Features of intracranial hemorrhage in cerebral venous thrombosis.,Journal of Neurology

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Features of intracranial hemorrhage in cerebral venous thrombosis.
Journal of Neurology ( IF 4.8 ) Pub Date : 2020-06-22 , DOI: 10.1007/s00415-020-10008-0
K Afifi _{1,

2} , G Bellanger _{2,

3} , P J Buyck ₄ , S M Zuurbier ₅ , C G Esperon ₆ , M A Barboza ₇ , P Costa ₈ , I Escudero _{9,

10} , D Renard ₁₁ , R Lemmens _{12,

13,

14} , N Hinteregger ₁₅ , F Fazekas ₁₆ , J Jimenez Conde _{17,

18} , E Giralt-Steinhauer _{17,

18} , S Hiltunen ₁₉ , A Arauz ₇ , A Pezzini _{20,

21} , J Montaner _{10,

18,

22} , J Putaala ₁₉ , C Weimar ₂₃ , Marc Schlamann ₂₄ , T Gattringer ₁₅ , T Tatlisumak _{19,

22,

25} , J M Coutinho ₅ , P Demaerel ₄ , V Thijs _{2,

26}

Affiliation

Department of Neurology, Menoufia University, Al Minufya, Menoufia, Egypt.
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia.
Department of Neuroradiology, Purpan University Hospital, Toulouse, France.
Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.
Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México.
Department of Head and Neck, Neurology Clinic, University of Brescia, Brescia, Italy.
Neurology Department, University Hospital Virgen del Rocio, Sevilla, Spain.
Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain.
Department of Neurology, Nîmes University Hospital, Nîmes, France.
Department of Neurosciences, Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium.
Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium.
Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria.
Department of Neurology, Medical University of Graz, Graz, Austria.
Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain.
Universitat Autònoma de Barcelon, Barcelona, Spain.
Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
Department of Clinical and Experimental Sciences, Neurology Clinic University of Brescia, Brescia, Italy.
Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.
Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Neurology, University Hospital Essen, Essen, Germany.
Institute for Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany.
Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Department of Neurology, Austin Health, Heidelberg, VIC, Australia.

Background

Cerebral venous thrombosis (CVT) is associated with intracranial hemorrhage.

Aim

To identify clinical and imaging features of CVT-associated intracranial hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracranial hemorrhage.

Methods

We performed a retrospective analysis of an international, multicenter cohort of patients with confirmed cerebral venous thrombosis who underwent computed tomography within 2 weeks of symptom onset. Clinical and imaging features were compared between patients with and without intracranial hemorrhage. Clot burden was assessed by counting the number of thrombosed venous sinuses and veins on confirmatory imaging.

Results

We enrolled 260 patients from 10 institutions in Europe and Mexico. The mean age was 42 years and 74% were female. Intracranial hemorrhage was found in 102 (39%). Among them parenchymal hemorrhage occurred in 64 (63%), in addition, small juxta-cortical hemorrhage was found in 30 (29%), subarachnoid hemorrhage in 24 (24%) and subdural hemorrhage in 11 (11%). Multiple concomitant types of hemorrhage occurred in 23 (23%). Older age and superior sagittal thrombosis involvement were associated with presence of hemorrhage. The number of thrombosed venous sinuses was not associated with intracranial hemorrhage (median number IQRInterquartile ratio] of sinuses/veins involved with hemorrhage 2 (1–3) vs. 2 (1–3) without hemorrhage, p = 0.4).

Conclusion

The high rate of intracranial hemorrhage in cerebral venous thrombosis is not explained by widespread involvement of the venous sinuses. Superior sagittal sinus involvement is associated with higher bleeding risk.

中文翻译：

脑静脉血栓形成的颅内出血特征。

背景

脑静脉血栓形成（CVT）与颅内出血有关。

目标

确定与CVT相关的颅内出血的临床和影像学特征。我们假设较高的血凝块负担与较高的颅内出血风险相关。

方法

我们对国际上多中心确诊为脑静脉血栓形成的患者进行了回顾性分析，这些患者在症状发作后两周内进行了计算机断层扫描。比较有无颅内出血的患者的临床和影像学特征。通过在确认性成像上计算血栓形成的静脉窦和静脉的数目来评估血块负担。

结果

我们从欧洲和墨西哥的10个机构招募了260名患者。平均年龄为42岁，女性占74％。102例（39％）发现颅内出血。其中发生实质性出血的有64例（63％），此外，还有少量的近颈皮质出血的有30例（29％），蛛网膜下腔出血的有24例（24％）和硬膜下出血的有11例（11％）。23例（23％）发生多种并发性出血。老年人和上肢矢状血栓形成参与与出血的存在有关。血栓性静脉窦的数量与颅内出血无关（伴有出血的鼻窦/静脉的中位数IQR四分位数比）为2（1-3）与无出血的2（1-3），p = 0.4）。