Current Affairs: Hillary Clinton’s Illness and Prognosis of Cerebral Venous Thrombosis

 

Our classic long-term follow up of CVT. Fulltext is available here, courtesy of Stroke:

Long-term Prognosis in Cerebral Venous Thrombosis

Follow-up of 77 Patients

  1. Maurice Preter, MD;
  2. Christophe Tzourio, MD;
  3. Alain Ameri, MD;
  4. Marie-Germaine Bousser, MD

+ Author Affiliations


  1. From the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY (M.P.); INSERM, U 360, Recherches Epidémiologiques en Neurologie et Psychopathologie, La Salpêtrière, Paris (C.T.); Service de Neurologie, Hôpital de Meaux, Meaux (A.A.); and Service de Neurologie, Hôpital Saint-Antoine, Paris (M.-G.B.), France.

Abstract

Background and Purpose Very little is known about the long-term outcome of patients with cerebral venous thrombosis (CVT), particularly regarding the risk of residual epilepsy and further thrombotic events. We retrospectively studied 77 patients with CVT diagnosed by angiography and/or MRI.

Methods A cohort of 77 patients aged 18 to 77 (mean, 38.5) years with CVT, evaluated from 1975 through 1990, was followed up for a mean of 77.8 months (range, 14 to 204 months; median, 63 months). Information on death, neurological status, seizures, recurrent CVT, other thrombotic events, and subsequent pregnancies was obtained from direct observation, mail questionnaire, or telephone interviews.

Results Sixty-six of 77 patients (85.7%) had no neurological sequelae during follow-up. Eleven patients (14.3%) remained neurologically impaired. Two who initially presented with isolated intracranial hypertension had blindness due to optic atrophy. The other 9 had focal signs at the time of CVT and were left with various cognitive or focal deficits. Four of 28 (14.3%) patients who had seizures at the acute stage had recurrent seizures. One of the 51 patients with lateral sinus thrombosis developed a dural arteriovenous fistula. Nine of the 77 patients (11.7%) suffered a second CVT, all but one in the first year. Noncerebral thrombotic events occurred in 11 patients (14.3%). No recurrence of CVT occurred during later pregnancies, but 1 patient had a postpartum deep vein thrombosis.

Conclusions In the present series, CVT has an essentially good long-term prognosis. The frequency of long-standing epilepsy was low, suggesting that long-term anticonvulsant treatment is not necessary in the majority of cases. A second CVT or another thrombotic episode occurred in 20% of patients, stressing the need in a minority of cases for long-term anticoagulation.

Key Words:

 

Maurice Preter, MD

About Maurice Preter MD

Maurice Preter, MD is a European and U.S. educated psychiatrist, psychotherapist, psychopharmacologist, neurologist, and medical-legal expert in private practice in Manhattan. He is also the principal of Fifth Avenue Concierge Medicine, PLLC, a medical concierge service and health advisory for select individuals and families.
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