Predictors and Outcome of Cerebral Venous Sinus Thrombosis Requiring Mechanical Ventilation

Background: The patients with cerebral venous thrombosis (CVT) having raised intracranial pressure and seizures require admission to the intensive care unit (ICU). We report the outcomes of ICU admitted CVT patients, and compare the in-hospital death and 3-months disability between mechanically ventilated (MV) and non-MV groups. Methods: Forty-five CVT patients admitted to ICU were included. Their clinical details, MRI and MRV findings were noted. The patients were intubated based on arterial blood gas analysis. All the patients received heparin followed by an oral anticoagulant. In-hospital death and functional outcomes at 3 months were recorded. Results: 18/45 (40%) CVT patients required MV for a median of 6.5 (1-15) days. 9(20%) patients died; MV group had an insignificantly higher deaths compared to non-MV group [2(27%) vs 4(14.8%); P=0.45]. On Cox regression analysis, the GCS score independently predicted death (adjusted hazard ratio 0.75; 95% CI 0.59-.0.96; P=0.02) but not MV (HR 1.78; 95%CI0.47-6.77; P=0.39). Amongst the survivors, 30(85.7%) had a good outcome which was comparable between the two groups. Conclusion: 40% of CVT patients in ICU require MV. The overall mortality is 20%, and 85.7% of patients have a good outcome at 3 months, which is comparable between MV and non-MV groups.