Early isolated SAH versus hemorrhagic infarction in cerebral venous thrombosis

Abstract

Background: Cerebral venous thrombosis (CVT) is a rare cerebral vascular disease the presentation of which is highly variable clinically and radiologically. A recent study has shown that isolated subarachnoid hemorrhage (iSAH) in CVT is not as rare as thought previously and may have a good prognostic significance. Hemorrhagic venous infarction, however, is an indicator of unfavorable outcome, mostly associated with multiple cerebral sinuses/veins occlusion. We hypothesized that our patients who initially suffered iSAH would have a better clinical outcome than those who suffered hemorrhagic cerebral infarction.

Patients and methods: We selected patients hospitalized due to CVT and who presented either isolated SAH or cerebral hemorrhagic infarction at admission or during the next 24 hours. They were 23 (10 men) aged 22-73 years. The data was extracted from hospital admission records, our computer data system and the radiological database system.

Results: The iSAH group consisted of 8 (6 men) aged 49.3 ± 16.2 and haemorrhagic infarction group contained 15 (4 men) aged 47.9 ± 16.8. The isolated SAH group had a significantly better outcome regarding mRS score than the haemorrhagic infarction group (Mann-Whitney Rank Sum Test, p =0.026) despite a significantly greater number of thrombosed venous sinuses/deep veins. (Mann-Whitney Rank Sum Test, p=0.002). Additional variables of significant impact were oedema formation (p=0.004) and sulcal obliteration (p=0.014).

Conclusions: The patients who suffer iSAH initially had a significantly better outcome prognosis than haemorrhagic infarction patients despite the greater number of thrombosed sinuses/veins. A possible explanation might include patent superficial cerebral communicating veins.