Predictors of Short-Term Outcome of Cerebral Venous Sinus Thrombosis

Abstract

Background: Cerebral venous sinus thrombosis (CVST) is a rare form of stroke characterized by various clinical manifestations, outcomes, and courses. Understanding the factors that predict outcomes can assist clinicians in making treatment decisions for CVST patients.

Objective: This study aimed to identify the predictors of short-term clinical outcome in CVST patients.

Methodology: This single-center prospective cohort study was conducted for 18 months from July 2022 to December 2023 at the Department of Neurology. Confirmed cases of CVST through MRI and contrast MRV reports were enrolled during this study period. Standard therapy and symptomatic treatment were administered. Patients were followed up at 30 and 90 days. Clinical outcome was assessed using the Modified Rankin Scale (mRS) which was dichotomized into Good (d”2) and Poor (>2).

Results: The Mean±SD age of participants was 32.82±12.25 years, with a higher proportion of females (F:M=3:1). Headache was the most common presentation (95%), followed by nausea or vomiting (91%). Seizures were observed in 36.7% of patients, while altered consciousness was present in 58.3%. Limb weakness, and papilledema were also documented in varying percentages of patients. Key risk factors identified included oral contraceptive pill (OCP) use, puerperium, pregnancy, infection, and anaemia. Transverse sinus involvement was the most common, followed by superior sagittal sinus. Hemorrhagic infarction was the predominant MRI finding. At the 90-day follow-up, 71.7% of patients showed a good outcome, while the overall mortality rate was 11.7%. Univariate analysis revealed factors associated with poor clinical outcomes were age over 40 years, altered consciousness, significant past medical history, low admission Glasgow Coma Scale (GCS) score, and hemorrhagic infarction on MRI. Multivariate analysis confirmed hemorrhagic infarction on MRI as an independent predictor of poor outcomes.

Conclusion: Hemorrhagic infarction on MRI emerged as an independent predictor of poor outcomes in CVST patients.