Cerebral Venous Thrombosis – Analysis of a Consecutive Series of 33 Patients

Česká verzia

Authors: D. Krajíčková ¹; M. Košťál ²; A. Krajina ³; L. Klzo ³; P. Ďulíček ²; M. Kubíková ¹
Authors place of work: LF UK a FN v Hradci Králové Neurologická klinika ¹; LF UK a FN v Hradci Králové II. interní klinika ²; LF UK a FN v Hradci Králové Radiologická klinika ³
Published in the journal: Cesk Slov Neurol N 2010; 73/106(4): 402-408
Category: Original Paper

Summary

Objective:
To investigate the risk factors for cerebral venous thrombosis, especially inherited thrombophilic states and the relationships between them, the extent of sinus thrombosis, and brain lesions, together with their overall influence on outcome. Thus the study is intended to record presenting clinical symptoms and their relations to the location of the thrombosis, to monitor the time and the extent of recanalization and to verify its relationship to clinical outcome. Material and methods: 33 patients were included (24 women), average age 37 (33 for the women), with diagnosis confirmed by magnetic resonance angiography (MRA). We thoroughly examined 32 patients for thrombophilias and 31 had MRA checks within 3–4 months. To monitor the possibility of incomplete recanalization, a subsequent MRA scan was planned for two years later. Clinical outcome was assessed after the modified Rankin scale (mRS) 3–4 months after diagnosis. Results: 56% of the patients had a high extent of sinus thrombosis. Isolated lateral sinus thrombosis appeared to be relatively benign. Hormonal contraception (75% of the females) was the most common predisposing factor. An inherited thrombophilic state was diagnosed in 7 (21%) patients. These were younger (average age 24), with greater extent of thrombosis (71% vs 56%), and more often had venous infarction (43% vs 33%), parenchymal hemorrhage (29% vs 21%) and worse clinical outcome. Neither venous infarction itself (33%) nor parenchymal haemorrhage (21%) influenced clinical outcome. Overall prognosis was good for 91% of the patients (30/33), with complete or nearly complete recovery – mRS < 2; only one patient had mRS 3. The single patient who died had generalized bronchogenic carcinoma. Clinical outcome was not influenced by the extent of recanalization (partial/complete recanalization 82%). Conclusion: Young people with undetected inherited thrombophilia represent the most at-risk group for cerebral venous thrombosis.

Key words:
cerebral venous thrombosis – thrombophilia – venous infarction – recanalization – clinical outcome

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