Association of admission clinical predictors and functional outcome in patients with Cerebral Venous and Dural Sinus Thrombosis.

Objectives: Cerebral venous sinus thrombosis (CVST) is a rare subtype of stroke that most commonly affects younger women. While most patients treated with anticoagulation therapy have good outcomes, a significant number go on to experience disability. The primary aim of this study was to identify objective, easily reproducible, clinical admission predictors of poor outcome at discharge in patients with CVST.

Patients And Methods: This was a retrospective cohort study of adult CVST patients admitted at our comprehensive stroke center between April 2004 and December 2017. The medical records of patients with a CVST discharge diagnosis code were reviewed for diagnosis confirmation and extraction of clinical and demographic admission data. Multivariable logistic regression was used to build predictive models of objective, standardized examination signs and adjusted for confounders. The primary endpoint was modified Rankin Scale score at discharge defined as good outcome (0-2) and poor outcome (3-6). Mortality was the secondary endpoint.

Results: A total of 176 CVST patients were identified. Most patients were white (91 %) and female (65 %). The median age was 40 years old. Headache was the most commonly reported symptom (74 %). Intracranial hemorrhage (ICH) was present in 27 % of patients, venous infarct occurred in 22 % of the patients, and 12 % had both. Age (OR = 1.03, 95 % CI 1.01-1.05), abnormal level of consciousness (OR = 4.38, 95 % CI 1.86-8.88), and focal motor deficits (OR = 3.49, 95 % CI 1.49-8.15) were found to be predictive of poor functional outcome. Pre-hospitalization infections (OR = 5.22, 95 % CI 1.51-18.07) and abnormal level of consciousness (OR = 9.22, 95 % CI 2.34-36.40) were significant predictors of mortality. The predictive effect remained significant after adjusting by median PTT level, presence of intracranial hemorrhage, and venous infarct.

Conclusions: Age, abnormal level of consciousness, and focal motor deficits identified at admission are independently associated with poor outcome in CVST patients. These frequently prevalent, easily reproducible examination signs represent the first step to develop a clinical prediction tool toward stratifying CVST patients with poor prognosis at admission.