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Risk factors for the development of secondary intracranial hypertension in acute cerebral venous thrombosis

  • Diagnostic Neuroradiology
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Abstract

Purpose

Intracranial hypertension (IH) can complicate cerebral venous thrombosis (CVT), potentially causing permanent visual loss. Current knowledge on risk factors for the development of IH following CVT is scarce. We applied a compound classifier (CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI) as a surrogate for IH and studied the predictive value of thrombus location, the number of thrombosed segments, and thrombus volume.

Methods

We prospectively included 26 patients with acute CVT and complete MRI data. IH was defined by CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI. Using high-resolution contrast-enhanced venography, we determined the thrombus location, number of thrombosed segments, and thrombus volume. We analyzed their association with IH by logistic regression, their predictive power by the area under the receiver operating characteristic curve, and their association with CSF opening pressure by linear regression.

Results

IH occurred in 46% of CVT patients and was associated with higher thrombus volume (AUC 0.759, p = 0.025) and superior sagittal sinus thrombosis both alone (OR 2.086, p = 0.049) and combined with transverse sinus thrombosis (OR 2.014, p = 0.028). Effects in patients presenting CSF opening pressure > 25 cm H2O and the compound classifier were consistent. Thrombus volume > 4 ml was the single most important predictor of higher CSF opening pressure (ß = 0.566, p = 0.035), increasing IH risk.

Conclusion

Larger thrombus volume, dominant transverse sinus occlusion, and extensive superior sagittal combined with transverse sinus thrombosis were associated with IH. Thrombus volumetry might identify patients at risk for IH and direct further clinical evaluation.

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Acknowledgements

We thank HJ Mast for the acquisition of MRI data and K. Whittaker for English proofreading.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Neurology and Neurophysiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany

    Florian Schuchardt & A. Harloff

  2. Department of Neuroradiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    T. Demerath, N. Lützen, S. Elsheikh, H. Urbach & S. Meckel

  3. Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    W. Lagrèze, M. Reich & S. Küchlin

  4. Institute of Diagnostic and Interventional Neuroradiology, Klinikum Ludwigsburg, Ludwigsburg, Germany

    S. Meckel

Authors
  1. Florian Schuchardt
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  2. T. Demerath
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  3. N. Lützen
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  4. S. Elsheikh
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Contributions

All authors made substantial contributions to the study. F. Schuchardt and A. Harloff concepted and designed the study. W. Lagrèze, S. Meckel, and H. Urbach gave important methodological advice. Material preparation, data collection, and statistical analysis were performed by F. Schuchardt. S. Küchlin and S. Elsheikh supported statistical analyses. M. Reich and W. Lagrèze performed neuroophthalmological examinations. T. Demerath, N. Lützen, and S. Elsheikh analyzed MR-imaging. The first draft of the manuscript was written by F. Schuchardt. All authors commented on previous versions of the manuscript, read, and approved the final manuscript.

Corresponding author

Correspondence to Florian Schuchardt.

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Conflict of interest

None of the authors declares conflicts of interest directly related to the study.

FS: unrelated to the submitted study: previous work on dural arterio-venous fistula in cerebral venous thrombosis was partially supported by Forschungskommission, Medical Faculty, Albert-Ludwigs-University, Freiburg (SCHU 1097/16). Grant 01VSF19053 by the Innovation Committee of the Federal Joint Committee (gemeinsamer Bundesausschuss).

TD: none declared.

NL: none declared.

SE: unrelated to the submitted study: research grant from Bracco S.p.A.; Forschungskommission, Medical Faculty, Albert-Ludwigs-University, Freiburg; Local PI of the Inspire Register-S, Medtronic.

WL: none declared.

MR: honorary as speaker in “OphthalmoLive – Schielen 2021”, unrelated to the study.

SK: none declared.

HU: honoraria for lectures from Eisai, Biogen, Mbits, Advisory Board Biogen, Shareholder Veobrain GmbH (up to 2019).

SM: Unrelated to present study: research grants (money paid to institution) from Bracco S.p.A., Novartis Pharma GmbH and Federal Ministry of Education and Research (BMBF) / Germany: research grant 2019-2021 (FKZ 13GW0359C); consulting fees from Acandis GmbH: consultant (ongoing-1/2023), Microvention: consultant (2/2021-1/2023), Stryker: consultant (2/2021-1/2023), Novartis Pharma GmbH: consultant; speaker honorarium from Medtronic: (modest) ÖGNR Klagenfurt 11/2021; travel support from Microvention, Stryker, Medtronic.

AH: Grant HA 5399/5-1 by the German Research Society (DFG), funding by the Berta-Ottenstein-Programme for Advanced Clinician Scientists, Faculty of Medicine, University of Freiburg, Germany, not related to the submitted article. Honoraria for lectures by AMGEN and Bristol-Myers-Squibb.

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The reporting of results adheres to the STARD recommendations.

Ethical approval

The study was approved by the ethics committee of our institution (protocol number 306/10) and conformed to the Declaration of Helsinki.

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Schuchardt, F., Demerath, T., Lützen, N. et al. Risk factors for the development of secondary intracranial hypertension in acute cerebral venous thrombosis. Neuroradiology 65, 463–477 (2023). https://doi.org/10.1007/s00234-022-03091-9

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