ABSTRACT NUMBER: ESOC2026A2344 ADVANCED ADMISSION CT MARKERS AS PREDICTORS OF PROGNOSIS IN CEREBRAL VENOUS SINUS THROMBOSIS

Abstract Background and aims Venous infarction and intracerebral hemorrhage are well-established prognostic factors in cerebral sinus vein thrombosis (CSVT). However, the prognostic significance of other subtle imaging markers has not yet been investigated. This study aims to assess whether the hyperdense sinus sign (HDSS), non-functional transverse sinus (NFTS), and involvement of the confluence of sinuses (COSI) are associated with CSVT prognosis. Methods Data from prospective multicenter CVST registries were analyzed. HDSS was defined as an attenuation greater than 70 Hounsfield units within a thrombosed venous structure. NFTS was defined as a non-thrombosed transverse sinus with severe luminal reduction compared with the contralateral side. Multivariable logistic regression was used to identify independent predictors of excellent functional outcome (mRS 0–1) and remote seizures. Results Among 465 patients (age 41.9±18.4 years; 64.3% female), 178 (38.3%) exhibited HDSS, 49 (11%) had NFTS and 154 (33%) had COS involvement. HDSS independently predicted reduced odds of Excellent-Functional-Outcome (OR 0.50, 95% CI 0.26–0.97, p=0.04) and increased risk of remote seizures (OR 2.54, 95% CI 1.01–6.42, p=0.048). Among patients with transverse/sigmoid sinus thrombosis, contralateral NFTS (OR 4.37 [1.5–13]) independently predicted non-excellent outcome. COS was associated with poorer outcomes in univariate analysis but did not remain significant in multivariable analysis. Conclusions Both HDSS and NFTS identify subgroups of patients with CSVT who experience poorer outcomes, supporting their potential value for early risk stratification. HDSS may reflect a more extensive and rapidly progressive thrombus burden, whereas NFTS may contribute to compromised cerebral venous drainage in CSVT. Conflict of interest All authors have no relevant disclosures.