Cerebral venous thrombosis: Clinical characteristics and factors affecting outcome

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

The aim of this study was to investigate clinical characteristics of cerebral venous thrombosis (CVT), risk-factors, and factors associated with poor outcome. We established retrospectively a database on all CVT patients treated at the Helsinki University Hospital from 1987 to 2015, and patients were invited for a follow-up visit. We formed collaboration with the Academic Medical Centre in Amsterdam, and Sahlgrenska University Hospital in Gothenburg. Helsinki CVT registry collected data on 243 patients. Patients aged from 15 to 82 years (median 42), and 60% were women. In the study investigating sinus recanalization, 43 of 91 patients had complete, 31 had partial, and 17 had no recanalization of the sinuses at follow-up. Poor recanalization was associated with older age, male gender, and absence of known risk factors or causes. In multivariate analysis recanalization was not associated with functional recovery. Fibrin D-dimer was measured in 71 out of 138 patients before initiation of anticoagulation. D-dimer 3mg/l in 35.2%. Levels of were lower in patients with longer symptom duration and higher when more sinuses were thrombosed. Hyperglycemia was investigated in 308 patients (169 from Amsterdam and 139 from Helsinki). Hyperglycemia (plasma glucose >7.8mmol/l) was present in 21% of the patients at admission. In multivariate analysis hyperglycemia was independently associated with recovery and mortality. Role of cancer as CVT risk was investigated in 594 cases (243 from Helsinki, 224 from Amsterdam, and 128 from Gothenburg) and 6278 controls. In the first year after cancer diagnosis the risk was clearly elevated in solid cancer, and very high in hematological cancer. The study investigating long-term outcome after CVT included 161 patients, with a mean follow-up of 39 months. Mortality was 11%, with 4% due to CVT. Good functional recovery (mRS 0-1) was observed in 83%, however residual symptoms were reported by 68% of patients. Vocational status analysis included 121 working-aged patients; 23% were unemployed, and 16% were on permanent disability pension. Major stroke symptoms, and compulsory education only were associated with both functional outcome and vocational status in multivariate analysis. In conclusion, our CVT cases in Helsinki are in demographically similar to other CVT series from high-income countries. Recanalization occurred less often in patients with known factors of poor outcome, but the importance of recanalization to recovery needs further studies. Fibrin D-dimer measurements cannot be reliably used to exclude CVT. We established hyperglycemia as a factor affecting outcome. Hyperglycemia should be treated, but optimum level needs investigation. Newly diagnosed cancer is a major risk factor for CV was confirmed. Functional outcome after CVT is generally good, however residual symptoms are common. Patients are often young, so even mild residual symptoms that affect working ability are of large importance.
Original languageEnglish
Supervisors/Advisors
  • Putaala, Jukka, Supervisor
  • Tatlisumak, Turgut, Supervisor
Award date10 Aug 2018
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4347-1
Electronic ISBNs978-951-51-4388-4
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Sinus Thrombosis, Intracranial
  • +complications
  • +diagnosis
  • +diagnostic imaging
  • +mortality
  • Age Factors
  • Antifibrinolytic Agents
  • Blood Glucose
  • Cerebrovascular Disorders
  • Fibrin Fibrinogen Degradation Products
  • Headache
  • Hematologic Neoplasms
  • Hemorrhage
  • Hyperglycemia
  • Neoplasms
  • Recovery of Function
  • Risk Factors
  • Stroke
  • Venous Thrombosis
  • 3112 Neurosciences
  • 3124 Neurology and psychiatry

Cite this

@phdthesis{6a3107e3b4df45eaac6e1fdad21c520d,
title = "Cerebral venous thrombosis: Clinical characteristics and factors affecting outcome",
abstract = "The aim of this study was to investigate clinical characteristics of cerebral venous thrombosis (CVT), risk-factors, and factors associated with poor outcome. We established retrospectively a database on all CVT patients treated at the Helsinki University Hospital from 1987 to 2015, and patients were invited for a follow-up visit. We formed collaboration with the Academic Medical Centre in Amsterdam, and Sahlgrenska University Hospital in Gothenburg. Helsinki CVT registry collected data on 243 patients. Patients aged from 15 to 82 years (median 42), and 60{\%} were women. In the study investigating sinus recanalization, 43 of 91 patients had complete, 31 had partial, and 17 had no recanalization of the sinuses at follow-up. Poor recanalization was associated with older age, male gender, and absence of known risk factors or causes. In multivariate analysis recanalization was not associated with functional recovery. Fibrin D-dimer was measured in 71 out of 138 patients before initiation of anticoagulation. D-dimer 3mg/l in 35.2{\%}. Levels of were lower in patients with longer symptom duration and higher when more sinuses were thrombosed. Hyperglycemia was investigated in 308 patients (169 from Amsterdam and 139 from Helsinki). Hyperglycemia (plasma glucose >7.8mmol/l) was present in 21{\%} of the patients at admission. In multivariate analysis hyperglycemia was independently associated with recovery and mortality. Role of cancer as CVT risk was investigated in 594 cases (243 from Helsinki, 224 from Amsterdam, and 128 from Gothenburg) and 6278 controls. In the first year after cancer diagnosis the risk was clearly elevated in solid cancer, and very high in hematological cancer. The study investigating long-term outcome after CVT included 161 patients, with a mean follow-up of 39 months. Mortality was 11{\%}, with 4{\%} due to CVT. Good functional recovery (mRS 0-1) was observed in 83{\%}, however residual symptoms were reported by 68{\%} of patients. Vocational status analysis included 121 working-aged patients; 23{\%} were unemployed, and 16{\%} were on permanent disability pension. Major stroke symptoms, and compulsory education only were associated with both functional outcome and vocational status in multivariate analysis. In conclusion, our CVT cases in Helsinki are in demographically similar to other CVT series from high-income countries. Recanalization occurred less often in patients with known factors of poor outcome, but the importance of recanalization to recovery needs further studies. Fibrin D-dimer measurements cannot be reliably used to exclude CVT. We established hyperglycemia as a factor affecting outcome. Hyperglycemia should be treated, but optimum level needs investigation. Newly diagnosed cancer is a major risk factor for CV was confirmed. Functional outcome after CVT is generally good, however residual symptoms are common. Patients are often young, so even mild residual symptoms that affect working ability are of large importance.",
keywords = "Sinus Thrombosis, Intracranial, +complications, +diagnosis, +diagnostic imaging, +mortality, Age Factors, Antifibrinolytic Agents, Blood Glucose, Cerebrovascular Disorders, Fibrin Fibrinogen Degradation Products, Headache, Hematologic Neoplasms, Hemorrhage, Hyperglycemia, Neoplasms, Recovery of Function, Risk Factors, Stroke, Venous Thrombosis, 3112 Neurosciences, 3124 Neurology and psychiatry",
author = "Sini Hiltunen",
note = "M1 - 78 s. + liitteet",
year = "2018",
language = "English",
isbn = "978-951-51-4347-1",
publisher = "[S. Hiltunen]",
address = "Finland",

}

Cerebral venous thrombosis : Clinical characteristics and factors affecting outcome. / Hiltunen, Sini.

Helsinki : [S. Hiltunen], 2018. 78 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Cerebral venous thrombosis

T2 - Clinical characteristics and factors affecting outcome

AU - Hiltunen, Sini

N1 - M1 - 78 s. + liitteet

PY - 2018

Y1 - 2018

N2 - The aim of this study was to investigate clinical characteristics of cerebral venous thrombosis (CVT), risk-factors, and factors associated with poor outcome. We established retrospectively a database on all CVT patients treated at the Helsinki University Hospital from 1987 to 2015, and patients were invited for a follow-up visit. We formed collaboration with the Academic Medical Centre in Amsterdam, and Sahlgrenska University Hospital in Gothenburg. Helsinki CVT registry collected data on 243 patients. Patients aged from 15 to 82 years (median 42), and 60% were women. In the study investigating sinus recanalization, 43 of 91 patients had complete, 31 had partial, and 17 had no recanalization of the sinuses at follow-up. Poor recanalization was associated with older age, male gender, and absence of known risk factors or causes. In multivariate analysis recanalization was not associated with functional recovery. Fibrin D-dimer was measured in 71 out of 138 patients before initiation of anticoagulation. D-dimer 3mg/l in 35.2%. Levels of were lower in patients with longer symptom duration and higher when more sinuses were thrombosed. Hyperglycemia was investigated in 308 patients (169 from Amsterdam and 139 from Helsinki). Hyperglycemia (plasma glucose >7.8mmol/l) was present in 21% of the patients at admission. In multivariate analysis hyperglycemia was independently associated with recovery and mortality. Role of cancer as CVT risk was investigated in 594 cases (243 from Helsinki, 224 from Amsterdam, and 128 from Gothenburg) and 6278 controls. In the first year after cancer diagnosis the risk was clearly elevated in solid cancer, and very high in hematological cancer. The study investigating long-term outcome after CVT included 161 patients, with a mean follow-up of 39 months. Mortality was 11%, with 4% due to CVT. Good functional recovery (mRS 0-1) was observed in 83%, however residual symptoms were reported by 68% of patients. Vocational status analysis included 121 working-aged patients; 23% were unemployed, and 16% were on permanent disability pension. Major stroke symptoms, and compulsory education only were associated with both functional outcome and vocational status in multivariate analysis. In conclusion, our CVT cases in Helsinki are in demographically similar to other CVT series from high-income countries. Recanalization occurred less often in patients with known factors of poor outcome, but the importance of recanalization to recovery needs further studies. Fibrin D-dimer measurements cannot be reliably used to exclude CVT. We established hyperglycemia as a factor affecting outcome. Hyperglycemia should be treated, but optimum level needs investigation. Newly diagnosed cancer is a major risk factor for CV was confirmed. Functional outcome after CVT is generally good, however residual symptoms are common. Patients are often young, so even mild residual symptoms that affect working ability are of large importance.

AB - The aim of this study was to investigate clinical characteristics of cerebral venous thrombosis (CVT), risk-factors, and factors associated with poor outcome. We established retrospectively a database on all CVT patients treated at the Helsinki University Hospital from 1987 to 2015, and patients were invited for a follow-up visit. We formed collaboration with the Academic Medical Centre in Amsterdam, and Sahlgrenska University Hospital in Gothenburg. Helsinki CVT registry collected data on 243 patients. Patients aged from 15 to 82 years (median 42), and 60% were women. In the study investigating sinus recanalization, 43 of 91 patients had complete, 31 had partial, and 17 had no recanalization of the sinuses at follow-up. Poor recanalization was associated with older age, male gender, and absence of known risk factors or causes. In multivariate analysis recanalization was not associated with functional recovery. Fibrin D-dimer was measured in 71 out of 138 patients before initiation of anticoagulation. D-dimer 3mg/l in 35.2%. Levels of were lower in patients with longer symptom duration and higher when more sinuses were thrombosed. Hyperglycemia was investigated in 308 patients (169 from Amsterdam and 139 from Helsinki). Hyperglycemia (plasma glucose >7.8mmol/l) was present in 21% of the patients at admission. In multivariate analysis hyperglycemia was independently associated with recovery and mortality. Role of cancer as CVT risk was investigated in 594 cases (243 from Helsinki, 224 from Amsterdam, and 128 from Gothenburg) and 6278 controls. In the first year after cancer diagnosis the risk was clearly elevated in solid cancer, and very high in hematological cancer. The study investigating long-term outcome after CVT included 161 patients, with a mean follow-up of 39 months. Mortality was 11%, with 4% due to CVT. Good functional recovery (mRS 0-1) was observed in 83%, however residual symptoms were reported by 68% of patients. Vocational status analysis included 121 working-aged patients; 23% were unemployed, and 16% were on permanent disability pension. Major stroke symptoms, and compulsory education only were associated with both functional outcome and vocational status in multivariate analysis. In conclusion, our CVT cases in Helsinki are in demographically similar to other CVT series from high-income countries. Recanalization occurred less often in patients with known factors of poor outcome, but the importance of recanalization to recovery needs further studies. Fibrin D-dimer measurements cannot be reliably used to exclude CVT. We established hyperglycemia as a factor affecting outcome. Hyperglycemia should be treated, but optimum level needs investigation. Newly diagnosed cancer is a major risk factor for CV was confirmed. Functional outcome after CVT is generally good, however residual symptoms are common. Patients are often young, so even mild residual symptoms that affect working ability are of large importance.

KW - Sinus Thrombosis, Intracranial

KW - +complications

KW - +diagnosis

KW - +diagnostic imaging

KW - +mortality

KW - Age Factors

KW - Antifibrinolytic Agents

KW - Blood Glucose

KW - Cerebrovascular Disorders

KW - Fibrin Fibrinogen Degradation Products

KW - Headache

KW - Hematologic Neoplasms

KW - Hemorrhage

KW - Hyperglycemia

KW - Neoplasms

KW - Recovery of Function

KW - Risk Factors

KW - Stroke

KW - Venous Thrombosis

KW - 3112 Neurosciences

KW - 3124 Neurology and psychiatry

M3 - Doctoral Thesis

SN - 978-951-51-4347-1

PB - [S. Hiltunen]

CY - Helsinki

ER -