ArticleJournal of neurology2026
Admission hyperdense sinus sign predicts poorer outcomes in cerebral venous sinus thrombosis.
Article in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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13 authors.
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Abstract
backgroundThe 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.
methodsData 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.
resultsAmong 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).
conclusionsHDSS identifies a CVST subgroup with more extensive thrombosis, greater parenchymal injury, and poorer outcomes, supporting its utility in early risk stratification.
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