K Afifi1,2, G Bellanger3,2, P J Buyck4, S M Zuurbier5, C G Esperon6, M A Barboza7, P Costa8, I Escudero9,10, D Renard11, R Lemmens12,13,14, N Hinteregger15, F Fazekas16, J Jimenez Conde17,18, E Giralt-Steinhauer17,18, S Hiltunen19, A Arauz7, A Pezzini20,21, J Montaner10,18,22, J Putaala19, C Weimar23, Marc Schlamann24, T Gattringer15, T Tatlisumak19,25,22, J M Coutinho5, P Demaerel4, V Thijs26,27. 1. Department of Neurology, Menoufia University, Al Minufya, Menoufia, Egypt. 2. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia. 3. Department of Neuroradiology, Purpan University Hospital, Toulouse, France. 4. Department of Radiology, University Hospitals Leuven, Leuven, Belgium. 5. Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands. 6. Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia. 7. Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México. 8. Department of Head and Neck, Neurology Clinic, University of Brescia, Brescia, Italy. 9. Neurology Department, University Hospital Virgen del Rocio, Sevilla, Spain. 10. Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain. 11. Department of Neurology, Nîmes University Hospital, Nîmes, France. 12. Department of Neurosciences, Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium. 13. Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium. 14. Department of Neurology, University Hospitals Leuven, Leuven, Belgium. 15. Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria. 16. Department of Neurology, Medical University of Graz, Graz, Austria. 17. Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain. 18. Universitat Autònoma de Barcelon, Barcelona, Spain. 19. Department of Neurology, Helsinki University Hospital, Helsinki, Finland. 20. Department of Clinical and Experimental Sciences, Neurology Clinic University of Brescia, Brescia, Italy. 21. Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain. 22. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. 23. Department of Neurology, University Hospital Essen, Essen, Germany. 24. Institute for Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany. 25. Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 26. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia. vincent.thijs@florey.edu.au. 27. Department of Neurology, Austin Health, Heidelberg, VIC, Australia. vincent.thijs@florey.edu.au.
Abstract
BACKGROUND: Cerebral venous thrombosis (CVT) is associated with intracranial hemorrhage. AIM: To identify clinical and imaging features of CVT-associated intracranial hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracranial hemorrhage. METHODS: We performed a retrospective analysis of an international, multicenter cohort of patients with confirmed cerebral venous thrombosis who underwent computed tomography within 2 weeks of symptom onset. Clinical and imaging features were compared between patients with and without intracranial hemorrhage. Clot burden was assessed by counting the number of thrombosed venous sinuses and veins on confirmatory imaging. RESULTS: We enrolled 260 patients from 10 institutions in Europe and Mexico. The mean age was 42 years and 74% were female. Intracranial hemorrhage was found in 102 (39%). Among them parenchymal hemorrhage occurred in 64 (63%), in addition, small juxta-cortical hemorrhage was found in 30 (29%), subarachnoid hemorrhage in 24 (24%) and subdural hemorrhage in 11 (11%). Multiple concomitant types of hemorrhage occurred in 23 (23%). Older age and superior sagittal thrombosis involvement were associated with presence of hemorrhage. The number of thrombosed venous sinuses was not associated with intracranial hemorrhage (median number IQRInterquartile ratio] of sinuses/veins involved with hemorrhage 2 (1-3) vs. 2 (1-3) without hemorrhage, p = 0.4). CONCLUSION: The high rate of intracranial hemorrhage in cerebral venous thrombosis is not explained by widespread involvement of the venous sinuses. Superior sagittal sinus involvement is associated with higher bleeding risk.
BACKGROUND:Cerebral venous thrombosis (CVT) is associated with intracranial hemorrhage. AIM: To identify clinical and imaging features of CVT-associated intracranial hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracranial hemorrhage. METHODS: We performed a retrospective analysis of an international, multicenter cohort of patients with confirmed cerebral venous thrombosis who underwent computed tomography within 2 weeks of symptom onset. Clinical and imaging features were compared between patients with and without intracranial hemorrhage. Clot burden was assessed by counting the number of thrombosed venous sinuses and veins on confirmatory imaging. RESULTS: We enrolled 260 patients from 10 institutions in Europe and Mexico. The mean age was 42 years and 74% were female. Intracranial hemorrhage was found in 102 (39%). Among them parenchymal hemorrhage occurred in 64 (63%), in addition, small juxta-cortical hemorrhage was found in 30 (29%), subarachnoid hemorrhage in 24 (24%) and subdural hemorrhage in 11 (11%). Multiple concomitant types of hemorrhage occurred in 23 (23%). Older age and superior sagittal thrombosis involvement were associated with presence of hemorrhage. The number of thrombosed venous sinuses was not associated with intracranial hemorrhage (median number IQRInterquartile ratio] of sinuses/veins involved with hemorrhage 2 (1-3) vs. 2 (1-3) without hemorrhage, p = 0.4). CONCLUSION: The high rate of intracranial hemorrhage in cerebral venous thrombosis is not explained by widespread involvement of the venous sinuses. Superior sagittal sinus involvement is associated with higher bleeding risk.
Authors: Naaem Simaan; Jeremy Molad; Shlomi Peretz; Andrei Filioglo; Eitan Auriel; Hen Hallevi; Estelle Seyman; Rani Barnea; José E Cohen; Ronen R Leker; Asaf Honig Journal: J Clin Med Date: 2022-02-17 Impact factor: 4.241