Trombose venosa cerebral: evolução clínica e fatores prognósticos em 111 pacientes / Cererbal venous thrombosis: clinical outcome and prognostic factors in 111 patients

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Introduction: The cerebral venous thrombosis (CVT) clinical evolution is quite variable from complete recovery to death. Some European series and a multicenter study had identified prognostic factors related to CVT prognosis. The identification of these factors is important for the best therapeutic decision to patients. This study aims to identify the prognostic factors enrolled in clinical evolution of 111 patients with CVT in a prospective outcome clinical trial during two years. Subjects and Methods: One hundred and eleven patients were prospective followed with the diagnosis of CVT since acute phase diagnosis, confirmed by brain MRI and/or brain angiography (MRA , CTA or digital angiography). Information about clinical features and follow-up were filled on a clinical form. 96% of the patients were anticoagulated on heparin followed by warfarin treatment. The patients were investigated to predisposing factors to CVT. The clinical evaluation was accessed by the modified Rakin scale (mRs) after 3, 6, 12 and 24 months, considering patients with good outcome when mRs 2. The acute phase clinical features, laboratory and imaging data were compared as possible prognosis factors beyond univariate 2 test and the factors with statistical significance (p<0,1) and then analyzed by logistic regression adjusted and Odds Ratio values (confidence interval CI=95%). Results: The mean age of the patients was 35 years, 72% were women, and 40% were African Brazilian. The main clinical features observed were: headache 97%, focal sign 47%, epileptic seizure 40%, isolated ICH syndrome 40% and altered mental status 28%. All the patients were investigated to predisposing factors; 75% of the women were on oral contraceptive, 31% of the patients presented hereditary thrombophilia, 13 % antiphospholipid syndrome, 6% presented vasculitis, 25% other protrhrombotic state, 7% presented some local feature (arterialvenous malformation or infection) and 5% of women were pregnant or on puerperium. The neuroimaging data showed that 42% of the patients presented thrombosis in more than one venous system, 33% had hemorrhage infarcts, 18% ischemic venous infarcts and 20% of the patients had thrombosis of the deep venous system. After two years 17% had a mRs >2 and the features enrolled on poor prognosis were: African Brazilian patients p=0,001; OR= 11,37 (95% IC 2.81- 46,08), altered mental status p=0,007; OR=4.56 (95% IC 1.61-19.45), male gender p=0,049 OR=3.55 (95% IC 1.00-12.55) and age over 32 years p=0,05 OR = 3.95 (95% IC 0,97- 15.20). The presence of oral contraceptives as isolated predisposing factor was related to good outcome CVT p=0,016; OR=5,17(95% IC 1.37-19.57) and after two years the mortality rate was 4,5%. Conclusion: This study data show that most patients with the diagnosis of CVT (83%) has a good outcome with the treatment, after two years follow up they have no symptoms or minimal deficits, and the presence of oral contraceptives as isolated predisposing factor was related to better outcome CVT. The patients with poor prognosis have the African Brazilian ethnic group, altered mental status, male gender and age over 32 years as the factors enrolled on bad clinical evolution in two years. The identification of these factors can have future value on treatment better choice on acute phase to selected CVT patients

ASSUNTO(S)

trombose dos seios intracranianos/diagnóstico intracranial sinus thrombosis/diagnosis trombose dos seios intracranianos/epidemiologia intracranial sinus thrombosis/epidemiology trombose dos seios intracranianos/terapia intracranianos/etiologia intracranial sinus thrombosis/etiology intracranial sinus thrombosis/therapy trombose dos seios prognosis prognóstico

ACESSO AO ARTIGO

Documentos Relacionados