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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(05): 426-432
DOI: 10.1055/s-0043-1767822
Original Article

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

Identificação dos fatores de risco para herniação intracranial em pacientes com trombose venosa cerebral
Yasemin Dinç 
1   Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye.
,
Rıfat Ozpar 
2   Uludağ University, Faculty of Medicine, Department of Radiology, Bursa, Türkiye.
,
Bahattin Hakyemez 
2   Uludağ University, Faculty of Medicine, Department of Radiology, Bursa, Türkiye.
,
Mustafa Bakar 
1   Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye.
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Abstract

Background Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important.

Objective This study aims to determine the risk factors for intracranial herniation in patients with CVST.

Methods A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study.

Results Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 ± 13.23 and 44.13 ± 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages.

Conclusion This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy.

Resumo

Antecedentes A trombose do seio venoso cerebral (CVST) não é tão bem compreendida como um acidente vascular cerebral isquémico de origem arterial. Embora o prognóstico de CVST seja geralmente bom lesões parenquimatosas podem ocorrer em alguns pacientes e o desenvolvimento de herniação intracraniana pode resultar em morte. Por esse motivo é importante reconhecer os fatores de risco para hérnia intracraniana e determinar com precisão os pacientes que devem ser submetidos à craniectomia descompressiva.

Objetivo Este estudo tem como objetivo determinar os fatores de risco para herniação intracraniana em pacientes com CVST.

Métodos Um total de 177 pacientes diagnosticados com CVST entre 2015 e 2021 em nosso centro terciário foram retrospectivamente incluídos neste estudo.

Resultados Dos 177 pacientes 124 eram do sexo feminino e 53 do masculino com média de idade de 40 65 ± 13 23 e 44 13 ± 17 09 respectivamente. Destes 18 pacientes desenvolveram hérnia intracraniana. Uma relação estatística significativa foi observada entre trombose do seio sagital superior trombose do seio reto escore de colateral venosa infarto venoso não hemorrágico presença de malignidade pequena hemorragia justacortical e trombose da veia cortical. Os resultados da análise de regressão logística binária mostraram que as variáveis mais significativas foram o escore colateral venoso de 0 malignidade e pequenas hemorragias justacorticais.

Conclusão Este estudo identificou pequenas hemorragias justacorticais a presença de malignidade e um escore colateral venoso de 0 como fatores de risco independentes para herniação intracraniana em pacientes CVST. Com base nesses resultados recomendamos uma observação clínica rigorosa dos pacientes CVST pois eles podem ser candidatos à craniectomia descompressiva.

Keywords

Sinus Thrombosis, Intracranial - Brain Edema - Intracranial Hypertension

Palavras-chave

Trombose dos Seios Intracranianos - Edema Encefálico - Hipertensão Intracraniana

Authors' Contributions

YD: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualization, writing the original draft, and review & editing; RO: investigation, methodology, writing the original draft, and review & editing; BH: conceptualization, data curation, formal analysis, investigation, methodology, writing the original draft, and review & editing; MB: visualization, and writing the original draft;




Publication History

Received: 15 October 2022

Accepted: 15 January 2023

Article published online:
31 May 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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