title: Outcome of a cohort of severe cerebral venous thrombosis in intensive care.
abstract: BACKGROUND
  Severity of cerebral venous thrombosis (CVT) may require the transfer to intensive care unit (ICU). This report described the context for CVT transfer to ICU, the strategy of care and the outcome after 1 year.
  
  
  METHODS
  Monocentric cohort of 41 consecutive CVT admitted in a French ICU tertiary hospital (National Referent Center for CVT). Data collected are as follows: demographic data, clinical course, incidence of craniectomy and/or endovascular procedures and outcome in ICU, after 3 and 12 months.
  
  
  RESULTS
  47 years old (IQ 26-53), with 73.2 % were female, having a SAPS II 41 (32-45), GCS 7 (5-8), and at least one episode of mydriasis in 48.8 %. Thrombosis location was 80.5 % in lateral sinus and 53.7 % in superior sagittal sinus; intracranial hematoma was present in 78.0 %, signs of intracranial hypertension in 60.9 %, cerebral edema in 58.5 % and venous ischemia in 43.9 %. All patients received heparin therapy, and 9 cases had endovascular treatment (21.9 %); osmotherapy (53.7 %) and decompressive craniectomy (16 cases, 39 %) necessary to control intracranial hypertension. Ten patients/41 (24.4 %) died in ICU and 18/31 (58.1 %) were discharged from ICU with outcome 0-3 of mRS. After 12 months, 92 % of survivors (23/25) had a mRS between 0 and 3. The proportion of death was 31.7 % at 1 year.
  
  
  CONCLUSIONS
  The large proportion of acceptable outcome in survivors, which continue to functionally improve after 1 year, motivates the hospitalization in ICU for severe CVT. For similar CVT severity, craniectomy did not improve outcome in comparison with the absence of craniectomy.
authors.affiliation: Department of Anesthesiology and Critical Care and SMUR, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France.|Université Diderot Sorbonne Paris Cité, Paris, France.|Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Soyer
authors.affiliation: Department of Anesthesiology and Critical Care and SMUR, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France.|Université Diderot Sorbonne Paris Cité, Paris, France.|Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Rusca
authors.affiliation: Department of Anesthesiology and Critical Care and SMUR, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France.|Université Diderot Sorbonne Paris Cité, Paris, France.|Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Lukaszewicz
authors.affiliation: Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France.|Service of Neurology, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Crassard
authors.affiliation: Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France.|Department of Neurovascular Imaging, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Guichard
authors.affiliation: Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France.|Service of Neurosurgery, Hôpital Lariboisière, AP-HP, Université Paris 7 Denis Diderot, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bresson
authors.affiliation: Department of Anesthesiology and Critical Care and SMUR, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France.|Université Diderot Sorbonne Paris Cité, Paris, France.|Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mateo
authors.affiliation: Department of Anesthesiology and Critical Care and SMUR, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75010, Paris, France. dpayen1234@orange.fr.|Université Diderot Sorbonne Paris Cité, Paris, France. dpayen1234@orange.fr.|Département Hospitalo-Universitaire (DHU) Neuro-Vasculaire, P R E S Paris Sorbonne Cité, Paris, France. dpayen1234@orange.fr.
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
keywords: Decompressive craniectomy; Endovascular therapies; Intracranial hematoma; Intracranial hypertension; Multimodal monitoring; Neuro-resuscitation; Severe cerebral venous thrombosis