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Causes and predictors of death in cerebral venous thrombosis
Patrícia Canhão1, José M Ferro, Arne G Lindgren
1Department of Neurosciences and Mental Health, Hospital Santa Maria, 1649-035 Lisbon, Portugal. pcanhao@fm.ul.pt
Insights
Acute death in cerebral venous thrombosis (CVT) is often due to neurologic complications like transtentorial herniation. Identifying predictors such as coma and deep CVT can help manage this condition.
Area of Science:
- Neurology
- Vascular Neurology
- Neurocritical Care
Background:
- Cerebral venous thrombosis (CVT) is a rare but serious condition.
- Causes of death in CVT patients have not been systematically studied.
- Understanding acute mortality is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the causes and predictors of death during the acute phase of CVT.
- To identify potentially preventable or treatable causes of mortality in CVT.
- To provide insights for clinical management and risk stratification.
Main Methods:
- Analysis of data from the multinational, prospective, observational International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT).
- Inclusion of 624 patients with CVT diagnosed between May 1998 and May 2001.
- Logistic regression analysis to identify predictors of death within 30 days of symptom onset.
Main Results:
- Transtentorial herniation was the primary cause of death, often due to mass effect or diffuse edema.
- Independent predictors of 30-day mortality included coma, mental disturbance, deep CVT, right intracerebral hemorrhage, and posterior fossa lesions.
- Worsening or new focal neurological deficits were associated with increased mortality risk.
Conclusions:
- Neurologic complications, particularly transtentorial herniation, are the main causes of acute death in CVT.
- Predictors identified can aid in early risk assessment and intervention.
- Further research into specific management strategies for high-risk CVT patients is warranted.
Background And Purpose:
The causes of death of patients with cerebral venous thrombosis (CVT) have not been systematically addressed in previous studies. We aimed to analyze the causes and predictors of death during the acute phase of CVT in the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) to identify preventable or treatable causes.
Methods:
ISCVT is a multinational, prospective, observational study including 624 patients with CVT occurring between May 1998 and May 2001, in which 27 patients (4.3%) died during the acute phase, 21 (3.4%) within 30 days from symptom onset. Inclusion forms and a questionnaire assessing the causes of death were analyzed. A logistic regression analysis was performed to identify the predictors of death within 30 days from symptom onset of CVT.
Results:
Median time between onset of symptoms and death was 13 days and between diagnosis and death, 5 days. Causes of death were mainly transtentorial herniation due to a unilateral focal mass effect (10 patients) or to diffuse edema and multiple parenchymal lesions (10 patients). Independent predictors of death were coma (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.8 to 27.7), mental disturbance (OR, 2.5; 95% CI 0.9 to 7.3), deep CVT thrombosis (OR, 8.5; 95% CI, 2.6 to 27.8), right intracerebral hemorrhage (OR, 3.4; 95% CI, 1.1 to 10.6), and posterior fossa lesion (OR, 6.5; 95% CI, 1.3 to 31.7). Worsening of previous focal or de novo focal deficits increased the risk of death.
Conclusions:
The main causes of acute death were neurologic, the most frequent mechanism being transtentorial herniation.
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