Introduction:
The majority of data describing Cerebral Venous Sinus Thrombosis (CVST) patients has been collected outside the United States (U.S.). Females are reported at higher incidence with more favorable outcomes. Available U.S. data have poor representation of the Appalachian region, which has a higher burden of chronic disease and lower socioeconomic level. The objective of this study was to examine the sex-based characteristics of an Appalachian CVST cohort.
Methods:
Data were collected in a retrospective cohort using the Kentucky Appalachian Stroke Registry (KApSR), from admissions in a comprehensive stroke center serving 554,300 from the Appalachian region. Patients 18 years and older diagnosed with CVST from 2010-2018 were retrieved via International Classification of Diseases 9 and 10 codes. Secondary analysis by review of patient records was performed to screen for inclusion criteria and acquire additional data points.
Results:
Fifty-eight patients met inclusion criteria and 35(60%) were female. Twenty-three (40%) (15F 8M) had Kentucky Medicaid as primary insurance. At least one comorbidity was documented in 44(76%) (26F 18M) and 32(55%) (17F 13M) had 2 or more comorbidities. Headache was the most common presenting complaint, present in 33(56%) (19F 14M) with 8 (5F 3M) absent symptoms other than headache. Those with headache were more likely to have multi-sinus involvement OR 7.9 (1.9-32.7). Abnormal neurological exam was documented at admission in 36(64%) (20F 16M). Infarct was present in 19(32%) (11F 8M) hemorrhage in 3(1F 2M). Those with infarct were more likely to have superior sagittal involvement OR 3.6 (1.1 - 12.0). The National Institutes of Health Stroke Scale (NIHSS) was administered to 43(25F 18M) patients. Median NIHSS was 2.0 at admission, 0.5 at discharge and 19 (13F 6M) recorded an NIHSS >2 at admission. Median length of stay was 6 days. Thirty-nine patients (67%) (20F 19M) were routinely discharged to home vs hospice, skilled nursing facility, long term care or death. Female patients were less likely to be discharged to home OR 0.3 (0.1-0.9).
Conclusion:
The results suggest a high burden of comorbid disease among CVST patients in the Appalachian region. This may explain the worse prognosis of female patients in this cohort.
Cerebral venous sinus thrombosis after resolution of COVID-19 in a non-hospitalised patient
