Abstract Background and aims To assess early imaging predictors of malignant course of cerebral vein and sinus thrombosis (CVST). Methods Patients admitted with a CVST underwent recurrent CT/MRI to monitor possible space-occupying edema and secondary intracerebral bleeding. Brain scans were scheduled upon admission, after 24 hours, 2 to 4 days and 4 to 7 days. The extent of cerebral edema and secondary bleeding was assessed in relation to the affected cerebral lobe and hemisphere: local ( 25%), partial (25-74%), complete (=75%). The functional outcome between 3 to 4.5 months served as outcome parameter assessed by the modified Rankin Scale. Cox regression was used for statistical analyses. Results We included 118 patients with cerebral vein (5) and sinus thromboses (113). Their mean age was 46.1 years (SD 18.5), 41 patients were men (34.7%). 54 patients (45.8%) showed some form of edema, 49 patients (41.1%) showed intracerebral hemorrhage. The overall outcome was good. 78 patients (66.1%) had no or no relevant functional deficit. 12 patients (10.2%) died or underwent craniotomy, and 6 patients (5.1%) were left with a severe deficit. The extent of edema in the brain scans performed within 24 hours after the onset of first symptoms (adjusted OR, 1.984; 95% CI, 1.050 to 3.748) and patients’ age (aOR, 1.121; CI 1.023 to 1.229) were predictors of a fatal or very severe clinical course, but not initial bleeding. Conclusions Presence and size of brain edema already within 24 hours of symptoms onset predict poor functional outcome in CVST. Conflict of interest Ferdinand Schüttoff: nothing to disclose
Schüttoff et al. (2026) studied this question.