Abstract
Abstract WP63: Global Cerebral Edema is Associated With Worse Outcomes in Patients With Cerebral Venous Sinus Thrombosis
Stroke (1970), Vol.49(Suppl_1)
01/22/2018
DOI: 10.1161/str.49.suppl_1.WP63
Abstract
Background and Purpose:
Obstruction of venous drainage may lead to venous hypertension, edema, infarction or intracerebral hemorrhage (ICH) in patients with cerebral venous thrombosis (CVST). While the presence of ICH and infarction are associated with worse outcomes, the independent effect of edema remains unknown. We aimed to evaluate the impact of the characteristics of brain edema on functional outcomes as measured by the modified Rankin Scale (mRS) at discharge.
Methods:
We retrospectively reviewed all patients who presented to the University of Iowa Health Care with CVST between 2004-2014. All patients received standard of care management per available AHA/ASA recommendations. Edema was categorized as focal vasogenic, focal cytotoxic or global cerebral edema (GCE). Vasogenic edema was described as hyperintensity on FLAIR MRI sequences around the location of venous clot while cytotoxic edema was noted when hyperintensities were visualized around the location of ICH/ venous infarction on FLAIR or DWI respectively. GCE was scored when bilateral finger-like extensions into gray white junction and effacement of gyri/sulci were seen on CT scans as described by Claassen et al. Edema scorer was blinded to outcome measures. Multiple regressions were conducted on mRS outcome to test hypotheses of interest. A
p
value ≤ 0.05 was set as statistically significant.
Results:
115 patients met inclusion criteria, 76 women, mean age 42. A total of 30(26%) had venous infarction, 34(30%)ICH , 57(50%) had cerebral edema(20% vasogenic, 35% cytotoxic and 32% GCE). The three edema types together explained 22% variance in discharge mRS (p<.001). The effect of GCE remained significant (p=.001) when adjusting for age, presence/absence of ICH and infarct. The 95%CIs for discharge mRS among those with GCE [2.89-4.17] compared to those without GCE [1.44-2.12]. Vasogenic and cytotoxic edema did not contribute significantly to prediction in multivariate analyses.
Conclusions:
Characterization of early cerebral edema might contribute to a better prognostication of high risk patients after CVTS. GCE in particular forecast an unfavorable outcome. Further understanding of its pathogenesis may represent a new therapeutic window for refractory patients to standard therapies.
Details
- Title: Subtitle
- Abstract WP63: Global Cerebral Edema is Associated With Worse Outcomes in Patients With Cerebral Venous Sinus Thrombosis
- Creators
- Amir Shaban - University of IowaEdgar Samaniego - University of IowaNazan Aksan - University of IowaBiyue Dai - University of IowaUzair Ahmed - Univ of Iowa, Iowa City, IAJulia Granchi - Univ of Iowa, Iowa City, IABinbin Zheng-Lin - University of IowaLara Lazarre - University of IowaHarold Adams - University of IowaColin Derdeyn - University of IowaEnrique Leira - University of IowaSantiago Ortega-Gutierrez - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.49(Suppl_1)
- DOI
- 10.1161/str.49.suppl_1.WP63
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 01/22/2018
- Academic Unit
- Neurosurgery; Epidemiology; Radiology; Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984303260402771
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