Predictors and outcome of deterioration during admission in patients with cerebral venous thrombosis.

Introduction: Cerebral venous thrombosis (CVT) is a less common stroke subtype. While long term outcome factors have been extensively studied, short term deterioration remains poorly understood.

Patients and methods: We conducted a 10-years retrospective analysis at a high-volume tertiary center, including consecutive patients diagnosed with CVT. The primary outcome was early deterioration (ED), defined as decrease in Glasgow Coma Scale, de novo or worsening of focal deficit, death from neurological cause, new or enlarged parenchymal lesions or subarachnoid hemorrhage during hospitalization. Multivariable logistic regression analysis was performed to identify factors associated with ED.

Results: We included 138 patients (81.2% female, median age 42.0 years (IQR 29.3-49.0)). Forty-five (32.6%) patients had ED, with 33 (23.9%) showing clinical deterioration and 35 of 104 (33.7%) imaging worsening. Variables selected from the multivariate model for association with ED were aphasia (OR 4.63, 95% CI 1.61-13.32), motor deficits (OR 2.34, 95% CI 0.97-5.61), and parenchymal lesion (OR 3.65, 95% CI 1.38-9.67). Twenty-seven patients underwent endovascular treatment after deterioration. Patients in the ED group had worse functional outcome at discharge, 6 and 12 months (p < 0.001).

Discussion: One third of patients in this cohort experienced ED. Patients with aphasia, motor deficit, or parenchymal brain lesion at baseline were at higher risk. These patients performed worse at long term follow-up.

Conclusion: We identified predictors of ED in patients with CVT. These patients should be carefully monitored. These findings may inform the design of future clinical trials aimed at evaluating additional therapeutic interventions in the acute phase.