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Long-term outcome after cerebral venous thrombosis: analysis of functional and vocational outcome, residual symptoms, and adverse events in 161 patients

Journal article
Authors S. Hiltunen
J. Putaala
E. Haapaniemi
Turgut Tatlisumak
Published in Journal of Neurology
Volume 263
Issue 3
Pages 477-484
ISSN 0340-5354
Publication year 2016
Published at Institute of Neuroscience and Physiology
Pages 477-484
Language en
Links dx.doi.org/10.1007/s00415-015-7996-...
Keywords Cerebral venous thrombosis, Sinus thrombosis, Long-term outcome, Anticoagulation, Follow-up, Vocational status, dural sinus thrombosis, young-women, follow-up, recurrence, prognosis, vein, recanalization, risk
Subject categories Clinical Medicine

Abstract

Cerebral venous thrombosis (CVT) affects mainly working-aged individuals. Functional recovery after CVT is generally considered good with about 3/4 of patients achieving short-term independence. However, vascular events, long-term functional outcome, and employment after CVT remain poorly investigated. We identified consecutive adult CVT patients treated at the Helsinki University Hospital (1987-2013) and invited them to a follow-up visit. Each clinical examination was combined with interview. We also recorded recurrent venous thromboembolism (VTE) and hemorrhagic events during follow-up and antithrombotic medication use. A modified Rankin Scale (mRS) served to assess functional outcome. Logistic regression served to identify independent factors associated with unemployment and functional recovery. Of the 195 patients identified, 21 died, 9 declined to participate, and 4 were excluded from the study. Thus, 161 patients (106 women) underwent an examination after a median of 39 months (interquartile range 14-95). VTE (one of which was CVT) occurred in 9 (6 %) patients, and severe hemorrhagic events in 10 (6 %). Functional outcome was good, with 84 % scoring 0-1 on the mRS; 42 % reported residual symptoms. Altogether, 91 (57 %) patients were employed. After adjusting for age and sex, a National Institutes of Health Stroke Scale score > 2 at admission and low education level, associated with both unfavorable functional outcome and unemployment. Long-term functional outcome after CVT may appear good if measured with mRS, but patients often have residual symptoms and are frequently unable to return to their previous work.

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