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Admission hyperdense sinus sign predicts poorer outcomes in cerebral venous sinus thrombosis

Asaf Honig1,2, Ruth Eliahou3, Naaem Simaan4,5

  • 1The Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.

Journal of Neurology
|February 7, 2026
PubMed

Insights

The hyperdense sinus sign (HDSS) on CT scans indicates more severe cerebral venous sinus thrombosis (CVST) with increased risk of brain injury and poorer outcomes. This finding aids in early patient risk assessment.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • The hyperdense sinus sign (HDSS) is a non-contrast CT finding indicating acute thrombus in cerebral venous sinus thrombosis (CVST).
  • Early identification of CVST severity and patient prognosis is crucial for effective management.

Purpose of the Study:

  • To characterize features associated with HDSS in CVST patients.
  • To evaluate the prognostic significance of HDSS on patient outcomes.

Main Methods:

  • Analysis of data from prospective multicenter CVST registries.
  • Definition of HDSS as attenuation >70 Hounsfield units in thrombosed venous structures.
  • Comparison of baseline characteristics and outcomes between patients with and without HDSS using multivariable logistic regression.

Main Results:

  • HDSS was present in 38.3% of 465 CVST patients.
  • HDSS correlated with increased oral contraceptive use, seizures, sinus involvement, deep venous thrombosis, cortical vein thrombosis, and multisite occlusion.
  • Patients with HDSS showed higher rates of intracerebral hemorrhage and venous infarction, poorer functional outcomes (mRS 0-1), and increased remote seizures at 90 days.

Conclusions:

  • HDSS identifies a CVST subgroup with more extensive thrombosis and greater parenchymal injury.
  • HDSS is an independent predictor of reduced excellent functional outcomes and increased remote seizures.
  • HDSS is a valuable tool for early risk stratification in CVST patients.
Abstract

Keywords:
Acute symptomatic seizureCerebral sinus venous thrombosisDense vessel signHyperdense sinus signPapilledema

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