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Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

Yasemin Dinç1, Rıfat Ozpar2, Bahattin Hakyemez2

  • 1Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye.

Arquivos De Neuro-Psiquiatria
|May 31, 2023
PubMed

Insights

Cerebral venous sinus thrombosis (CVST) can lead to intracranial herniation. Small juxtacortical hemorrhages, malignancy, and a venous collateral score of 0 are key risk factors. Close observation is recommended for these patients.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neurosurgery

Background:

  • Cerebral venous sinus thrombosis (CVST) is less understood than arterial ischemic stroke.
  • While often having a good prognosis, CVST can cause parenchymal lesions and fatal intracranial herniation.
  • Identifying risk factors for herniation is crucial for timely intervention, including decompressive craniectomy.

Purpose of the Study:

  • To determine the independent risk factors for intracranial herniation in patients diagnosed with cerebral venous sinus thrombosis.
  • To identify specific clinical and radiological markers associated with increased risk of herniation in CVST.

Main Methods:

  • Retrospective analysis of 177 patients diagnosed with CVST between 2015 and 2021.
  • Inclusion criteria: confirmed diagnosis of CVST.
  • Statistical analysis, including binary logistic regression, to identify significant risk factors.

Main Results:

  • Out of 177 patients, 18 developed intracranial herniation.
  • Significant associations were found between herniation and superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis.
  • Binary logistic regression identified a venous collateral score of 0, malignancy, and small juxtacortical hemorrhages as the most significant independent risk factors.

Conclusions:

  • Small juxtacortical hemorrhages, presence of malignancy, and a venous collateral score of 0 are independent risk factors for intracranial herniation in CVST patients.
  • These findings highlight the need for close clinical monitoring of CVST patients.
  • Patients identified with these risk factors may benefit from consideration for decompressive craniectomy.
Abstract

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