ABSTRACT
BACKGROUND: Several case reports have linked iron deficiency anemia with the occurrence of cerebral venous thrombosis (CVT) or stroke, yet, it is unclear whether this is a chance association. METHODS: In a case-control design data of whole blood count and screening for thrombophilic coagulation abnormalities of 121 prospectively identified patients with CVT and 120 healthy controls were compared. Anemia was defined as a hemoglobin (Hb) concentration of <120 g/l in females, and <130 g/l in males, severe anemia as a Hb <90 g/l. Adjusted odds ratios (OR) were calculated based on a logistic regression model treating variables with a level of significance of p < or = 0.2 on univariate analysis as potential confounders. RESULTS: Thrombophilia (OR 1.22, 95% CI 1.07-1.76, p < 0.01), severe anemia (OR 1.10, 95% CI 1.01-2.22, p < 0.05), and hypercholesterinemia (OR 1.21, 95% CI 1.04-2.57, p < 0.05) were the only independent variables associated with CVT on multivariate analysis. CONCLUSION: Severe anemia is significantly and independently associated with CVT.
Subject(s)
Anemia/epidemiology , Cerebral Veins/physiopathology , Intracranial Thrombosis/epidemiology , Intracranial Thrombosis/physiopathology , Venous Thrombosis/epidemiology , Venous Thrombosis/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Blood Coagulation Disorders/epidemiology , Case-Control Studies , Cerebral Veins/pathology , Comorbidity , Cranial Sinuses/pathology , Cranial Sinuses/physiopathology , Female , Humans , Hypercholesterolemia/epidemiology , Logistic Models , Male , Middle Aged , Odds Ratio , Prevalence , Prospective Studies , Risk Assessment , Risk Factors , Sinus Thrombosis, Intracranial/epidemiology , Sinus Thrombosis, Intracranial/physiopathology , Thrombophilia/epidemiologyABSTRACT
BACKGROUND: There is insufficient data on short- and especially long-term prognosis of cerebral venous thrombosis (CVT). METHODS: In 79 consecutive patients, we analyzed factors for acute death and functional outcome at hospital discharge and after 6 months as well as long-term prognosis >/=12 months. Neurological deficits were graded on the National Institute of Health Stroke Scale (NIHSS), functional outcome on the modified Rankin Scale (mRS). Primary outcome was defined as mRS >/= 3 at 6 months, secondary outcomes were death during hospital treatment and number as well as type of complications during follow-up >/=12 months after hospital discharge. Forty-two patients were recruited prospectively, 37 were identified by chart review. Information on outcome was based on neurological examinations at our outpatient clinic. RESULTS: Factors significantly related to acute death were age, the NIHSS on admission, more than two seizures despite antiepileptic treatment, venous infarct, and hemorrhagic transformation of the venous infarct. Primary outcome after 6 months in 74 patients was excellent with 73% of patients reaching a mRS 0-1, 4% a mRS of 2, and 23% a mRS 3-6, including 12 deaths in the acute stage of illness. Factors significantly related to a mRS >/= 3 at 6 months in a logistic regression analysis were age and items 1a-c of the NIHSS on admission related to consciousness. Fifty-eight surviving patients had a follow-up >/= 12 months (median: 31; mean: 52 +/- 61 months). Most frequent complication on long-term follow-up was epilepsy in nine patients and recurrent venous thrombosis in seven patients. CONCLUSIONS: When the acute stage of illness has been survived, CVT has a good prognosis unlike arterial ischemic stroke.
Subject(s)
Intracranial Thrombosis/diagnosis , Recovery of Function , Venous Thrombosis/diagnosis , Acute Disease , Adolescent , Adult , Aged , Chronic Disease , Female , Follow-Up Studies , Humans , Intracranial Thrombosis/complications , Intracranial Thrombosis/mortality , Male , Middle Aged , Prognosis , Prospective Studies , Retrospective Studies , Time Factors , Venous Thrombosis/complications , Venous Thrombosis/mortalityABSTRACT
BACKGROUND AND PURPOSE: Recanalization in dural sinus thrombosis (DST) has been observed previously; however, systematic prospective data are lacking. The influence of recanalization on DST outcome has not yet been thoroughly evaluated. METHODS: Thirty-seven consecutive patients with DST were prospectively examined. Neurological deficits were graded with the National Institutes of Health Stroke Scale (NIHSS) on hospital admission and discharge. Functional outcome was assessed with the modified Rankin Scale (mRS) on hospital discharge and after 12 months. All patients were treated with intravenous heparin in the acute stage of illness, followed by oral anticoagulation for 12 months. Imaging follow-up with MR angiography and, in a few cases, with CT or conventional angiography was performed on hospital discharge and after 6 and 12 months. RESULTS: Twelve-month functional outcome was excellent in 89% of patients with an mRS of 0 or 1. A recanalization rate of 60% was already observed on hospital discharge (22+/-6 days); thereafter, recanalization rates increased insignificantly. Early recanalization was not related to NIHSS score on hospital discharge or an mRS of 0 on discharge or after 12 months. CONCLUSIONS: We found a high frequency of early recanalization but without influence on clinical outcome parameters. Frequent imaging follow-ups in DST are not useful because they provide no information on patient outcome.
