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Assessment of Patients with Intracerebral Hemorrhage or Hemorrhagic Transformation in the VENOST Study

Taşkın Duman1, Vildan Yayla2, Derya Uludüz3

  • 1Department of Neurology, Mustafa Kemal University, Antakya, Turkey.

European Neurology
|November 1, 2020
PubMed

Insights

Cerebral venous sinus thrombosis (CVST) can cause brain bleeds in over 20% of patients. Gynecologic causes are common, and symptoms like seizures and altered consciousness indicate a poor outcome.

Area of Science:

  • Neurology
  • Radiology
  • Stroke Medicine

Background:

  • Cerebral venous and sinus thrombosis (CVST) is a significant cause of stroke, particularly in younger individuals.
  • CVST can lead to serious complications including cerebral edema, increased intracranial pressure, and both ischemic and hemorrhagic lesions.
  • Intracerebral hemorrhages (CH) are a known complication, occurring in approximately one-third of CVST patients.

Purpose of the Study:

  • To assess and compare the clinical and radiological findings in patients with cerebral hemorrhage (CH) secondary to CVST.
  • To identify risk factors and clinical presentations associated with CH in the context of CVST.
  • To evaluate the outcomes for CVST patients who develop CH.

Main Methods:

  • Retrospective analysis of 1,193 patients with CVST from the VENOST study, conducted across 35 national stroke centers.
  • Data collected included demographics, clinical symptoms, admission signs, radiological findings (CT and MRI), etiology, treatment, and outcomes.
  • Patients were categorized into groups based on the presence or absence of cerebral hemorrhage.

Main Results:

  • Cerebral hemorrhage (CH) was identified in 21.1% of CVST patients (241/1,193), including hemorrhagic infarction (198 patients) and intracerebral hemorrhage (43 patients).
  • Gynecologic causes were the most frequent etiology (41.7%) for CVST.
  • Patients with CH more frequently presented with headache, epileptic seizures, nausea/vomiting, altered consciousness, and focal neurological deficits. Modified Rankin Scale (mRS) ≥3 was observed in 23.1% of the CH group.

Conclusions:

  • CVST requires close monitoring, especially in patients presenting with headache, multiple sinus involvement, and CH.
  • The presence of older age and parenchymal lesions (hemorrhagic infarction or intracerebral hemorrhage) are indicators of a poor prognosis in CVST patients.
  • Identifying CH as a complication of CVST is crucial for risk stratification and management.
Abstract

Keywords:
Cerebral hemorrhageCerebral venous thrombosisVENOST

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