title: Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis.
abstract: Severe cerebral venous-sinus thrombosis (CVT) is a rare disease, and its clinical course, imaging correlates, as well as long-term prognosis have not yet been investigated systematically.
  
  
  
  Multicenter retrospective study. Inclusion criteria were CVT, Glasgow coma scale ≤9, and treatment in the intensive care unit. Primary outcome was death or dependency, assessed by a modified Rankin Score (mRS) >2 at last follow-up.
  
  
  
  114 patients were included. At last follow-up (median 2.5 years), 38 patients (33.3 %) showed no or minor residual symptoms (mRS = 0 or 1), 12 (10.5 %) had a mild (mRS = 2), 13 (11.4 %) a moderate (mRS = 3), 12 (10.5 %) a severe disability (mRS = 4 or 5), and 39 (34.2 %) had died. In bivariate analysis, predictors of poor outcome were any signs of mass effect on imaging, clinical deterioration after admission, and age. In contrast, clinical symptoms on admission and parenchymal lesions per se, such as edema, infarction, or hemorrhage were not predictive. Multivariate predictors of poor outcome were an increase in National Institutes of Health Stroke Scale ≥3 after admission [odds ratio (OR) 6.7], bilateral motor signs in the further course (OR 9.2), and midline shift (OR 5.1).
  
  
  
  The outcome of severe CVT is almost equally divided between severe impairment or death and survival with no or only mild handicap. Specifically, space-occupying mass effect and associated neurologic deterioration seem to determine a poor outcome. Therefore, early detection and treatment of mass effect should be the focus of critical care.
authors.affiliation: Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Kowoll
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Kaminski
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Weiß
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
authors.affiliation: Department of Neurology, Nuremburg Hospital, Breslauer Str. 201, 90471, Nuremberg, Germany.
authors.forename: Wenke
authors.initials: W
authors.lastname: Dietrich
authors.affiliation: Department of Neurology, Ostalb Hospital, Im Kälblesrain 1, 73430, Aalen, Germany.|Department of Neurology, University Hospital Charité, Center for Stroke Research, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Jüttler
authors.affiliation: Department of Neurology, University Hospital Charité, Center for Stroke Research, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Flechsenhar
authors.affiliation: Department of Neurology, University Hospital Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Guenther
authors.affiliation: Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.affiliation: Department of Neurology, University Hospital Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
authors.forename: Wolf-Dirk
authors.initials: WD
authors.lastname: Niesen
authors.affiliation: Department of Neurology, University Hospital Munich (LMU), Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
authors.affiliation: Department of Neurology, University Hospital Giessen, Klinikstr. 33, 35385, Giessen, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Schirotzek
authors.affiliation: Department of Neurology, University Hospital Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Schneider
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|Institute of Neuroradiology, University Hospital Charité, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Liebig
authors.affiliation: Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany. christian.dohmen@uk-koeln.de.|Max Planck Institute for Metabolism Research, Cologne, Germany. christian.dohmen@uk-koeln.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Dohmen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010690:Phlebography; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Cerebral venous thrombosis; Intensive care; Neurocritical care; Prognosis; Stroke