Objective:

To study the outcome of CVT with hemorrhage compared to CVT without hemorrhage, and risk
factors for hemorrhage. Secondly, we assessed prevalence of antiphospholipid antibodies, and IgG
antibodies to spike protein of SARS CoV₂.

Background:

Cerebral venous thrombosis (CVT) is thrombosis of dural venous sinuses and/or cerebral veins,
leading to venous infarct ± hemorrhage. Mortality is reportedly higher in those with hemorrhagic
lesions.

Design/Methods:

Study was observational retrospective from Jan 2019 to August 2020; prospective from September
2020 to August 2021 with follow-up at 3 months. CVT was confirmed by CT venography or MRI
venography. Clinical data, imaging findings, presence of infarct, intracerebral hemorrhage, location
of lesions were collected. Outcome was death in hospital and at 90 days, functional outcome by
modified Rankin Scale (mRS) score at discharge and day 90.

Results:

We included 155 patients (40 retrospectively and 115 prospectively); Mean age-39.2 years, 66.5%
were men, 58.7% had subacute presentation (2-28 days), 8.4% had GCS < 8 at presentation. 70% -
Superior sagittal sinus thrombosis, 48.5% had ≥2 sinus involvement; 68/115(595) had hemorrhagic
lesions. Presence of seizures, weakness, language disturbances were more in Hemorrhagic group
(HG); while isolated raised ICT were common in Non-Hemorrhagic group (NHG). Analyzing 115
patients, no difference in no. of death between HG Vs NHG in-hospital & at day 90. At discharge,
those with poor outcome (mRS >3) was 42 (82.3%) vs 41 (64%) in HG vs NHG, p=0.037. At day 90,
the proportion with poor outcomes were similar: 20 (39%) vs 15 (23.4%), p=0.1. Prevalence of
Anticardiolipin IgM, IgG, anti-β2GP1 IgM, IgG was 43%, 32%, 2.6%, 1.7% respectively. IgG to SARS
CoV₂ spike protein was prevalent in 45% patients.

Conclusions:

The presence of hemorrhagic lesions was not associated with higher mortality but was associated
with poor outcome at discharge from hospital that became similar by 90 days.