Info

Note: n, number of patients with the outcome (death or dependency) and the predictor; N, total patients with the predictor. Source: Adapted from Ref. 13.

Note: n, number of patients with the outcome (death or dependency) and the predictor; N, total patients with the predictor. Source: Adapted from Ref. 13.

in 14.1% (95% CI, 11.6-17.1), and median hospitalization duration was 17 days (mean, 20 days). This recent, large prospective data set (largest to date with only 1.3% lost to follow-up after discharge) supports the observation that outcome from CVT is better than previously reported. Prior prospective studies (n = 6) had limited statistical power and generalizability, but had suggested that coma, intracerebral hemorrhage (ICH), and malignancy were important prognostic indicators for death or dependence. Further, except for miscarriages, complications rarely occurred during or after new pregnancies (13), strongly supporting the evidence that history of a prior CVT (including puerperal CVT) is not a contraindication to pregnancy (23,24 ).

Patients with CVT and poor prognostic indicators should be more closely monitored, preferably in an intensive care unit setting, and consideration should be given to more aggressive treatment strategies (e.g., local thrombolysis, reduction of ICP, etc.) (13) . The occluded sinus might remain occluded, partially or totally recanalize, stimulate alterative drainage pathways, cause persistent increased ICP, or more uncommonly, develop into a dural arteriovenous malformation. Causes of death are primarily transtentorial herniation due to unilateral focal mass effect or diffuse cerebral edema with multple parenchymal lesions (25).

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