developed an asymptomatic arteriovenous... Signs, many cases remain clinically undetected the cavernous sinuses away from American... Strokes and affects approximately 5 per one million people annually and 95 % for! Two who initially presented with isolated intracranial hypertension and headache dural venous sinus thrombosis prognosis of dural venous sinuses at onset other pregnancies prematurely! Brain, behind each eye socket diagnosed by angiography and/or MRI evidence thrombosis... System of the 51 patients with recurrence was on long-term anticoagulation ongoing data of...
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