Santiago Ortega-Gutierrez1, Andrea Holcombe2, Nazan Aksan2, Biyue Dai3, Amir Shaban2, Lara Lazarre2, Binbin Zheng-Lin2, Lauren Sager4, Sudeepta Dandapat2, Fazeel M Siddiqui5, Nicholas M Mohr6. 1. Department of Neurology, University of Iowa Hospitals and Clinics, 2007 Roy J. Carver Pavilion, 200 Hawkins Dr., Iowa City, IA, 52242, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, 1800 John Pappajohn Pavilion, 200 Hawkins Dr., Iowa City, IA, 52242, USA; Department of Radiology, University of Iowa Hospitals and Clinics, 3970 John Pappajohn Pavilion, 200 Hawkins Dr., Iowa City, IA, 52242, USA. Electronic address: santy-ortega@uiowa.edu. 2. Department of Neurology, University of Iowa Hospitals and Clinics, 2007 Roy J. Carver Pavilion, 200 Hawkins Dr., Iowa City, IA, 52242, USA. 3. Department of Neurology, University of Iowa Hospitals and Clinics, 2007 Roy J. Carver Pavilion, 200 Hawkins Dr., Iowa City, IA, 52242, USA; Department of Biostatistics, College of Public Health, University of Iowa, 100 College of Public Health Building, 145 N. Riverside Dr., Iowa City, IA, 52242, USA. 4. Department of Biostatistics, College of Public Health, University of Iowa, 100 College of Public Health Building, 145 N. Riverside Dr., Iowa City, IA, 52242, USA. 5. Department of Neurology, Southern Illinois University School of Medicine, P.O. Box 19620, Springfield, IL, 62794, USA. 6. Department of Emergency Medicine, University of Iowa Hospitals and Clinics, 1 Roy J Carver Pavilion, 200 Hawkins Dr., Iowa City, IA, 52242, USA; Department of Anesthesia, University of Iowa Hospitals and Clinics, 6618 John Colloton Pavilion, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
Abstract
OBJECTIVES: Cerebral venous sinus thrombosis (CVST) is a rare subtype of stroke that most commonly affects younger women. While most patients treated with anticoagulation therapy have good outcomes, a significant number go on to experience disability. The primary aim of this study was to identify objective, easily reproducible, clinical admission predictors of poor outcome at discharge in patients with CVST. PATIENTS AND METHODS: This was a retrospective cohort study of adult CVST patients admitted at our comprehensive stroke center between April 2004 and December 2017. The medical records of patients with a CVST discharge diagnosis code were reviewed for diagnosis confirmation and extraction of clinical and demographic admission data. Multivariable logistic regression was used to build predictive models of objective, standardized examination signs and adjusted for confounders. The primary endpoint was modified Rankin Scale score at discharge defined as good outcome (0-2) and poor outcome (3-6). Mortality was the secondary endpoint. RESULTS: A total of 176 CVST patients were identified. Most patients were white (91 %) and female (65 %). The median age was 40 years old. Headache was the most commonly reported symptom (74 %). Intracranial hemorrhage (ICH) was present in 27 % of patients, venous infarct occurred in 22 % of the patients, and 12 % had both. Age (OR = 1.03, 95 % CI 1.01-1.05), abnormal level of consciousness (OR = 4.38, 95 % CI 1.86-8.88), and focal motor deficits (OR = 3.49, 95 % CI 1.49-8.15) were found to be predictive of poor functional outcome. Pre-hospitalization infections (OR = 5.22, 95 % CI 1.51-18.07) and abnormal level of consciousness (OR = 9.22, 95 % CI 2.34-36.40) were significant predictors of mortality. The predictive effect remained significant after adjusting by median PTT level, presence of intracranial hemorrhage, and venous infarct. CONCLUSIONS: Age, abnormal level of consciousness, and focal motor deficits identified at admission are independently associated with poor outcome in CVST patients. These frequently prevalent, easily reproducible examination signs represent the first step to develop a clinical prediction tool toward stratifying CVST patients with poor prognosis at admission.
OBJECTIVES:Cerebral venous sinus thrombosis (CVST) is a rare subtype of stroke that most commonly affects younger women. While most patients treated with anticoagulation therapy have good outcomes, a significant number go on to experience disability. The primary aim of this study was to identify objective, easily reproducible, clinical admission predictors of poor outcome at discharge in patients with CVST. PATIENTS AND METHODS: This was a retrospective cohort study of adult CVSTpatients admitted at our comprehensive stroke center between April 2004 and December 2017. The medical records of patients with a CVST discharge diagnosis code were reviewed for diagnosis confirmation and extraction of clinical and demographic admission data. Multivariable logistic regression was used to build predictive models of objective, standardized examination signs and adjusted for confounders. The primary endpoint was modified Rankin Scale score at discharge defined as good outcome (0-2) and poor outcome (3-6). Mortality was the secondary endpoint. RESULTS: A total of 176 CVSTpatients were identified. Most patients were white (91 %) and female (65 %). The median age was 40 years old. Headache was the most commonly reported symptom (74 %). Intracranial hemorrhage (ICH) was present in 27 % of patients, venous infarct occurred in 22 % of the patients, and 12 % had both. Age (OR = 1.03, 95 % CI 1.01-1.05), abnormal level of consciousness (OR = 4.38, 95 % CI 1.86-8.88), and focal motor deficits (OR = 3.49, 95 % CI 1.49-8.15) were found to be predictive of poor functional outcome. Pre-hospitalization infections (OR = 5.22, 95 % CI 1.51-18.07) and abnormal level of consciousness (OR = 9.22, 95 % CI 2.34-36.40) were significant predictors of mortality. The predictive effect remained significant after adjusting by median PTT level, presence of intracranial hemorrhage, and venous infarct. CONCLUSIONS: Age, abnormal level of consciousness, and focal motor deficits identified at admission are independently associated with poor outcome in CVSTpatients. These frequently prevalent, easily reproducible examination signs represent the first step to develop a clinical prediction tool toward stratifying CVSTpatients with poor prognosis at admission.
Authors: Adrian Scutelnic; Katarzyna Krzywicka; Sven Poli; Mirjam R Heldner; Joshua Mbroh; Anita van de Munckhof; Mayte Sánchez van Kammen; Diana Aguiar de Sousa; Erik Lindgren; Katarina Jood; Albrecht Günther; Sini Hiltunen; Jukka Putaala; Andreas Tiede; Frank Maier; Rolf Kern; Thorsten Bartsch; Katharina Althaus; Alfonso Ciccone; Markus Wiedmann; Mona Skjelland; Antonio Medina; Elisa Cuadrado-Godia; Thomas Cox; Avinash Aujayeb; Nicolas Raposo; Katia Garambois; Jean-Francois Payen; Fabrice Vuillier; Guillaume Franchineau; Serge Timsit; David Bougon; Marie-Cécile Dubois; Audrey Tawa; Clement Tracol; Emmanuel De Maistre; Fabrice Bonneville; Caroline Vayne; Annerose Mengel; Dominik Michalski; Johann Pelz; Matthias Wittstock; Felix Bode; Julian Zimmermann; Judith Schouten; Alina Buture; Sean Murphy; Vincenzo Palma; Alberto Negro; Alexander Gutschalk; Simon Nagel; Silvia Schoenenberger; Giovanni Frisullo; Carla Zanferrari; Francesco Grillo; Fabrizio Giammello; Mar Morin Martin; Alvaro Cervera; Jim Burrow; Carlos Garcia Esperon; Beng Lim Alvin Chew; Timothy J Kleinig; Cristina Soriano; Domenico S Zimatore; Marco Petruzzellis; Ahmed Elkady; Miguel S Miranda; João Fernandes; Åslög Hellström Vogel; Elias Johansson; Anemon Puthuppallil Philip; Shelagh B Coutts; Simerpreet Bal; Brian Buck; Catherine Legault; Dylan Blacquiere; Hans D Katzberg; Thalia S Field; Vanessa Dizonno; Thomas Gattringer; Christian Jacobi; Annemie Devroye; Robin Lemmens; Espen Saxhaug Kristoffersen; Monica Bandettini di Poggio; Masoud Ghiasian; Theodoros Karapanayiotides; Sophie Chatterton; Miriam Wronski; Karl Ng; Robert Kahnis; Thomas Geeraerts; Peggy Reiner; Charlotte Cordonnier; Saskia Middeldorp; Marcel Levi; Eric C M van Gorp; Diederik van de Beek; Justine Brodard; Johanna A Kremer Hovinga; Marieke J H A Kruip; Turgut Tatlisumak; José M Ferro; Jonathan M Coutinho; Marcel Arnold Journal: Ann Neurol Date: 2022-07-04 Impact factor: 11.274