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Risk factors for the development of secondary intracranial hypertension in acute cerebral venous thrombosis

Florian Schuchardt1, T Demerath2, N Lützen2

  • 1Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany. florian.schuchardt@googlemail.com.

Neuroradiology
|November 29, 2022
PubMed

Insights

Intracranial hypertension (IH) in cerebral venous thrombosis (CVT) is linked to larger thrombus volume and specific sinus locations. Thrombus volumetry may identify patients at risk for IH and guide clinical evaluation.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Intracranial hypertension (IH) is a serious complication of cerebral venous thrombosis (CVT).
  • Risk factors for IH development following CVT are not well understood.
  • Early identification of patients at risk for IH is crucial to prevent visual loss.

Purpose of the Study:

  • To investigate the predictive value of thrombus location, number of thrombosed segments, and thrombus volume for IH in acute CVT patients.
  • To apply a compound classifier for IH diagnosis.
  • To analyze the association between thrombus characteristics and IH development.

Main Methods:

  • Prospective inclusion of 26 acute CVT patients with complete MRI data.
  • IH defined by CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI.
  • Thrombus characteristics (location, volume, segments) determined using high-resolution contrast-enhanced venography.

Main Results:

  • IH occurred in 46% of CVT patients.
  • Higher thrombus volume and superior sagittal sinus thrombosis (alone or combined with transverse sinus thrombosis) were associated with IH.
  • Thrombus volume > 4 ml was the strongest predictor of higher CSF opening pressure.

Conclusions:

  • Larger thrombus volume and specific sinus occlusions (transverse, superior sagittal) are associated with IH in CVT.
  • Thrombus volumetry can identify patients at risk for IH.
  • These findings may guide further clinical evaluation and management.
Abstract

Keywords:
Cerebral venous thrombosisCerebrospinal fluid opening pressurePapilledemaSecondary intracranial hypertensionVenography

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