Letter

Originally Published 16 July 2009

Delay in the Diagnosis of Cerebral Vein and Dural Sinus Thrombosis: Influence on Outcome

José M. Ferro, MD, PhD, Patrícia Canhão, MD, Jan Stam, MD, Marie-Germaine Bousser, MD, Fernando Barinagarrementeria, MD, Ayrton Massaro, MD, Xavier Ducrocq, MD, Scott E. Kasner, MD, and for the ISCVT InvestigatorsAuthor Info & Affiliations

Stroke

Volume 40, Number 9

https://doi.org/10.1161/STROKEAHA.109.553891

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Abstract

Background and Purpose— Diagnostic delay of cerebral vein and dural sinus thrombosis may have an impact on outcome.

Methods— In the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) cohort (624 patients with cerebral vein and dural sinus thrombosis), we analyzed the predictors and the impact on outcome of diagnostic delay. Primary outcome was a modified Rankin Scale score >2 at the end of follow-up. Secondary outcomes were modified Rankin Scale score 0 to 1 at the end of follow-up, death, and visual deficits (visual acuity or visual field).

Results— Median delay was 7 days (interquartile range, 3 to 16). Patients with disturbance of consciousness (P<0.001) and of mental status (P=0.042), seizure (<0.001), and with parenchymal lesions on admission CT/MR (P<0.001) were diagnosed earlier, whereas men (P=0.01) and those with isolated intracranial hypertension syndrome (P=0.04) were diagnosed later. Between patients diagnosed earlier and later than the median delay, no statistically significant differences were found in the primary (P=0.33) and in secondary outcomes: modified Rankin Scale score 0 to 1 (P=0.86) or deaths (P=0.53). Persistent visual deficits were more frequent in patients diagnosed later (P=0.05). In patients with isolated intracranial hypertension syndrome, modified Rankin Scale score >2 at the end of follow-up was more frequent in patients diagnosed later (P=0.02).

Conclusions— Diagnostic delay was considerable in this cohort and was associated with an increased risk of visual deficit. In patients with isolated intracranial hypertension syndrome, diagnostic delay was also associated with death or dependency.

The identification of variables that delay the diagnosis of cerebral vein and dural sinus thrombosis (CVT) is of clinical and medicolegal relevance. Two previous studies^1,2 identified clinical variables associated with admission delay, but could not demonstrate an influence of admission delay on outcome. The purposes of this study were to describe the delay in the diagnosis of CVT and to analyze its predictors and its influence on the outcome of a large cohort of patients with CVT.

Methods

Diagnostic delay was defined as the interval (days) between the onset of symptoms (day of first symptom judged to be related to CVT by the investigator) and the confirmation of CVT by MR and/or angiography. We also measured the interval (days) between onset of symptoms and hospital admission (first hospital). Early admission was defined as an admission delay below the median of the sample.

We used the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) cohort consisting of 624 consecutive symptomatic patients with CVT with a mean follow-up of 478 days.³ Follow-up visits were performed at 6 and12 months and yearly thereafter.

The primary outcome was death or dependency defined as a modified Rankin Scale score (mRS) >2 at end of follow-up. Secondary outcomes were all deaths, complete recovery (mRS 0 to 1) at the end of follow-up, and any persistent visual deficit related to CVT (decreased visual acuity or visual field defect) at final follow-up. Confrontation testing of visual fields and measurement of visual acuity were recommended at each follow-up, but perimetry was optional.

We compared diagnostic delay for potential explanatory and confounding variables listed in Table 1.

Table 1. Association Between Diagnostic Delay and Potential Predictors

Variable	Days Between Onset and Diagnosis								P
	<4		4–7		8–16		>16
	n	Percent	n	Percent	n	Percent	n	Percent
Age
<37 years	91	29.2	80	25.6	73	23.4	68	21.8	0.069
≥37 years	74	23.8	79	25.4	77	24.8	81	26.0
Gender
Female	130	28.0	121	26.1	115	24.8	98	21.1	0.014
Male	35	22.0	38	23.9	35	22.0	51	32.1
Center
European	142	29.3	122	25.2	114	23.5	107	22.1	0.006
North-American	15	22.1	19	27.9	19	27.9	15	22.1
South-American	7	12.1	15	25.9	14	24.1	22	37.9
High GNI^*	148	29.1	128	25.2	118	23.2	114	22.4	0.013
Medium-low GNI^*	17	14.8	31	27.0	32	27.8	35	30.4
<10 patients	80	31.7	56	22.2	61	24.2	55	21.8	0.104
≥10 patients	85	22.9	103	27.8	89	24.0	94	25.3
Referred^†
Yes	79	28.1	76	27.0	56	24.0	70	25.3	0.826
No	83	25.2	83	24.6	91	27.0	78	23.1
Intra-arterial angiography for diagnosis
Yes	36	24.8	32	22.1	39	26.9	38	26.2	0.225
No	129	27.0	127	26.6	111	23.2	111	23.2
Headache
Yes	142	31.9	145	26.2	132	23.9	134	24.2	0.553
No	22	31.9	14	20.3	18	26.1	15	21.7
Isolated headache
Yes	16	29.6	13	24.1	13	24.1	12	22.2	0.539
No	148	26.1	146	25.7	137	24.2	136	24.0
Papilledema
Yes	21	12.1	32	18.4	54	31.0	67	38.5	0.001
No	140	31.9	125	28.5	95	21.6	79	18.0
IIHS
Yes	33	23.1	29	20.3	40	28.0	41	28.7	0.035
	no	132	27.5	130	27.1	110	22.9	108	22.5
GCS 14–15
Yes	114	23.6	119	24.6	126	26.1	124	25.7	0.001
No	43	37.7	34	29.8	21	18.4	16	14.0
GCS <9
Yes	14	45.2	6	19.4	5	16.1	6	19.4	0.045
No	143	25.3	147	26.0	142	25.1	134	13.7
Mental disturbance
Yes	38	27.7	49	35.8	24	17.5	26	19.0	0.042
No	127	26.1	110	22.6	126	25.9	123	25.3
Seizure
Yes	81	33.1	70	28.6	54	22.0	40	16.3	0.001
No	84	22.2	89	23.5	96	25.4	109	28.8
Motor deficit
Yes	67	28.9	66	28.4	52	22.4	47	20.3	0.061
No	98	25.1	93	23.8	98	25.1	102	26.1
(Continued)

Table 1. Continued

Variable	Days Between Onset and Diagnosis								P
	<4		4–7		8–16		>16
	n	Percent	n	Percent	n	Percent	n	Percent
Note. Percent is within condition (yes or no) of variable in each quartile of delay.
*World Bank categories.
†Patients referred from other hospitals versus patients coming directly to the participating hospital.
IIHS indicates isolated intracranial hypertension syndrome; GCS, Glasgow Coma Score; GNI, gross national income.
Aphasia
Yes	31	26.1	33	27.7	23	19.3	32	26.9	0.930
No	134	26.2	126	25.0	127	25.2	117	23.2
Sensory loss
Yes	8	23.5	7	20.6	8	23.5	11	32.4	0.197
No	157	26.7	152	25.8	142	24.1	138	23.4
Brain lesion
Yes	118	30.2	113	28.9	82	21.0	78	19.9	0.001
No	47	20.3	46	19.9	67	29.9	71	30.7
Venous infarct
Yes	92	31.7	89	30.7	57	19.7	52	17.9	0.001
No	73	22.0	70	21.1	92	27.7	97	29.2
Hemorrhagic lesion
Yes	67	27.5	67	27.5	52	21.3	58	23.8	0.232
No	98	25.9	92	24.3	97	25.7	91	24.1
Occlusion of multiple sinuses
Yes	84	26.9	80	25.6	70	22.4	78	25.0	0.860
No	80	25.8	79	25.5	80	25.8	71	22.9

We used nonparametric statistics (median and quartile distribution, Mann-Whitney U and Kruskal-Wallis tests). We performed the following subgroup analysis: (1) low CVT risk score (<3) and high risk (CVT risk score ≥3) patients⁴; (2) patients presenting as isolated intracranial hypertension syndrome; (3) patients in coma (Glasgow Coma Score <9); (4) patients with brain lesions on admission CT/MR; and (5) patients who were anticoagulated in therapeutical dosages after the diagnosis of CVT. Additionally, we performed logistic regression for the primary outcome, forcing diagnostic delay in the ISCVT prognostic model, considering the interactions with unbalanced predictors.

Results

There were 623 valid cases for analysis with information on onset to diagnosis delay. The median delay was 7 days and the interquartile range 3 to 16 days. The distribution showed a strong left-sided skew (skewness=11.36). There were 619 patients with valid information on admission delay. The median admission delay was 4 days and the interquartile range 1 to 11 days.

Early admission was associated with higher gross national income (P=0.02), disturbance of consciousness (P=0.001), mental disturbance (P=0.03), seizure (P=0.001), motor deficit (P=0.02), and parenchymal lesion on admission CT/MR (P=0.001).

Diagnostic Delay

Median delay (interquartile range) was 9 days (5 to 18) for countries with low-middle gross national income per capita and 7 days (3 to 15) for countries with high gross national income per capita (P=0.013). Diagnostic delay was decreased females and in patients with decreased vigilance, mental disturbance, seizure, and venous infarct on admission CT/MR. There were no significant differences in diagnostic delay in relation to age, centers with <10 patients, patients referred from other centers and patients requiring intra-arterial angiography for diagnosis, focal deficits (motor, sensory or language), the number or site of thrombosed sinus and veins, and any of the associated conditions or risk factors. Diagnostic delay was longer in patients with papilledema and isolated intracranial hypertension syndrome. More patients with diagnostic delay above the median were not prescribed anticoagulants in therapeutic dosages: 11% (22.4% versus 11.4%, χ²=13.5, P<0.001).

No statistically significant differences were found in the primary outcome and in secondary outcomes: mRS 0 to 1 or death. Persistent visual loss (visual field defects in 6 patients and decreased visual acuity in 21 patients; median visual acuity in right and left eyes 8 of 10; range, 9.5 to 5.5 of 10) was more frequent in patients diagnosed later (Table 2). We performed logistic regression with mRS >2 at final follow-up as the outcome and the variables of the ISCVT prognostic model and diagnostic delay as predictors. Diagnostic delay was not retained in the model either when dichotomized in below/above the median (P=0.056; adjusted OR, 0.60; 95% CI, 0.35 to 1.01) or when quartiles were considered (P=0.24; adjusted OR, 0.87; 95% CI, 0.69 to 1.10).

Table 2. Delay in Diagnosis of CVT and Outcome

Outcome^*	Days Between Onset and Diagnosis								P^†
	<4		4–7		8–16		>16
	n	Percent	n	Percent	n	Percent	n	Percent
Note. Percent is within condition (yes or no) of variable in each quartile of delay.
*At the end of follow-up.
†Kruskal-Wallis test.
mRS >2
Yes	26	30.6	15	17.6	21	24.7	23	27.1	0.329
No	139	25.8	144	26.8	129	24.0	126	23.4
mRS 0–1
Yes	128	26.0	129	26.2	119	24.2	116	23.6	0.858
No	37	28.2	30	22.9	31	23.7	33	25.2
Death
Yes	15	28.8	10	19.2	16	30.8	11	21.2	0.526
No	150	26.3	149	26.1	134	23.5	138	24.2
Visual deficit
Yes	3	11.1	7	25.9	5	18.5	12	44.4	0.049
No	162	27.2	152	25.5	145	24.3	137	23.0

Subgroup Analysis

Diagnostic delay was significantly associated with visual loss in patients with isolated intracranial hypertension syndrome and in the low CVT risk score subgroups (Table 3). In patients with isolated intracranial hypertension syndrome, poor outcome was significantly more frequent in patients with longer diagnostic delay.

Table 3. Delay in Diagnosis of CVT and Outcome: Subgroup Analysis

Subgroup Outcome*	Days Between Onset and Diagnosis								P†
	<4		4–7		8–16		>16
	n	Percent	n	Percent	n	Percent	n	Percent
Isolated intracranial hypertension syndrome
mRS >2
Yes	0	0	1	10.0	2	20.0	7	70.0	0.022
No	33	24.8	28	21.1	38	28.6	34	25.6
mRS 0–1
Yes	31	24.0	28	21.7	37	28.7	33	25.6	0.093
No	2	14.3	1	7.1	3	21.4	8	57.1
Death
Yes	0	0	0	0	2	33.3	4	66.7	0.117
No	33	24.1	29	21.2	38	27.7	37	27.0
Visual deficit
Yes	2	16.7	1	8.3	1	8.3	8	66.7	0.023
No	31	23.7	28	21.4	39	29.8	33	25.2
Coma on admission
mRS >2
Yes	7	58.3	3	25.0	2	16.7	0	0	0.194
No	7	36.8	3	15.8	3	15.8	6	31.6
mRS 0–1
Yes	5	38.5	2	15.4	2	15.4	4	30.8	0.602
No	9	50.0	4	22.2	3	16.7	2	11.1
Death
Yes	6	54.5	3	27.3	2	18.2	0	0	0.252
No	8	40.0	3	15.0	3	15.0	6	30.0
Visual deficit
Yes	0	0	0	0	0	0	0	0	1.00
No	14	45.2	6	19.4	5	16.1	6	19.4	no
Low-risk patients (CVT risk score <3)
mRS >2
Yes	17	28.8	9	15.3	16	27.1	17	28.8	0.352
No	123	25.3	125	25.7	124	25.5	114	23.5
mRS 0–1
Yes	113	25.3	113	25.3	114	25.5	107	23.9	0.876
No	27	27.6	21	21.4	26	26.5	24	24.5
Death
Yes	8	22.9	5	14.3	1	34.3	10	28.6	0.373
No	132	25.9	129	25.3	128	25.1	121	23.7
Visual deficit
Yes	3	11.5	6	23.1	5	25.1	12	42.5	0.043
No	137	26.4	128	24.7	133	26.0	11	22.9
High-risk patients (CVT risk score ≥3)
mRS >2
Yes	9	34.6	6	23.1	5	19.2	6	23.1	0.426
No	15	30.6	18	36.7	4	8.2	12	24.5
mRS 0–1
Yes	14	33.3	15	35.7	4	9.5	9	21.4	0.753
No	10	30.3	9	27.3	5	15.2	9	27.3
Death
Yes	7	41.2	5	29.4	4	23.5	1	5.9	0.112
No	17	29.3	19	32.8	5	8.6	17	29.3
Visual deficit
Yes	0	0	1	100.0	0	0	0	0	0.547
No	24	32.4	23	31.1	9	12.2	18	24.3
(Continued)

Table 3. Continued

Subgroup Outcome^*	Days Between Onset and Diagnosis								P^†
	<4		4–7		8–16		>16
	n	Percent	n	Percent	n	Percent	n	Percent
Note. Percent is within condition (yes or no) of variable in each quartile of delay.
*At the end of follow-up.
†Kruskal-Wallis test.
Brain lesion on admission CT/MR
mRS >2
Yes	25	36.8	14	20.6	15	22.1	14	20.6	0.361
No	93	28.8	99	30.7	67	20.7	64	19.8
mRS 0–1
Yes	86	29.9	88	30.6	58	20.1	56	19.4	0.666
No	32	31.1	25	24.3	24	23.3	22	21.4
Death
Yes	14	35.0	10	25.0	11	27.5	5	12.5	0.438
No	104	29.6	103	29.3	71	20.2	73	20.8
Visual deficit
Yes	3	20.0	5	33.3	4	26.7	3	20.0	0.830
No	115	30.6	108	28.7	78	20.7	75	19.9
On therapeutic anticoagulation
mRS >2
Yes	24	36.4	11	16.7	15	22.7	16	24.2	0.182
No	124	27.4	128	28.3	107	23.6	94	20.8
mRS 0–1
Yes	115	27.9	113	27.4	99	24.0	25	6.1	0.778
No	33	30.8	26	24.3	23	21.5	25	23.4
Death
Yes	15	36.6	7	17.1	10	24.4	9	22.0	0.457
No	133	27.8	132	27.6	112	23.4	101	21.1
Visual deficit
Yes	3	12.0	7	28.0	5	20.0	4	40.0	0.071
No	145	29.4	132	26.7	117	23.7	97	20.2

No significant differences for any of the outcomes were detected in the other subgroup analysis (Table 3).

Discussion

In this multicenter cohort, the median interval between onset of symptoms and confirmation of CVT diagnosis was 7 days. Patients with more severe clinical presentations, women, and patients in high-income countries tend to be diagnosed earlier. In the overall sample, diagnostic delay had no influence on death or dependency or complete recovery. However, diagnostic delay was associated with an increased risk of poor outcome and of visual deficit in patients presenting with a syndrome of isolated increased intracranial hypertension.

Although visual acuity and confrontation testing of the visual fields were performed in the majority of the patients with visual complaints, information on visual acuity was not always recorded by the investigators and its frequency is probably underestimated. A standardized evaluation of visual consequences of CVT would require formal neuro-ophthalmological examination. We used a pragmatic approach considering any objective visual deficit not explained by an ocular cause as CVT-related. Another limitation of the research on diagnostic delay in CVT is the difficulty in establishing the onset of symptoms in patients with subacute or chronic presentations. This is certainly subject to considerable interexaminer variation, which was not studied in our investigation. Results of this study cannot be generalized to world regions that did not participate or were underrepresented in ISCVT such as Africa or Asia. Median admission delay and predictors of admission delay were consistent with the findings of the 2 previous studies with smaller sample sizes.^1,2

Early diagnosis is more likely to have a favorable influence in outcome if an intervention has increased efficacy if applied earlier. There are no studies analyzing the influence on outcome of the delay on starting anticoagulation. Starting treatment earlier in patients with good initial condition may prevent pulmonary embolism and thrombus progression. Local thrombolysis, hematoma evacuation, or hemicraniectomy were used in a minority of patients in serious condition who, as we have shown, tend to present and be diagnosed earlier.

Acknowledgments

We thank the investigators who participated in the ISCVT. Their names and centers are listed in reference ³.

Sources of Funding

This study was supported by grants from the “Fundação para a Ciência e Tecnologia” PRAXIS C/SAU/10248/1998 and the “Associação para o Desenvolvimento da Investigação da Doença Vascular Cerebral.”

Disclosures

None.

References

Ferro JM, Lopes MG, Rosas MJ, Fontes J; for the VENOPORT Investigators. Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 2005; 19: 152–156.

Crossref

PubMed

Google Scholar

de Bruijn SFTM, de Haan RJ, Stam J; for the Cerebral Venous Thrombosis Study Group. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. J Neurol Neurosurg Psychiatry. 2001; 70: 105–108.

Crossref

PubMed

Google Scholar

Ferro JM, Canhão P, Stam J, Bousser M-G, Barinagarrementeria F; for the ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004; 35: 664–670.

Crossref

PubMed

Google Scholar

Ferro JM, Rodrigues T, Bacelar-Nicolau L, Bacelar-Nicolau H, Canhão P, Crassard I, Dutra A, Massaro A, Mackowiak-Cordiolani MA, Leys D, Fontes J. Development of a risk score to predict the prognosis of cerebral vein and dural sinus thrombosis (CVT). Cerebrovasc Dis. 2007; 23 (suppl 2): 141.

Google Scholar

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On the cover: The illustration (the author’s own reconstruction of Marlowe’s carotid artery wound) is taken from an article in this issue, “Reflections on the Carotid Artery: 438 BC to 2009 AD: The Karolinska 2008 Award Lecture in Stroke Research” by Barnett (Stroke. 2009;40:3143–3148).

Stroke

Volume 40 • Number 9 • 1 September 2009

Pages: 3133 - 3138

PubMed: 19608994

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Received: 2 April 2009

Accepted: 8 May 2009

Published online: 16 July 2009

Published in print: 1 September 2009

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Authors

Affiliations

José M. Ferro, MD, PhD

From the Department of Neurology (J.M.F., P.C.), Hospital Santa Maria, University of Lisboa, Lisboa, Portugal; the Academic Medical Centre (J.S.), Amsterdam, The Netherlands; Hôpital Lariboisière (M.G.B.), Paris, France; Instituto Nacional de Neurologia y Neurocirurgia (F.B.), México City, México; Hospital das Clínicas (A.M.), Universidade de São Paulo, São Paulo, Brazil; Hôpital Central (X.D.), Nancy, France; and the University of Pennsylvania Medical Center (S.E.K.), Philadelphia, Pa.

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Patrícia Canhão, MD

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Jan Stam, MD

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Marie-Germaine Bousser, MD

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Fernando Barinagarrementeria, MD

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Ayrton Massaro, MD

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Xavier Ducrocq, MD

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Scott E. Kasner, MD

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for the ISCVT Investigators

Notes

Correspondence to José M. Ferro, MD, PhD, Department of Neurology, Hospital Santa Maria, 1649-035 Lisboa, Portugal. E-mail [email protected]

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- Nikhil Vojjala,
- Supriya Peshin,
- Jayalekshmi Jayakumar,
- Nikhil Kotla,
- Adit Dharia,
- Mamtha Balla,
- Geetha Krishnamoorthy,
Re-optimizing the Time Frame for Classifying Cerebral Venous Sinus Thrombosis: An Unmet Need, Cureus, (2024).https://doi.org/10.7759/cureus.75951
Crossref
- Rahul S Patil,
- Ahsan A Faruqi,
A Case Report of Simultaneous Intracranial Hemorrhage and Cerebral Venous Sinus Thrombosis in a Young Indian Male: Diagnostic and Therapeutic Challenges, Cureus, (2024).https://doi.org/10.7759/cureus.55642
Crossref
- Aaisha Mohammed Rafi,
- Karuna Khan,
- Ammar Alomar,
- Aya AlSayyad,
- Nahla Yousef,
Lower cranial neuropathy as a presentation of cerebral venous sinus thrombosis secondary to antiphospholipid syndrome: A case report, International Journal of Case Reports and Images, 15, 1, (30-35), (2024).https://doi.org/10.5348/101440Z01AR2024CR
Crossref
- Zeina Waheed,
- Thalia S. Field,
- Lily W. Zhou,
Health Care Encounters Prior to Hospitalization for Cerebral Venous Thrombosis Patients, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 52, 2, (225-231), (2024).https://doi.org/10.1017/cjn.2024.48
Crossref
- Ali Namjoo-Moghadam,
- Vida Abedi,
- Venkatesh Avula,
- Nahid Ashjazadeh,
- Etrat Hooshmandi,
- Niloufar Abedinpour,
- Zahra Rahimian,
- Afshin Borhani-Haghighi,
- Ramin Zand,
Machine learning-based Cerebral Venous Thrombosis diagnosis with clinical data, Journal of Stroke and Cerebrovascular Diseases, 33, 9, (107848), (2024).https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107848
Crossref
- Jessica A. Sun,
- Tais Estrela,
- Ryan Gise,
Clinical Course and Visual Outcomes of Papilledema in Pediatric Cerebral Venous Sinus Thrombosis, American Journal of Ophthalmology, 263, (126-132), (2024).https://doi.org/10.1016/j.ajo.2024.02.001
Crossref
- Florian F. Schuchardt,
- Niklas Lützen,
- Sebastian Küchlin,
- Michael Reich,
- Wolf A. Lagrèze,
- Hansjörg Mast,
- Matthias Weigel,
- Stephan Meckel,
- Horst Urbach,
- Cornelius Weiller,
- Andreas Harloff,
- Theo Demerath,
Clinical value of neuroimaging indicators of intracranial hypertension in patients with cerebral venous thrombosis, Neuroradiology, 66, 7, (1161-1176), (2024).https://doi.org/10.1007/s00234-024-03363-6
Crossref
- Beatrice E Torere,
- Joseph Weigold,
- Henry O Aiwuyo,
- Gabriel Alugba,
- Olanipekun Ntukidem,
- Jiahuai Tan,
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Crossref
- Xuan Lu,
- Cao Yan,
- Hui Chen,
- Xiaochuan Wu,
Analysis of 6 pediatric nephrotic syndrome cases with complications of cerebral sinovenous thrombosis and literature review, Frontiers in Pediatrics, 11, (2023).https://doi.org/10.3389/fped.2023.1226557
Crossref
- Ava L. Liberman,
Diagnosis and Treatment of Cerebral Venous Thrombosis, CONTINUUM: Lifelong Learning in Neurology, 29, 2, (519-539), (2023).https://doi.org/10.1212/CON.0000000000001211
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Delay in the Diagnosis of Cerebral Vein and Dural Sinus Thrombosis

Stroke

Vol. 40
No. 9

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Stroke

Vol. 40
No. 9

Delay in the Diagnosis of Cerebral Vein and Dural Sinus Thrombosis: Influence on Outcome

Abstract

Methods

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Diagnostic Delay

Subgroup Analysis

Discussion

Acknowledgments

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Comment Response

Abstract

Methods

Results

Diagnostic Delay

Subgroup Analysis

Discussion

Acknowledgments

References

eLetters(0)

Information

Published In

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History

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Keywords

Authors

Affiliations

Notes

Metrics

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