• Christina M Kowoll, Julia Kaminski, Verena Weiß, Julian Bösel, Wenke Dietrich, Eric Jüttler, Julia Flechsenhar, Albrecht Guenther, Hagen B Huttner, Wolf-Dirk Niesen, Thomas Pfefferkorn, Ingo Schirotzek, Hauke Schneider, Thomas Liebig, and Christian Dohmen.
• Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
• Neurocrit Care. 2016 Dec 1; 25 (3): 392-399.

BackgroundSevere 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.MethodsMulticenter 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.Results114 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).ConclusionThe 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.

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