Outcome of Cerebral Venous Thrombosis Requiring Mechanical Ventilation

Background: Patients with cerebral venous thrombosis (CVT) requiring mechanical ventilation (MV) may have a severe procoagulant state, extensive venous sinus thrombosis, and a worse outcome, but there is a paucity of studies on this topic. We compare the clinical risk factors, radiological findings, and outcomes between CVT patients requiring MV and the non-MV group. Methods: Consecutive CVT patients admitted to our service were included. Their clinical details, prothrombotic states and MRI and MRV findings were noted. The patients were admitted to the intensive care unit (ICU) if the Glasgow Coma Scale (GCS) score was below 14 and intubated if arterial blood gas analysis was abnormal. All the patients received heparin followed by an oral anticoagulant. In-hospital death was noted, and functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS). Results: Ninety-eight patients with CVT were admitted during the study period; 45 (45.9%) required ICU care, and 18 of them required MV for a median of 6.5 (1-15) days. The MV patients had a shorter duration of illness, a lower GCS score, and protein C deficiency. Twelve (12.2%) patients died: five (27.8%) in the MV, four (14.8%) in the non-MV ICU, and three (5.7%) in the non-MV non-ICU groups. Poor outcomes were 5.5%, 14.8%, and 5.7%, respectively. On Cox regression analysis, the MV had an association with death [adjusted hazard ratio (AHR) 0.40, 95% confidence interval 0.21-0.77; p = 0.007] and poor outcome at 3 months (AHR 0.45, 95% CI 0.27-0.76; p = 0.003). Conclusions: About 18.4% of CVT patients require MV with a mortality of 27.8%. Amongst the survivors, 90.7% of patients have a good outcome at 3 months.