Causes and predictors of death in cerebral venous thrombosis.
OBJECTIVE
The causes of death of patients with cerebral venous thrombosis (CVT) have not been systematically addressed in previous studies. We aimed to analyze the causes and predictors of death during the acute phase of CVT in the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) to identify preventable or treatable causes.


METHODS
ISCVT is a multinational, prospective, observational study including 624 patients with CVT occurring between May 1998 and May 2001, in which 27 patients (4.3%) died during the acute phase, 21 (3.4%) within 30 days from symptom onset. Inclusion forms and a questionnaire assessing the causes of death were analyzed. A logistic regression analysis was performed to identify the predictors of death within 30 days from symptom onset of CVT.


RESULTS
Median time between onset of symptoms and death was 13 days and between diagnosis and death, 5 days. Causes of death were mainly transtentorial herniation due to a unilateral focal mass effect (10 patients) or to diffuse edema and multiple parenchymal lesions (10 patients). Independent predictors of death were coma (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.8 to 27.7), mental disturbance (OR, 2.5; 95% CI 0.9 to 7.3), deep CVT thrombosis (OR, 8.5; 95% CI, 2.6 to 27.8), right intracerebral hemorrhage (OR, 3.4; 95% CI, 1.1 to 10.6), and posterior fossa lesion (OR, 6.5; 95% CI, 1.3 to 31.7). Worsening of previous focal or de novo focal deficits increased the risk of death.


CONCLUSIONS
The main causes of acute death were neurologic, the most frequent mechanism being transtentorial herniation.
Canhão
Patrícia
P
Department of Neurosciences and Mental Health, Hospital Santa Maria, 1649-035 Lisbon, Portugal. pcanhao@fm.ul.pt
Ferro
José M
JM
Lindgren
Arne G
AG
Bousser
Marie-Germaine
MG
Stam
Jan
J
Barinagarrementeria
Fernando
F
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000401:mortality*