Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis

Neurocrit Care. 2016 Dec;25(3):392-399. doi: 10.1007/s12028-016-0256-8.


Background: 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.

Methods: Multicenter 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.

Results: 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 ≥3 after admission [odds ratio (OR) 6.7], bilateral motor signs in the further course (OR 9.2), and midline shift (OR 5.1).

Conclusion: 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.

Keywords: Cerebral venous thrombosis; Intensive care; Neurocritical care; Prognosis; Stroke.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use*
  • Cerebral Angiography
  • Cerebral Veins / diagnostic imaging
  • Cerebral Veins / pathology
  • Disease Progression*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Thrombosis / diagnosis*
  • Intracranial Thrombosis / diagnostic imaging
  • Intracranial Thrombosis / drug therapy*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Phlebography
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index*
  • Sinus Thrombosis, Intracranial / diagnostic imaging
  • Sinus Thrombosis, Intracranial / drug therapy
  • Sinus Thrombosis, Intracranial / pathology
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / pathology
  • Young Adult


  • Anticoagulants