The clinical spectrum of intracerebral hematoma, hemorrhagic infarct, non-hemorrhagic infarct, and non-lesional venous stroke in patients with cerebral sinus-venous thrombosis.
OBJECTIVE
The clinical spectrum of different neuroradiological features of cerebral sinus-venous thrombosis (CSVT) varies considerably. We sought the relationship between different neuroradiological aspects and clinical presentations in these patients.


METHODS
The diagnosis of cerebral sinus-venous thrombosis has been confirmed by conventional angiography, MRI combined with MR venography following established diagnostic criteria. We analyzed clinical data, symptoms and signs, imaging findings, location and extent of the thrombus, and parenchymal lesions, retrospectively.


RESULTS
There were 220 consecutive patients with cerebral sinus-venous thrombosis; 98 (45%) had non-lesional sinus-venous thrombosis (NL CSVT), 51 (23%) had non-hemorrhagic infarct (NHI), 45 (20%) had hemorrhagic infarct (HI), and 26 (12%) had intracerebral hemorrhage (ICH). In patients with hemorrhagic lesion (HI+ICH), advanced age, headache (99%), behavioral disturbances (55%), consciousness disturbances (35%), seizures (41%), and language deficits (42%) were significantly higher than the other patients (NL+NHI) (P < 0.001). High blood pressure at admission, puerperium, sigmoid and straight sinus thrombosis, multiple sinus and vein involvement were more frequent in patients with hemorrhagic lesion than those with non-hemorrhagic lesion. Patients with hemorrhagic lesion were more dependent or died (32%) than the other patients (12%) (P < 0.001), and most of the patients with NL and NHI had no disability compared with the other patients at the 3 month of follow-up (96% and 65%; P < 0.001).


CONCLUSIONS
Headache, convulsion, behavioral disorder, seizures, and speech disorders were the most frequent clinical symptoms of patients with hemorrhagic CSVT. Specific risk factors, including pregnancy/puerberium, early and extended thrombosis of large sinus, and presence of high blood pressure at admission, are associated with hemorrhagic lesion and unfavorable outcome.
Stroke Unit, Neurology Department, Ege University, School of Medicine, İzmir, Turkey. emre.kumral@ege.edu.tr
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Kumral
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Uzunköprü
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Callı
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Kitiş
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D020520:Brain Infarction / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D016009:Chi-Square Distribution; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D012851:Sinus Thrombosis, Intracranial / Q000150:complications*; D013064:Speech Disorders / Q000209:etiology; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000150:complications*; D055815:Young Adult