# Distinct long-term neurological trajectories and their predictors in cerebral venous sinus thrombosis: a latent class mixed model analysis

## TL;DR

This study identifies two distinct recovery patterns in patients with cerebral venous sinus thrombosis and finds that age and venous collateral circulation are key predictors of long-term outcomes.

## Contribution

The study introduces a novel use of latent class mixed models to identify distinct neurological recovery trajectories in CVST patients.

## Key findings

- Two distinct recovery trajectories were identified in CVST patients: 'Poor-Recovery' and 'Favorable-Recovery'.
- Older age and poor venous collateral circulation were strong predictors of the 'Poor-Recovery' trajectory.
- Younger patients with better collateral circulation showed rapid and near-complete recovery.

## Abstract

The long-term neurological recovery of patients with cerebral venous sinus thrombosis (CVST) exhibits significant heterogeneity, and the mechanisms underlying these distinct trajectories remain poorly understood.

This study aimed to identify distinct long-term trajectories of functional outcome in CVST patients and to investigate their baseline predictors.

In a longitudinal cohort of 127 CVST patients with complete follow-up data, we employed latent class mixed models (LCMM) to analyze repeated measures of the modified Rankin Scale (mRS) over time. The optimal number of trajectory classes was determined using established information criteria. Multivariable logistic regression was then used to identify baseline factors independently associated with class membership.

A two-trajectory model best characterized the heterogeneity in long-term outcomes. Class 1 (the “Poor-Recovery” Class, n = 66, 52%) was characterized by older age, poorer venous collateral circulation, higher D-dimer levels, more severe initial brain parenchymal changes, and a slower, incomplete functional recovery. Class 2 (the “Favorable-Recovery” Class, n = 61, 48%) consisted of younger patients with better collateral circulation and a rapid, near-complete recovery. Multivariable analysis confirmed that increasing age [odds ratio (OR): 1.11 per year, 95% confidence interval (CI): 1.06–1.18, p = 0.0001] was an independent risk factor, while a higher venous collateral circulation score (indicating better collateral function; OR: 0.255 per point, 95% CI: 0.108–0.540, p = 0.0008) was a strong protective factor against belonging to the “Poor-Recovery” class.

CVST patients follow one of two distinct long-term functional trajectories, which are predominantly driven by age and the status of the venous collateral circulation. These findings provide a mechanism-based framework for prognosis and highlight the potential for early risk stratification, paving the way for more personalized patient management.