Prognosis of cerebral vein and dural sinus thrombosis - Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)

Background and Purpose - The natural history and long-term prognosis of cerebral vein and dural sinus thrombosis (CVT) have not been examined previously by adequately powered prospective studies. Methods - We performed a multinational ( 21 countries), multicenter ( 89 centers), prospective observational study. Patients were followed up at 6 months and yearly thereafter. Primary outcome was death or dependence as assessed by modified Rankin Scale ( mRS) score > 2 at the end of follow-up. Results - From May 1998 to May 2001, 624 adult patients with CVT were registered. At the end of follow-up ( median 16 months), 356 patients (57.1%) had no symptom or signs ( mRS = 0), 137 (22%) had minor residual symptoms ( mRS = 1), and 47 (7.5%) had mild impairments ( mRS = 2). Eighteen (2.9%) were moderately impaired ( mRS = 3), 14 (2.2%) were severely handicapped ( mRS = 4 or 5), and 52 (8.3%) had died. Multivariate predictors of death or dependence were age > 37 years ( hazard ratio [HR] = 2.0), male sex ( HR = 1.6), coma ( HR = 2.7), mental status disorder ( HR = 2.0), hemorrhage on admission CT scan ( HR = 1.9), thrombosis of the deep cerebral venous system ( HR = 2.9), central nervous system infection ( HR = 3.3), and cancer ( HR = 2.9). Fourteen patients ( 2.2%) had a recurrent sinus thrombosis, 27 (4.3%) had other thrombotic events, and 66 (10.6%) had seizures. Conclusions - The prognosis of CVT is better than reported previously. A subgroup (13%) of clinically identifiable CVT patients is at increased risk of bad outcome. These high-risk patients may benefit from more aggressive therapeutic interventions, to be studied in randomized clinical trials.