Cerebral venous thrombosis in elderly patients

Abstract

Background and purpose: We aimed to report the characteristics of cerebral venous thrombosis (CVT) in elderly people (aged ≥65 years).

Methods: This multicenter retrospective cohort included elderly patients hospitalized for a first CVT in nine Paris-Ile-de-France hospitals between 2011 and 2021. The estimated incidence was compared to CVT recorded by the French health insurance data system. Lariboisière Hospital's CVT registry allowed comparisons of our elderly cohort with individuals younger than 65 years.

Results: One hundred fourteen patients were included in this study (mean age = 74.2 years, range = 65-93, 61% female). The CVT annual incidence in Ile-de-France was 5.9-7.1 per million elderly individuals versus 8.5 per million nationwide. Headaches and focal deficits were the most common initial clinical features (50% and 51%, respectively), followed by seizures and confusion (40% and 27%). Treatment included anticoagulation (93%) and, rarely, endovascular procedure (2%) or craniectomy (1%). Compared with adult patients aged <65 years (younger adults), elderly patients presented fewer headaches (50% vs. 96%, p < 0.01) and intracranial hypertension (7% vs. 22%, p < 0.01) but more seizures and focal deficits (40% vs. 27% and 51% vs. 38%, respectively, p < 0.01). Underlying cancer, hemopathy, and locoregional infections were more frequent in elderly patients than among younger adults (p < 0.01). The prognosis of patients from our elderly cohort was poorer than that of younger adults; 8% died in the acute phase, and 73% had a favorable outcome at 1 year (vs. 1.7% and 87%, respectively, p < 0.01).

Conclusions: CVT in elderly patients has a specific clinical presentation, epidemiology, and risk factors such as cancer or hemopathy, justifying specialized management.

Keywords: cerebral venous thrombosis; cohort; elderly; etiology; incidence; prognosis; risk factors; thrombophlebitis.

FIGURE 1

Annual incidence of cerebral venous thrombosis (CVT) according to age in our cohort, the Ile‐de‐France region, and France overall. Estimated incidence of CVT in patients aged ≥65 years was calculated from the symptomatic CVT cases of our cohort (white), and using data extracted from the French national discharge database (International Classification of Diseases, 10th Revision coding) in the Ile‐de‐France region (gray) and France overall (black).

FIGURE 2

Comparison of the modified Rankin Score at 1 year in our cohort (114 cerebral venous thrombosis [CVT] patients aged ≥65 years) and the Lariboisière register (478 CVT patients aged <65 years). (Modified Rankin score 0: no symptoms; 1: no significant disability, despite symptoms; able to perform all usual duties and activities; 2: slight disability; unable to perform all previous activities but able to look after own affairs without assistance; 3: moderate disability; requires some help, but able to walk without assistance; 4: moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance; 5: severe disability; bedridden, incontinent, and requires constant nursing care and attention; and 6: dead.)