Imaging predictors of clinical deterioration in cerebral venous thrombosis

Cerebral venous thrombosis (CVT) is a rare stroke subtype with a highly variable clinical course. There is limited information on clinical deterioration in these patients, and imaging predictors of deterioration have not been studied adequately. Therefore, we aimed to investigate the radiological predictors of clinical deterioration in patients with CVT. We conducted a retrospective study of 106 consecutive patients from 1997 to 2010. All patients were confirmed as having CVT using imaging techniques. The following clinical data were collected: patient demographics, clinical presentation, radiological findings, treatment and clinical deterioration. Of the 106 patients, there were 77 females and 29 males, with a mean age of 43 years (range 19-79 years). The common symptoms of clinical presentation included headache (72%), seizure (29%) and severe motor impairment (20%). Overall, 34% of the patients with CVT developed clinical deterioration during hospital admission. Univariate analysis showed venous infarcts and hyperintensity on diffusion-weighted imaging (DWI) as predictors of clinical deterioration. Parenchymal haemorrhage, vasogenic oedema, midline shift and thrombosis location were not predictive of clinical deterioration. In conclusion, our study showed that venous infarcts and hyperintensity on DWI were associated with clinical deterioration in patients with CVT. These findings suggest that close monitoring is necessary in these groups of patients as they may require more aggressive therapy.