Original Article
Cerebral Venous Thrombosis in a Mexican Multicenter Registry of Acute Cerebrovascular Disease: The RENAMEVASC Study

https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.01.001Get rights and content

Background

Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease that is usually not mentioned in multicenter registries on all-type acute stroke. We aimed to describe the experience on hospitalized patients with CVT in a Mexican multicenter registry on acute cerebrovascular disease.

Methods

CVT patients were selected from the RENAMEVASC registry, which was conducted between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging, and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed.

Results

Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%), contraceptive use (18%), and pregnancy (12%) were the main risk factors in women. In 67% of men, CVT was registered as idiopathic, but thrombophilia assessment was suboptimal. Longitudinal superior sinus was the most frequent thrombosis location (78%). Extensive (>5 cm) venous infarction occurred in 36% of patients. Only 81% of patients received anticoagulation since the acute phase, and 3% needed decompressive craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic thromboembolism (8.5%) were the main in-hospital complications. The 30-day case fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards model, only age <40 years was associated with a mRS score of 0 to 2 (functional independence; rate ratio, 3.46; 95% CI, 1.34-8.92).

Conclusions

The relative frequency of CVT and the associated in-hospital complications were higher than in other registries. Thrombophilia assessment and acute treatment was suboptimal. Young age is the main determinant of a good short-term outcome.

Section snippets

Patients

This prospective, hospital-based multicenter registry was conducted between November 2002 and October 2004 in 25 referral centers from 14 states of Mexico. All investigators were neurologists trained in cerebrovascular disease. The complete methodology of the RENAMEVASC study has been reported elsewhere.16, 17 Briefly, consecutive patients were registered if a suspected acute cerebrovascular disease was confirmed and accurately classified by computed tomographic (CT) or magnetic resonance

Results

The RENAMEVASC registry included 2000 hospitalized patients with all types of acute cerebrovascular disease. In all, 59 (2.97%; 95% CI, 2.3-3.8%) had CVT. There were 50 (85%) women and 9 (15%) men (female:male ratio, 5:1), with a median age of 31 years (interquartile range, 22-39 years). A total of 45 (76%) patients were younger than 40 years of age. The median time from neurologic symptoms to hospital presentation was 48 hours (interquartile range, 15-96 hrs). Only 1 case of CVT was identified

Discussion

The RENAMEVASC study is the first collaborative, nongovernmental, non–industry sponsored registry on patients hospitalized with all-type acute cerebrovascular disease. In this registry, we observed 3% of cases with CVT among all stroke types. In other countries, the relative frequency ranges from 0.5% to 2%.2, 5, 9, 10 However, in autopsy studies, CVT has been observed in a relative frequency of as much as 10%,19 which suggests that CVT is often clinically overlooked. Here we observed a very

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