Features of intracranial hemorrhage in cerebral venous thrombosis

Abstract

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.

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Acknowledgments

The Florey Institute of Neuroscience and Mental Health acknowledges the strong support from the Victorian Government and in particular the funding from the Operational Infrastructure Support Grant.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Affiliations

Authors

Contributions

VT designed the manuscript and collected data. KA collected data and wrote the initial draft of the manuscript. GB analysed the images. The other authors (SZ, PB, CE, MB, PC, IE, DR, NH, RL, FF, JJC, ES, SH, AA, AP, JM, JP, CW, TG, TT, JC, PD, MS) collected data. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to V. Thijs.

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Conflicts of interest

The authors declare that there is no conflict of interest.

Consent to participate

Informed consent was not sought for the present study because of the retrospective, anonymized nature of the study, in accordance with the participating center’s ethics committee’s policies.

Ethical approval

Specific approval of the project by an Ethics Committee (Leuven, Graz) or a waiver due to the anonymized, retrospective data and imaging collection (Amsterdam, Nîmes, Mexico City, Essen, Brescia, Sevilla, Barcelona, Helsinki) were obtained by each participating site, according to local regulations.

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Afifi, K., Bellanger, G., Buyck, P.J. et al. Features of intracranial hemorrhage in cerebral venous thrombosis. J Neurol (2020). https://doi.org/10.1007/s00415-020-10008-0

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Keywords

  • Bleeding.
  • Cerebral venous thrombosis
  • Hemorrhage
  • Stroke