Natural history of cerebral vein thrombosis

There is increasing information on the natural history of cerebral vein thrombosis. The objectives of this review are to evaluate the mortality rates and the rate of residual disability in cerebral vein thrombosis patients, to determine clinical and radiological predictors of death and dependence, and to estimate the cumulative incidence of recurrent cerebral vein thrombosis after a first episode.

Mortality rates appear to be low during the acute phase or after follow-up. Most surviving patients recover completely or present only mild functional or cognitive deficits. Recanalization appears to occur within the first months following cerebral vein thrombosis, but not thereafter, irrespective of anticoagulation. Recurrences of cerebral vein thrombosis and other thromboembolic complications after a first episode are uncommon. Patients with intracranial hemorrhage at onset or patients with epileptic seizures seem to have an increased risk of death and residual disability in comparison with the other patients.

Prognosis of cerebral vein thrombosis is better than previously believed. Mortality and residual disability are relevant in patients presenting with intracranial hemorrhage or with epileptic seizures. Although heparin is widely used as a first-line therapy of cerebral vein thrombosis, there is still scant evidence of its efficacy and safety in comparison with placebo.