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Background <p>The hyperdense sinus sign (HDSS) is a readily identifiable non-contrast CT marker of acute thrombus in cerebral venous sinus thrombosis (CVST). We aimed to characterize HDSS associated features and prognostic significance.</p> Methods <p>Data from prospective multicenter CVST registries was analysed. HDSS was defined as attenuation &gt; 70 Hounsfield units within a thrombosed venous structure. Baseline characteristics and outcomes were compared between patients with and without HDSS on admission CT. Multivariable logistic regression identified independent predictors of Excellent-Functional-Outcome (mRS 0–1) and remote seizures.</p> Results <p>Among 465 patients (mean age 41.9 ± 18.4&#xa0;years; 64.3% female), 178 (38.3%) exhibited HDSS. Patients with HDSS had higher rates of oral contraceptives use (28% vs 18%, p = 0.009), seizures at presentation (23% vs 14%, p = 0.015), superior sagittal (45% vs 35%, p = 0.028) and transverse sinus involvement (78% vs 67%, p = 0.01), deep venous thrombosis (8% vs 2%, p = 0.003), cortical vein thrombosis (19% vs 9%, p = 0.004), and multisite occlusion (34% vs 22%, p = 0.002). Parenchymal lesions were more common in HDSS patients, including intracerebral hemorrhage (27% vs 13%, p &lt; 0.001) and venous infarction (22% vs 11%, p = 0.004). On day-90, HDSS was associated with lower Excellent-Functional-Outcome rates (71% vs 82%, p = 0.022), higher rates of remote seizures (9% vs 3%, p = 0.001), and similar recanalization rates. HDSS independently predicted reduced odds of Excellent-Functional-Outcome (OR = 0.491 [0.261–0.926], p = 0.028) and increased remote seizures (OR = 2.693 [1.057–6.861], p = 0.038).</p> Conclusions <p>HDSS identifies a CVST subgroup with more extensive thrombosis, greater parenchymal injury, and poorer outcomes, supporting its utility in early risk stratification.</p>

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Admission hyperdense sinus sign predicts poorer outcomes in cerebral venous sinus thrombosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月7日

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  • Asaf Honig,
  • Ruth Eliahou,
  • Naaem Simaan,
  • Hen Hallevi,
  • Issa Metanis,
  • Rom Mendel,
  • Rani Barnea,
  • Eitan Auriel,
  • Jonathan Naftali,
  • Shorooq Aladdin,
  • David Orion,
  • Ronen R. Leker,
  • Jeremy Molad

摘要

Background

The hyperdense sinus sign (HDSS) is a readily identifiable non-contrast CT marker of acute thrombus in cerebral venous sinus thrombosis (CVST). We aimed to characterize HDSS associated features and prognostic significance.

Methods

Data from prospective multicenter CVST registries was analysed. HDSS was defined as attenuation > 70 Hounsfield units within a thrombosed venous structure. Baseline characteristics and outcomes were compared between patients with and without HDSS on admission CT. Multivariable logistic regression identified independent predictors of Excellent-Functional-Outcome (mRS 0–1) and remote seizures.

Results

Among 465 patients (mean age 41.9 ± 18.4 years; 64.3% female), 178 (38.3%) exhibited HDSS. Patients with HDSS had higher rates of oral contraceptives use (28% vs 18%, p = 0.009), seizures at presentation (23% vs 14%, p = 0.015), superior sagittal (45% vs 35%, p = 0.028) and transverse sinus involvement (78% vs 67%, p = 0.01), deep venous thrombosis (8% vs 2%, p = 0.003), cortical vein thrombosis (19% vs 9%, p = 0.004), and multisite occlusion (34% vs 22%, p = 0.002). Parenchymal lesions were more common in HDSS patients, including intracerebral hemorrhage (27% vs 13%, p < 0.001) and venous infarction (22% vs 11%, p = 0.004). On day-90, HDSS was associated with lower Excellent-Functional-Outcome rates (71% vs 82%, p = 0.022), higher rates of remote seizures (9% vs 3%, p = 0.001), and similar recanalization rates. HDSS independently predicted reduced odds of Excellent-Functional-Outcome (OR = 0.491 [0.261–0.926], p = 0.028) and increased remote seizures (OR = 2.693 [1.057–6.861], p = 0.038).

Conclusions

HDSS identifies a CVST subgroup with more extensive thrombosis, greater parenchymal injury, and poorer outcomes, supporting its utility in early risk stratification.