Abstract
Cerebral venous thrombosis (CVT) affects mainly working-aged individuals. Functional recovery after CVT is generally considered good with about 3/4 of patients achieving short-term independence. However, vascular events, long-term functional outcome, and employment after CVT remain poorly investigated. We identified consecutive adult CVT patients treated at the Helsinki University Hospital (1987–2013) and invited them to a follow-up visit. Each clinical examination was combined with interview. We also recorded recurrent venous thromboembolism (VTE) and hemorrhagic events during follow-up and antithrombotic medication use. A modified Rankin Scale (mRS) served to assess functional outcome. Logistic regression served to identify independent factors associated with unemployment and functional recovery. Of the 195 patients identified, 21 died, 9 declined to participate, and 4 were excluded from the study. Thus, 161 patients (106 women) underwent an examination after a median of 39 months (interquartile range 14–95). VTE (one of which was CVT) occurred in 9 (6 %) patients, and severe hemorrhagic events in 10 (6 %). Functional outcome was good, with 84 % scoring 0–1 on the mRS; 42 % reported residual symptoms. Altogether, 91 (57 %) patients were employed. After adjusting for age and sex, a National Institutes of Health Stroke Scale score >2 at admission and low education level, associated with both unfavorable functional outcome and unemployment. Long-term functional outcome after CVT may appear good if measured with mRS, but patients often have residual symptoms and are frequently unable to return to their previous work.
Similar content being viewed by others
References
Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F, ISCVT I (2004) Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke 35(3):664–670
Putaala J, Hiltunen S, Salonen O, Kaste M, Tatlisumak T (2010) Recanalization and its correlation to outcome after cerebral venous thrombosis. J Neurol Sci 292(1–2):11–15
de Bruijn SF, de Haan RJ, Stam J (2001) Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For the cerebral venous sinus thrombosis study group. J Neurol Neurosurg Psychiatry 70(1):105–108
Miranda B, Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F, Scoditti U, ISCVT I (2010) Venous thromboembolic events after cerebral vein thrombosis. Stroke 41(9):1901–1906
Martinelli I, Bucciarelli P, Passamonti SM, Battaglioli T, Previtali E, Mannucci PM (2010) Long-term evaluation of the risk of recurrence after cerebral sinus-venous thrombosis. Circulation 121(25):2740–2746
Gosk-Bierska I, Wysokinski W, Brown RD Jr, Karnicki K, Grill D, Wiste H, Wysokinska E, McBane RD (2006) Cerebral venous sinus thrombosis: incidence of venous thrombosis recurrence and survival. Neurology 67(5):814–819
Ciron J, Godeneche G, Vandamme X, Rosier MP, Sharov I, Mathis S, Larrieu D, Neau JP (2013) Obstetrical outcome of young women with a past history of cerebral venous thrombosis. Cerebrovasc Dis 36(1):55–61
Lamy C, Hamon JB, Coste J, Mas JL (2000) Ischemic stroke in young women: risk of recurrence during subsequent pregnancies. French study group on stroke in pregnancy. Neurology 55(2):269–274
Ferro JM, Lopes MG, Rosas MJ, Ferro MA, Fontes J, Cerebral Venous Thrombosis Portugese Collaborative Study Group (2002) Long-term prognosis of cerebral vein and dural sinus thrombosis. Results of the VENOPORT study. Cerebrovasc Dis 13(4):272–278
Preter M, Tzourio C, Ameri A, Bousser MG (1996) Long-term prognosis in cerebral venous thrombosis. Follow-up of 77 patients. Stroke 27(2):243–246
Strupp M, Covi M, Seelos K, Dichgans M, Brandt T (2002) Cerebral venous thrombosis: correlation between recanalization and clinical outcome—a long-term follow-up of 40 patients. J Neurol 249(8):1123–1124
Breteau G, Mounier-Vehier F, Godefroy O, Gauvrit JY, Mackowiak-Cordoliani MA, Girot M, Bertheloot D, Henon H, Lucas C, Leclerc X, Fourrier F, Pruvo JP, Leys D (2003) Cerebral venous thrombosis 3-year clinical outcome in 55 consecutive patients. J Neurol 250(1):29–35
de Bruijn SF, Budde M, Teunisse S, de Haan RJ, Stam J (2000) Long-term outcome of cognition and functional health after cerebral venous sinus thrombosis. Neurology 54(8):1687–1689
Buccino G, Scoditti U, Patteri I, Bertolino C, Mancia D (2003) Neurological and cognitive long-term outcome in patients with cerebral venous sinus thrombosis. Acta Neurol Scand 107(5):330–335
Koopman K, Uyttenboogaart M, Vroomen PC, van der Meer J, De Keyser J, Luijckx GJ (2009) Long-term sequelae after cerebral venous thrombosis in functionally independent patients. J Stroke Cerebrovasc Dis 18(3):198–202
Haghighi AB, Edgell RC, Cruz-Flores S, Feen E, Piriyawat P, Vora N, Callison RC, Alshekhlee A (2012) Mortality of cerebral venous-sinus thrombosis in a large national sample. Stroke 43(1):262–264
Simes J, Becattini C, Agnelli G, Eikelboom JW, Kirby AC, Mister R, Prandoni P, Brighton TA, INSPIRE Study Investigators (International Collaboration of Aspirin Trials for Recurrent Venous Thromboembolism) (2014) Aspirin for the prevention of recurrent venous thromboembolism: the INSPIRE collaboration. Circulation 130(13):1062–1071
Bugnicourt JM, Guegan-Massardier E, Roussel M, Martinaud O, Canaple S, Triquenot-Bagan A, Wallon D, Lamy C, Leclercq C, Hannequin D, Godefroy O (2013) Cognitive impairment after cerebral venous thrombosis: a two-center study. J Neurol 260(5):1324–1331
Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20(7):864–870
Acknowledgments
We thank Marja Metso (RN) and Saija Eirola (RN) for their dedication and technical support.
Sources of funding
This project received funding from the Helsinki University Hospital Research Funds (TT) and the National Graduate School of Clinical Investigation (SH).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Ethical standards
All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Hiltunen, S., Putaala, J., Haapaniemi, E. et al. Long-term outcome after cerebral venous thrombosis: analysis of functional and vocational outcome, residual symptoms, and adverse events in 161 patients. J Neurol 263, 477–484 (2016). https://doi.org/10.1007/s00415-015-7996-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-015-7996-9