Cerebral venous thrombosis: an all or nothing disease? Prognostic factors and long-term outcome.

Background: There is insufficient data on short- and especially long-term prognosis of cerebral venous thrombosis (CVT).
Methods: In 79 consecutive patients, we analyzed factors for acute death and functional outcome at hospital discharge and after 6 months as well as long-term prognosis >/=12 months. Neurological deficits were graded on the National Institute of Health Stroke Scale (NIHSS), functional outcome on the modified Rankin Scale (mRS). Primary outcome was defined as mRS >/= 3 at 6 months, secondary outcomes were death during hospital treatment and number as well as type of complications during follow-up >/=12 months after hospital discharge. Forty-two patients were recruited prospectively, 37 were identified by chart review. Information on outcome was based on neurological examinations at our outpatient clinic.
Results: Factors significantly related to acute death were age, the NIHSS on admission, more than two seizures despite antiepileptic treatment, venous infarct, and hemorrhagic transformation of the venous infarct. Primary outcome after 6 months in 74 patients was excellent with 73% of patients reaching a mRS 0-1, 4% a mRS of 2, and 23% a mRS 3-6, including 12 deaths in the acute stage of illness. Factors significantly related to a mRS >/= 3 at 6 months in a logistic regression analysis were age and items 1a-c of the NIHSS on admission related to consciousness. Fifty-eight surviving patients had a follow-up >/= 12 months (median: 31; mean: 52 +/- 61 months). Most frequent complication on long-term follow-up was epilepsy in nine patients and recurrent venous thrombosis in seven patients.
Conclusions: When the acute stage of illness has been survived, CVT has a good prognosis unlike arterial ischemic stroke.