Thai Venous Stroke Prognostic Score: TV-SPSS
Niphon Poungvarin MD, FRCP*, Naraporn Prayoonwiwat MD*, Disya Ratanakorn MD**, Somchai Towanabut MD***, Tassanee Tantirittisak MD***, Nijasri Suwanwela MD****, Kamman Phanthumchinda MD****, Somsak Tiamkoa MD*****, Siwaporn Chankrachang MD******, Samart Nidhinandana MD*******, Somsak Laptikultham MD********, Sansern Limsoontarakul MD*, Suthipol Udomphanthuruk MSc*
Affiliation : * Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *** Neurological Unit, Prasat Neurological Institute, Bangkok, Thailand **** Neurological Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ***** Neurological Unit, Department of Medicine, Faculty of Medicine, Srinakarind Hospital, Khon Khen University, Khon Khen, Thailand ****** Division of Neurology, Department of Medicine, Faculty of Medicine, Maharaj Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand ******* Division of Neurology, Department of Medicine, Faculty of Medicine, Pramongkutklao Hospital, Bangkok, Thailand ******** Neurological Unit, Rajavithi Hospital, Bangkok, Thailand
Background and Objective : Prognosis of cerebral venous sinus thrombosis (CVST) has never been studied in
Thailand. A simple prognostic score to predict poor prognosis of CVST has also never been reported. The
authors are aiming to establish a simple and reliable prognostic score for this condition.
Material and Method: The medical records of CVST patients from eight neurological training centers in
Thailand who received between April 1993 and September 2005 were reviewed as part of this retrospective
study. Clinical features included headache, seizure, stroke risk factors, Glasgow coma scale (GCS), blood
pressure on arrival, papilledema, hemiparesis, meningeal irritation sign, location of occluded venous sinuses,
hemorrhagic infarction, cerebrospinal fluid opening pressure, treatment options, length of stay, and other
complications were analyzed to determine the outcome using modified Rankin scale (mRS). Poor prognosis
(defined as mRS of 3-6) was determined on the discharge date.
Results : One hundred ninety four patients’ records, 127 females (65.5%) and mean age of 36.6 + 14.4 years,
were analyzed. Fifty-one patients (26.3%) were in the poor outcome group (mRS 3-6). Overall mortality was
8.4%. Univariate analysis and then multivariate analysis using SPSS version 11.5 revealed only four statistically
significant predictors influencing outcome of CVST. They were underlying malignancy, low GCS, presence of
hemorrhagic infarction (for poor outcome), and involvement of lateral sinus (for good outcome). Thai venous
stroke prognostic score (TV-SPSS) was derived from these four factors using a multiple logistic model.
Conclusion : A simple and pragmatic prognostic score for CVST outcome has been developed with high
sensitivity (93%), yet low specificity (33%). The next study should focus on the validation of this score in other
prospective populations.
Keywords : Venous Stroke, Cerebrovascular Disease, Prognosis
