Outcome of a cohort of severe cerebral venous thrombosis in intensive care

Abstract

Background: Severity of cerebral venous thrombosis (CVT) may require the transfer to intensive care unit (ICU). This report described the context for CVT transfer to ICU, the strategy of care and the outcome after 1 year.

Methods: Monocentric cohort of 41 consecutive CVT admitted in a French ICU tertiary hospital (National Referent Center for CVT). Data collected are as follows: demographic data, clinical course, incidence of craniectomy and/or endovascular procedures and outcome in ICU, after 3 and 12 months.

Results: 47 years old (IQ 26-53), with 73.2 % were female, having a SAPS II 41 (32-45), GCS 7 (5-8), and at least one episode of mydriasis in 48.8 %. Thrombosis location was 80.5 % in lateral sinus and 53.7 % in superior sagittal sinus; intracranial hematoma was present in 78.0 %, signs of intracranial hypertension in 60.9 %, cerebral edema in 58.5 % and venous ischemia in 43.9 %. All patients received heparin therapy, and 9 cases had endovascular treatment (21.9 %); osmotherapy (53.7 %) and decompressive craniectomy (16 cases, 39 %) necessary to control intracranial hypertension. Ten patients/41 (24.4 %) died in ICU and 18/31 (58.1 %) were discharged from ICU with outcome 0-3 of mRS. After 12 months, 92 % of survivors (23/25) had a mRS between 0 and 3. The proportion of death was 31.7 % at 1 year.

Conclusions: The large proportion of acceptable outcome in survivors, which continue to functionally improve after 1 year, motivates the hospitalization in ICU for severe CVT. For similar CVT severity, craniectomy did not improve outcome in comparison with the absence of craniectomy.

Keywords: Decompressive craniectomy; Endovascular therapies; Intracranial hematoma; Intracranial hypertension; Multimodal monitoring; Neuro-resuscitation; Severe cerebral venous thrombosis.

Fig. 1

Flowchart of the CVT cohort along the survey period. Along the 13-year survey period, 47 patients were recruited. Six were excluded because a postoperative context (ENT surgery and one meningioma surgery). “Spontaneous medical” CVT were finally collected: 10 died in ICU, 3 died after ICU discharge and 3 were lost; 25 are currently alive and were studied for functional outcome after at least 1 year evolution

Fig. 2

Outcome of severe CVT from ICU discharge to the next 12 months. a The evolution of the distribution of patients along the survey period with white bars for the number of the patients. At each period of monitoring (in ICU, at ICU discharge, 3 and 12 months), patients are divided into: group “good recovery” mRS 0–3 (light gray bars), “poor recovery” mRS 4–5 (dark gray bars) and death mRS 6 (black bars). b The distribution of mRS along the survey period at ICU discharge, 3 and 12 months. Proportion for functional ranking was calculated as a ratio between mRS value divided by the number of patients at the time of evaluation. Patients lost after discharge were excluded