Kowoll, Christina M., Kaminski, Julia, Weiss, Verena, Boesel, Julian, Dietrich, Wenke, Juettler, Eric, Flechsenhar, Julia, Guenther, Albrecht, Huttner, Hagen B., Niesen, Wolf-Dirk, Pfefferkorn, Thomas, Schirotzek, Ingo, Schneider, Hauke ORCID: 0000-0002-9641-0922, Liebig, Thomas and Dohmen, Christian (2016). Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis. Neurocrit. Care, 25 (3). S. 392 - 400. TOTOWA: HUMANA PRESS INC. ISSN 1556-0961

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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 ae<currency>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 ae<yen>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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kowoll, Christina M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kaminski, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weiss, VerenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boesel, JulianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dietrich, WenkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Juettler, EricUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Flechsenhar, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guenther, AlbrechtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huttner, Hagen B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Niesen, Wolf-DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfefferkorn, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schirotzek, IngoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, HaukeUNSPECIFIEDorcid.org/0000-0002-9641-0922UNSPECIFIED
Liebig, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dohmen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-255009
DOI: 10.1007/s12028-016-0256-8
Journal or Publication Title: Neurocrit. Care
Volume: 25
Number: 3
Page Range: S. 392 - 400
Date: 2016
Publisher: HUMANA PRESS INC
Place of Publication: TOTOWA
ISSN: 1556-0961
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
DECOMPRESSIVE HEMICRANIECTOMY; CASE SERIES; THROMBECTOMY; THROMBOLYSIS; VEINMultiple languages
Critical Care Medicine; Clinical NeurologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/25500

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