51
|
Svart K, Jensen RH, Høgedal L, Vukovic-Cvetkovic V, Beier D, Korsbæk JJ. Phenotyping non-idiopathic pseudotumor cerebri syndrome - A prospective cohort study. Cephalalgia 2022; 42:1510-1520. [PMID: 35983777 DOI: 10.1177/03331024221120073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify the most frequent causes of secondary pseudotumor cerebri syndrome and compare phenotype, clinical presentation, and symptoms of secondary pseudotumor cerebri syndrome to the primary form of pseudotumor cerebri syndrome, idiopathic intracranial hypertension. METHODS The study was a prospective cohort study including patients with new-onset pseudotumor cerebri syndrome. Diagnostic work up was standardized. Patients were diagnosed with secondary pseudotumor cerebri syndrome or idiopathic intracranial hypertension according to the revised Friedman criteria. Secondary pseudotumor cerebri syndrome patients were categorized into five causes: medication, systemic causes, sleep apnea, cerebrovascular causes, and several competing causes. Phenotype, clinical presentation, symptoms and neuroimaging were compared between groups. RESULTS Out of 278 cases, 28 secondary pseudotumor cerebri syndrome and 120 idiopathic intracranial hypertension patients were included. The most frequent causes of secondary pseudotumor cerebri syndrome were medication (n = 8, 28.6%) and systemic causes (n = 8, 28.6%), followed by sleep apnea (n = 5, 17.9%), cerebrovascular causes (n = 4, 14.3%) and several competing causes (n = 3, 10.7%). Secondary pseudotumor cerebri syndrome and idiopathic intracranial hypertension patients were phenotypically alike and predominately female, premenopausal, and obese. Symptoms and objective findings at disease onset were similar between groups. CONCLUSION Secondary pseudotumor cerebri syndrome should be considered in all patients with suspected pseudotumor cerebri syndrome as secondary pseudotumor cerebri syndrome and idiopathic intracranial hypertension patients are phenotypically and clinically alike. A thorough diagnostic workup is needed as treatment of idiopathic intracranial hypertension and secondary pseudotumor cerebri syndrome is markedly different.
Collapse
Affiliation(s)
- Katrine Svart
- Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Høgedal
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Dagmar Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Johanne Juhl Korsbæk
- Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, Denmark.,University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
52
|
Early isolated subarachnoid hemorrhage versus hemorrhagic infarction in cerebral venous thrombosis. Radiol Oncol 2022; 56:303-310. [PMID: 35962950 PMCID: PMC9400440 DOI: 10.2478/raon-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a rare cerebral vascular disease, the presentation of which is highly variable clinically and radiologically. A recent study demonstrated that isolated subarachnoid hemorrhage (iSAH) in CVT is not as rare as thought previously and may have a good prognostic significance. Hemorrhagic venous infarction, however, is an indicator of an unfavorable outcome. We therefore hypothesized that patients who initially suffered iSAH would have a better clinical outcome than those who suffered hemorrhagic cerebral infarction. PATIENTS AND METHODS We selected patients hospitalized due to CVT, who presented either with isolated SAH or cerebral hemorrhagic infarction at admission or during the following 24 hours: 23 (10 men) aged 22-73 years. The data were extracted from hospital admission records, our computer data system, and the hospital radiological database. RESULTS The iSAH group consisted of 8 (6 men) aged 49.3 ± 16.2 and the hemorrhagic infarction group included 15 (4 men) aged 47.9 ± 16.8. Despite having a significantly greater number of thrombosed venous sinuses/deep veins (Mann-Whitney Rank Sum Test, p = 0.002), the isolated SAH group had a significantly better outcome on its modified Rankin Score (mRs) than the hemorrhagic infarction group (Mann-Whitney Rank Sum Test, p = 0.026). Additional variables of significant impact were edema formation (p = 0.004) and sulcal obliteration (p = 0.014). CONCLUSIONS The patients who suffer iSAH initially had a significantly better outcome prognosis than the hemorrhagic infarction patients, despite the greater number of thrombosed sinuses/veins in the iSAH group. A possible explanation might include patent superficial cerebral communicating veins.
Collapse
|
53
|
Hu S, Lee H, Zhao H, Ding Y, Duan J. Inflammation and Severe Cerebral Venous Thrombosis. Front Neurol 2022; 13:873802. [PMID: 35937062 PMCID: PMC9353263 DOI: 10.3389/fneur.2022.873802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare type of venous thromboembolism (VTE). It is an important cause of stroke in young adults and children. Severe CVT, which is characterized by cerebral venous infarction or hemorrhage, seizures, or disturbance of consciousness, has more severe clinical manifestations and a worse prognosis. It is commonly believed that the onset of severe CVT gave credit to venous return disorder, with the underlying pathogenesis remaining unclear. There is increasing evidence suggesting that an inflammatory response is closely associated with the pathophysiology of severe CVT. Preclinical studies have identified the components of neuroinflammation, including microglia, astrocytes, and neutrophils. After CVT occurrence, microglia are activated and secrete cytokines (e.g., interleukin-1β and tumor necrosis factor-α), which result in a series of brain injuries, including blood-brain barrier disruption, brain edema, and cerebral venous infarction. Additionally, astrocytes are activated at the initial CVT stage and may interact with microglia to exacerbate the inflammatory response. The extent of cerebral edema and neutrophil recruitment increases temporally in the acute phase. Further, there are also changes in the morphology of inflammatory cells, expression of inflammatory mediators, and inflammatory pathway molecules with CVT progression. Lately, some clinical research suggested that some inflammation-related biomarkers are of great value in assessing the course, severity, and prognosis of severe CVT. Moreover, basic and clinical research suggested that anti-inflammatory therapy might hold promise in severe CVT. This study reviews the current literature regarding the involvement of inflammation in the pathophysiology and anti-inflammatory interventions of severe CVT, which would contribute to informing the pathophysiology mechanism and laying a foundation for exploring novel severe CVT therapeutic strategies.
Collapse
Affiliation(s)
- Shuyuan Hu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hangil Lee
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Haiping Zhao
- Cerebrovascular Diseases Research Institute and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
54
|
Kalita J, Misra UK, Singh VK, Kumar S, Jain N. Does gender difference matter in cerebral venous thrombosis? J Clin Neurosci 2022; 102:114-119. [PMID: 35779363 DOI: 10.1016/j.jocn.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Female specific risk factors (FSRFs) in cerebral venous thrombosis (CVT) may have difference in clinical, imaging and outcome parameters compared to those females with additional risk factors and males. We compare the clinical, MRI and outcome between male and female patients with CVT. We also compare female patients with and without female specific risk factors. 172 patients were included from a prospectively maintained CVT registry. The diagnosis was confirmed on magnetic resonance venography (MRV). Clinical details, risk factors, MRI and MRV findings were noted. The risk factors in the females were categorized as 1) Isolated FSRF (oral contraceptive, pregnancy, puerperium), 2) FSRF in addition to other risk factor, 3) non FSRF only, and 4) no risk factor groups. Outcome at 6 months was assessed using modified Rankin Scale (mRS) as death, poor (mRS 3-5) and good (mRS ≤ 2). There were 80 (46.5%) females; 24 (30%) had FSRFs and 18 (75%) of whom also had other risk factors leaving only 6(25%) females with isolated FSRF. The frequency of other prothrombotic risk factors, and clinical and imaging findings were similar in males and females except more frequent hyperhomocysteinemia in males (59% vs 41%; P = 0.036) and altered sensorium in females (66% vs 40%; P = 0.001). 17(9.9%) patients died, 12(7%) had poor and 143(83.1%) had good outcome, which were similar in both the gender, and in the females with and without FSRF. Isolated FSRF is rare in CVT, and there is no gender difference in terms of non FSRFs, clinico-radiological severity and outcome.
Collapse
Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road Lucknow, Uttar Pradesh 226014, India.
| | - Usha K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road Lucknow, Uttar Pradesh 226014, India; Department of Neurology, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh 226007, India
| | - Varun K Singh
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Sunil Kumar
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road Lucknow, Uttar Pradesh 226014, India
| | - Neeraj Jain
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road Lucknow, Uttar Pradesh 226014, India
| |
Collapse
|
55
|
Zhao Y, Su X, Liu Z, Zhou C, Yu J, Wang X, Zhou L, Shi Z, Liu L, Lu H, Zhao P, Li Z, Bu K, Guo L, Liu X. Effect of intracranial venous collaterals on neurological outcomes in cerebral venous thrombosis. J Clin Neurosci 2022; 102:95-100. [PMID: 35763987 DOI: 10.1016/j.jocn.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/04/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
This study identifies predictors of favourable intracranial venous collaterals and the effect of intracranial venous collaterals on outcomes and recanalization in patients with cerebral venous thrombosis (CVT). Data of 61 patients with CVT were retrospectively reviewed. Venous collateralization was defined as expanded cortical vein formation through different drainage pathways. Recanalization grades were classified into complete or partial recanalization based on images obtained during hospitalisation and follow-up. Independent predictors of collateral formation and poor prognosis were investigated via univariate and binary logistic regression analyses. The effects of different intracranial venous collaterals on recanalization in patients with CVT were assessed. A risk prediction nomogram for prognosis was constructed. Age ≤ 35 years (odds ratio (OR) = 7.067; 95% confidence interval (CI) = 1.776-28.277; P = 0.006) and male sex (OR = 5.490; 95% CI = 1.205-25.004; P = 0.028) were independent predictors of favourable venous collaterals. Venous collaterals were associated with early recanalization (P = 0.017) and not with long-term recanalization (P = 0.252). Male sex (OR = 0.047; 95% CI = 0.003-0.651; P = 0.023), subacute onset (OR = 0.026; 95% CI = 0.002-0.367; P = 0.007), and good collateral grade (OR = 0.168; 95% CI = 0.029-0.985; P = 0.048) were independent factors of favourable neurological outcomes at discharge. Haemorrhage on computed tomography at admission (OR = 10.868; 95% CI = 2.082-56.733; P = 0.005) was inversely correlated with prognosis. These findings suggested that male patients under 35 years of age are more likely to have favourable venous collaterals and good outcomes. Venous collaterals are significantly associated with early recanalization. These findings highlight the importance of venous collateral evaluation in patients with CVT.
Collapse
Affiliation(s)
- Yanying Zhao
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, Hebei 050000, China; Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Xudong Su
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Zengpin Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Cunhe Zhou
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Jianghua Yu
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Xiaopeng Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Lixia Zhou
- Department of Radiology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Zhaoxia Shi
- Department of Radiology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Lin Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Honglin Lu
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Pandi Zhao
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Zhongzhong Li
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Kailin Bu
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China
| | - Xiaoyun Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, 215 West, Heping Road, Shijiazhuang, Hebei 050000, China; Neuroscience Research Center, Medicine and Health Institute, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang, Hebei 050000, China.
| |
Collapse
|
56
|
Effect of Clinical Nursing Pathway Intervention Based on Evidence-Based Medicine on Venous Thrombosis in Long-Term Bedridden Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5120569. [PMID: 35320999 PMCID: PMC8938046 DOI: 10.1155/2022/5120569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
Background Venous thrombosis is a type of medical condition that establishes as deep vein thrombosis of the limb or pulmonary embolism. This disease arises as a result of interrelating hereditary, ecological, and interactive risk aspects. Clinical nursing pathways also known as critical pathways are pathways that guide nurses when developing a patient's care plan. However, the effect of nursing intervention on venous thrombosis in long-term bedridden patients from the perspective of evidence-based medicine had not been reported. Methods A total of 170 patients hospitalized in the hospital from January 2021 to October 2021 were selected, and the bed time was more than 2 weeks. The patients were randomly divided into the control group and observation group. 85 cases in the control group received routine nursing in cardiology, and 85 cases in the observation group received clinical nursing pathway. Venous thrombosis, lower limb pain, swelling, D-dimer level, hemodynamic parameters, and nursing satisfaction were compared in two groups. Results The incidence of deep venous thrombosis in the observation group was 8.2%, lower than 24.7% in the control group (P < 0.05). The incidence of lower limb pain and elevated D-dimer in the observation group was lower than that in the control group (P < 0.05). The improvement of hemodynamic parameters such as SBP, DBP, CBV, PR, CI, and CO in the study group was better than that in the control group (P < 0.05). The satisfaction of the observation group was 90.58%, which was higher than that of the control group (82.35%) (P < 0.05). Conclusion Clinical nursing pathway can improve patients' nursing efficiency, improve the treatment effect, shorten hospital stay, and improve nursing satisfaction.
Collapse
|
57
|
Heckelmann J, Dafotakis M, Schulz JB. [Cerebral venous sinus thrombosis : An overview of causes, diagnostics and treatment]. DER NERVENARZT 2022; 93:413-421. [PMID: 35412038 PMCID: PMC9004207 DOI: 10.1007/s00115-022-01283-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Die Sinus‑/Hirnvenenthrombose ist eine teils fulminant verlaufende, jedoch mit einer Inzidenz von 1,32 Fällen pro 100.000 Personenjahre eher seltene neurologische Diagnose. Nichtsdestotrotz ist die Erkrankung für etwa 0,5–1 % aller Schlaganfälle verantwortlich. Die neurologische Untersuchung zeigt oft ein unspezifisches Bild, gerade bei jüngeren Patientinnen mit akut bis subakut aufgetretenen, lageabhängigen Kopfschmerzen sollte diese Differenzialdiagnose jedoch unbedingt bedacht werden. Im Rahmen dieses Artikels erfolgt die Präsentation der häufigsten Ursachen, einschließlich eines Exkurses zur vakzininduzierten immunthrombotischen Thrombozytopenie (VITT), und es werden Empfehlungen zur klinischen, laborchemischen und bildgebenden Diagnostik gegeben. Zudem werden relevante Komplikationen, mit besonderem Augenmerk auf epileptische Anfälle im Rahmen der Krankheitsentität und die leitliniengemäße Akuttherapie und Sekundärprophylaxe dargestellt.
Collapse
Affiliation(s)
- Jan Heckelmann
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Manuel Dafotakis
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Jörg B Schulz
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| |
Collapse
|
58
|
Mu S, Li J, Lin K, Fang Y, Lin F, Li Z, Xu Y, Wang S. Predictive Factors for Early-Onset Seizures in Patients With Cerebral Venous Sinus Thrombosis. Front Neurol 2022; 13:842807. [PMID: 35422753 PMCID: PMC9001912 DOI: 10.3389/fneur.2022.842807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Seizures are reported to be important factors contributing to poor prognosis in patients with cerebral venous sinus thrombosis (CVST). However, the predictive factors for concurrent early onset seizures in patients with CVST remain unclear. To identify the predictive factors of early seizures in patients with CVST, this study retrospectively evaluated the clinical data of patients diagnosed with CVST at two centers from January 2011 to December 2020 and analyzed the relationship between admission characteristics and early onset seizures. A total of 112 CVST patients (63 men and 49 women; mean age 39.82 ± 15.70 years) were enrolled in this study, of whom 34 (30.36%) had seizures. For patients with seizures, cerebral hemorrhage, cortical vein thrombosis, anterior superior sagittal sinus (SSS) thrombosis, middle SSS thrombosis, CVST score, modified Rankin Scale, National Institute of Health Stroke Scale (NIHSS) score, neutrophil percentage, and D-dimer level were more severe than those without seizures. Logistic regression analysis showed that cerebral hemorrhage (P = 0.002), anterior SSS thrombosis (P = 0.003), NIHSS score ≥5 (P = 0.003), and D-dimer ≥0.88 mg/L (P = 0.004) were all significant predictive factors of early-onset seizures in CVST patients. Combining the four factors further improved the predictive capability with an area under the curve of 0.871 (95% confidence interval = 0.803–0.939). Further large-scale prospective studies are required to confirm these findings.
Collapse
Affiliation(s)
- Shuwen Mu
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jun Li
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Kunzhe Lin
- Department of Neurosurgery, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Yi Fang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Feng Lin
- School of Medicine, Xiamen University, Xiamen, China
| | - Ziqi Li
- School of Medicine, Xiamen University, Xiamen, China
| | - Yongjun Xu
- Laboratory of Basic Medicine, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Yongjun Xu
| | - Shousen Wang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Shousen Wang
| |
Collapse
|
59
|
Yang X, Wu F, Liu Y, Duan J, Fisher M, Ji X, Meng R, Zhang H, Fan Z, Yang Q. Diagnostic performance of MR black-blood thrombus imaging for cerebral venous thrombosis in real-world clinical practice. Eur Radiol 2022; 32:2041-2049. [PMID: 34542696 DOI: 10.1007/s00330-021-08286-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/24/2021] [Accepted: 08/19/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES MR black-blood thrombus imaging (BTI) has been developed for the detection of cerebral venous thrombosis (CVT). Yet, there is a lack of real-world data to verifying its clinical performance. This study aims to evaluate the performance of BTI in diagnosing and staging CVT in a 5-year period. METHODS Patients suspected of CVT were enrolled between 2014 and 2019. Patients with or without BTI scans were classified into group A and group B, respectively. The prevalence of correct diagnosis of CVT and patients with evaluable clot age were compared. The diagnostic performance of BTI including sensitivity, specificity, and specific staging information was further analyzed. RESULTS Two hundred and twenty-one of the 308 patients suspected of CVT were eligible in the current study (114 in group A and 97 in group B), with 125 diagnosed by multidisciplinary teams to have CVTs (56 in group A, 69 in group B). The rate of correct diagnosis of CVT was higher in group A than that in group B (94.7% vs 60.8%, p < 0.001, x2 = 36.517) after adding BTI images. The percent of patients with evaluable staged segments between the two groups were 96.4% and 33.9%, respectively (x2 = 48.191, p < 0.001). BTI showed a sensitivity of 96.4% and 87.9% in the detection of CVT on per-patient and per-segment level, respectively. Up to 98.1% of all thrombosed segments could be staged by BTI and 59.6% of them were matched with clinical staging. CONCLUSIONS In the actual clinical practice, BTI improves diagnostic confidence and has an excellent performance in confirming and staging CVT. KEY POINTS • Black-blood thrombus imaging has good diagnostic performance in detecting cerebral venous thrombosis compared to traditional imaging methods with strong evidence in the actual clinical setting. • BTI helps clinicians to diagnose CVT with more accuracy and confidence, which can be served as a promising imaging examination. • BTI can also provide additional information of different thrombus ages objectively, the valuable reference for clinical strategy.
Collapse
Affiliation(s)
- Xiaoxu Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Fang Wu
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Yuehong Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Beijing, China
| | - Marc Fisher
- Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Beijing, China
| | - Huibo Zhang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Zhaoyang Fan
- Radiology and Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China.
- Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China.
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China.
| |
Collapse
|
60
|
Tomassini L, Paolini D, Petrasso PEY, Maria Manta A, Piersanti V, Straccamore M, Ciallella C. What about cerebral venous sinus thrombosis? A series of three autopsy cases. Leg Med (Tokyo) 2022; 56:102052. [PMID: 35276490 PMCID: PMC9553194 DOI: 10.1016/j.legalmed.2022.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/10/2022] [Accepted: 03/02/2022] [Indexed: 12/03/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon cerebrovascular disorder that gained massive media attention in 2021, when an association between COVID-19 and its vaccines was found in several reported cases, raising the suspicion of a causative relation that is still debated. Three cases of CVST unrelated to COVID-19 are reported in this article to highlight the difficulty in the early recognition and management of this condition, as it occurs in a variety of diseases with different clinical and pathological manifestations. When the diagnosis cannot be achieved in the clinical setting, the role of the pathologist becomes essential in the determination of the cause of death and in the identification of the etiology of CVST. During the autopsy, coordination between the physician and the forensic pathologist is crucial to correlate the clinical presentation with the pathological picture.
Collapse
|
61
|
Wittstock M, Walter U, Volmer E, Storch A, Weber MA, Großmann A. Cerebral venous sinus thrombosis after adenovirus-vectored COVID-19 vaccination: review of the neurological-neuroradiological procedure. Neuroradiology 2022; 64:865-874. [PMID: 35184205 PMCID: PMC8929723 DOI: 10.1007/s00234-022-02914-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/03/2022] [Indexed: 01/22/2023]
Abstract
Cerebral venous and sinus thrombosis (CVST) after adenovirus-vectored COVID-19 ChAdOx1 nCov-19 (Oxford–AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson) is a rare complication, occurring mainly in individuals under 60 years of age and more frequently in women. It manifests 4–24 days after vaccination. In most cases, antibodies against platelet factor-4/polyanion complexes play a pathogenic role, leading to thrombosis with thrombocytopenia syndrome (TTS) and sometimes a severe clinical or even fatal course. The leading symptom is headache, which usually increases in intensity over a few days. Seizures, visual disturbances, focal neurological symptoms, and signs of increased intracranial pressure are also possible. These symptoms may be combined with clinical signs of disseminated intravascular coagulation such as petechiae or gastrointestinal bleeding. If TTS-CVST is suspected, checking d-dimers, platelet count, and screening for heparin-induced thrombocytopenia (HIT-2) are diagnostically and therapeutically guiding. The imaging method of choice for diagnosis or exclusion of CVST is magnetic resonance imaging (MRI) combined with contrast-enhanced venous MR angiography (MRA). On T2*-weighted or susceptibility weighted MR sequences, the thrombus causes susceptibility artefacts (blooming), that allow for the detection even of isolated cortical vein thromboses. The diagnosis of TTS-CVST can usually be made reliably in synopsis with the clinical and laboratory findings. A close collaboration between neurologists and neuroradiologists is mandatory. TTS-CVST requires specific regimens of anticoagulation and immunomodulation therapy if thrombocytopenia and/or pathogenic antibodies to PF4/polyanion complexes are present. In this review article, the diagnostic and therapeutic steps in cases of suspected TTS associated CSVT are presented.
Collapse
Affiliation(s)
- Matthias Wittstock
- Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20 18147 Rostock, Germany.
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20 18147 Rostock, Germany
| | - Erik Volmer
- Institute for Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock, Germany
| | - Alexander Storch
- Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20 18147 Rostock, Germany
| | - Marc-André Weber
- Institute for Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock, Germany
| | - Annette Großmann
- Institute for Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock, Germany
| |
Collapse
|
62
|
Abstract
PURPOSE OF REVIEW Cerebrovascular disorders during pregnancy and puerperium are uncommon but potentially serious entities. This review aims to provide guidance on the diagnosis and management of these diseases, according to the most recent findings. RECENT FINDINGS Proteinuria is no longer a mandatory criterion for the diagnosis of preeclampsia. Favourable long-term foetal and maternal outcomes are achieved in most patients with ruptured cerebral arterial malformations during pregnancy receiving interventional treatment prior to delivery. Despite the recent recommendations, physicians still hesitate to administer thrombolysis in pregnant women. In women with a history of cerebral venous thrombosis, prophylaxis with low molecular weight heparin during pregnancy and puerperium is associated with lower rates of recurrent thrombotic events and miscarriage. SUMMARY Hypertensive disorders of pregnancy are a continuum of failure of autoregulation mechanisms that may lead to eclampsia, posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome and stroke. MRI is the preferred imaging modality of choice. In the absence of specific contraindications, treatment of cerebrovascular complications should not be withheld from pregnant women, including reperfusion therapies in acute ischemic stroke and treatment of ruptured cerebral aneurysms. Previous history of stroke alone does not contraindicate future pregnancy, but counselling and implementation of prevention strategies are needed.
Collapse
Affiliation(s)
- Mónica Santos
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria - CHULN
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria - CHULN
- Faculdade de Medicina, Universidade de Lisboa
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| |
Collapse
|
63
|
Whitworth H, Raffini L. Practical Considerations for Use of Direct Oral Anticoagulants in Children. Front Pediatr 2022; 10:860369. [PMID: 35433559 PMCID: PMC9010784 DOI: 10.3389/fped.2022.860369] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Direct oral anticoagulants (DOACs) provide an attractive alternative for the management and prevention of thrombosis in pediatric patients. With multiple ongoing and published pediatric trials and recent regulatory approval of dabigatran and rivaroxaban, the landscape of pediatric anticoagulation is rapidly changing. However, as pediatricians gain experience with these drugs, it is important to be mindful of pediatric-specific considerations that may limit the use of DOACs in certain children and adolescents. While there is increasing adult data and experience, there is a paucity of real-world evidence to guide the use of these drugs in children who would not have met clinical trial inclusion criteria. In this mini review, we summarize pediatric specific data, areas for future research, and practical considerations for the use of DOACs in children and adolescents.
Collapse
Affiliation(s)
- Hilary Whitworth
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Leslie Raffini
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| |
Collapse
|
64
|
Jaiswal V, Nepal G, Dijamco P, Ishak A, Dagar M, Sarfraz Z, Shama N, Sarfraz A, Lnu K, Mitra S, Agarwala P, Naz S, Song D, Jaiswal A. Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Systematic Review. J Prim Care Community Health 2022; 13:21501319221074450. [PMID: 35142234 PMCID: PMC8841914 DOI: 10.1177/21501319221074450] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction: COVID-19 vaccines became available after being carefully monitored in clinical trials with safety and efficacy on the human body. However, a few recipients developed unusual side effects, including cerebral venous sinus thrombosis (CVST). We aim to systematically review the baseline features, clinical characteristics, treatment, and outcomes in patients developing CVST post-COVID-19 vaccination. Methods: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) 2020 guideline. Investigators independently searched PubMed, Embase, and Google Scholar for English language articles published from inception up until September 10, 2021, reporting the incidence of CVST post-COVID-19 vaccines. We analyzed CVST patients’ baseline data, type of vaccines, clinical findings, treatment, and outcomes. Our systematic review process yielded patient-level data. Result: The final analysis included 25 studies that identified 80 patients who developed CVST after the COVID-19 vaccination. Of the 80 CVST cases, 31 (39.24%) patients died. There was no significant relationship between mortality and age (P = .733), sex (P = .095), vaccine type (P = .798), platelet count (P = .93), and comorbidities such as hypertension (P = .734) and diabetes mellitus (P = .758). However, mortality was associated with the duration of onset of CVST symptoms after vaccination (P = .022). Patients with CVST post-COVID-19 vaccination were more likely to survive if treated with an anticoagulant (P = .039). Patients who developed intracranial hemorrhage (P = .012) or thrombosis in the cortical vein (P = .021) were more likely to die. Conclusion: COVID-19 vaccine-associated CVST is associated with high mortality rate. Timely diagnosis and management can be lifesaving for patients.
Collapse
Affiliation(s)
| | - Gaurav Nepal
- Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Patricia Dijamco
- St. Luke's Medical Center College of Medicine, Quezon City, Philippines
| | - Angela Ishak
- European University Cyprus School of Medicine, Nicosia, Cyprus
| | - Mehak Dagar
- Himalayan Institute of Medical Science, Dehradun, Uttarakhand, India
| | - Zouina Sarfraz
- Fatima Jinnah Medical University, Lahore, Punjab, Pakistan
| | - Nishat Shama
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | | | - Kriti Lnu
- UPMC Harrisburg, Harrisburg, PA, USA
| | - Saloni Mitra
- Bogomolets National Medical University, Kyiv, Ukraine
| | | | - Sidra Naz
- Harvard Medical School, Boston, MA, USA
| | - David Song
- Icahn School of Medicine at Mount Sinai, NY, USA
| | - Akash Jaiswal
- All India Institute of Medical Science, New Delhi, India
| |
Collapse
|
65
|
Timchenko L, Zhadan O, Gilevich I, Zaruba T. Pathogenetic and clinical features of cerebral venous thrombosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:139-144. [DOI: 10.17116/jnevro2022122061139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
66
|
Labagnara KF, Birnbaum J, Unda SR, Altschul DJ. Analyzing the Effects of Demographic Differences on Patient Outcomes Following Non-pyogenic Intracranial Venous Thrombosis. Cureus 2021; 13:e19753. [PMID: 34938630 PMCID: PMC8684964 DOI: 10.7759/cureus.19753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To investigate the effect of racial and demographic differences on the short-term outcome of patients following a non-pyogenic cerebral venous thrombosis. Methods: Data from the National Inpatient Sample were gathered from the years 2013 to 2016. Patients who had a non-pyogenic cerebral venous thrombosis were identified. Admissions of patients between different racial groups were compared. Outcome measures included inpatient mortality, length of stay (LOS), all patients refined diagnosis-related group (APR-DRG) severity and mortality risk scores, non-routine discharges, total charges, sepsis, and urinary tract infections (UTIs). Results: We identified 973 patients who were admitted with a non-pyogenic cerebral venous thrombosis between 2013 and 2016. Of those, 65.7% were classified as White, 15.6% as Black, 14.1% as Hispanic, and 4.6% as Asian or Pacific Islander. Compared to White patients, Black patients were found to have a higher severity score upon admission (2.94 ± 0.818 vs 2.77 ± 0.839; p = 0.025) as well as a longer adjusted LOS (8.085 ± 5.917 vs 6.503 ± 5.552; p = 0.004) and log LOS (0.934 ± 0.507 vs 0.773 ± 0.521; p = 0.001). On initial analysis, we found that older age, elevated WBC count, income group, anemia, and an expected primary payer of Medicare/Medicaid were significantly associated with Black race and also worse outcomes. When controlling for these variables using multivariate regression, older age, lower income group, and elevated WBC count were not significantly associated with any measures of outcome. The race was no longer associated with a higher APR-DRG severity score but was still significant for adjusted LOS (p = 0.001) and adjusted log LOS (p = 0.004). Lastly, we noted that anemia and the expected primary payer of Medicare/Medicaid were both independently and significantly associated with APR-DRG severity score (p = 0.003; p = 0.010) and the adjusted log LOS (p = 0.019; p = 0.035). Conclusions: Black patients admitted with a non-pyogenic intracranial venous thrombosis have significantly longer LOS compared to White patients. Anemia and Medicare/Medicaid as the primary expected payer also seem to play a role in longer LOS, as well as the severity of the case.
Collapse
|
67
|
Braun T, Viard M, Juenemann M, Struffert T, Schwarm F, Huttner HB, Roessler FC. Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome. Front Neurol 2021; 12:763049. [PMID: 34880826 PMCID: PMC8645635 DOI: 10.3389/fneur.2021.763049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
We present two cases of ChAdOx1 nCov-19 (AstraZeneca)-associated thrombotic thrombocytopenia syndrome (TTS) and cerebral venous sinus thrombosis (CVST). At the time of emergency room presentation due to persistent headache, blood serum levels revealed reduced platelet counts. Yet, 1 or 4 days after the onset of the symptom, the first MR-angiography provided no evidence of CVST. Follow-up imaging, performed upon headache refractory to nonsteroidal pain medication verified CVST 2–10 days after initial negative MRI. Both the patients received combined treatment with intravenous immunoglobulins and parenteral anticoagulation leading to an increase of platelet concentration in both the individuals and resolution of the occluded cerebral sinus in one patient.
Collapse
Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen, Giessen, Germany
| | - Tobias Struffert
- Department of Neuroradiology, University Hospital Giessen, Giessen, Germany
| | - Frank Schwarm
- Department of Neurosurgery, University Hospital Giessen, Giessen, Germany
| | - Hagen B Huttner
- Department of Neurology, University Hospital Giessen, Giessen, Germany
| | | |
Collapse
|
68
|
Foschi M, Pavolucci L, Rondelli F, Amore G, Spinardi L, Rinaldi R, Favaretto E, Favero L, Russo M, Pensato U, Benini M, Barone V, Guarino M. Clinicoradiological Profile and Functional Outcome of Acute Cerebral Venous Thrombosis: A Hospital-Based Cohort Study. Cureus 2021; 13:e17898. [PMID: 34532197 PMCID: PMC8435069 DOI: 10.7759/cureus.17898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction Acute cerebral venous thrombosis (CVT) may result in a variety of clinical presentations, with headache being the most common. The relationship between clinical and neuroradiological characteristics in acute CVT patients is still not univocally characterized. Materials and methods We enrolled 32 consecutive acute CVT patients admitted to our emergency department from January 1, 2012, to June 30, 2019. Clinicoradiological associations and their relationship with the functional outcome at the discharge were tested. Results Headache was the presenting symptom in 85% of patients, more frequently subacute (82%), new-onset (67%), with unusual features in respect to prior headache episodes (100%), and associated with concomitant neurological symptoms/signs (74%). Patients with holocranial headache showed more frequent venous ischemia (VI) compared to those with bilateral and unilateral headache (50% vs. 20% vs. 0%, respectively; p=0.027). Patients with concomitant neurological defects had a higher prevalence of VI (50.0% vs. 15.0%; p=0.049) and superior sagittal sinus thrombosis (67% vs. 30%; p=0.043) than those without. Vomit was more frequently observed in patients with straight sinus thrombosis (67% vs. 8%; p=0.005). Increasing age and VI were independently associated with poor (modified Rankin scale (mRS) 2-5) functional outcome (odds ratio (OR) = 1.081, 95% confidence interval (CI) 1.004-1.165; p=0.038 and OR = 12.089, 95% CI 1.141-128.104; p=0.039, respectively). Conclusions Our study confirms and enriches available data on the clinicoradiological profile of patients with acute CVT and suggests that increasing age and venous ischemia are independently associated with poor outcomes.
Collapse
Affiliation(s)
- Matteo Foschi
- Department of Neuroscience, Neurology Unit, S.Maria delle Croci Hospital of Ravenna - AUSL Romagna, Ravenna, ITA.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, ITA
| | - Lucia Pavolucci
- Department of Neuroscience, Neurology Unit, S.Maria delle Croci Hospital of Ravenna - AUSL Romagna, Ravenna, ITA
| | - Francesca Rondelli
- Neurology Unit, S.Orsola-Malpighi University Hospital of Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, ITA
| | - Giulia Amore
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITA
| | - Luca Spinardi
- Department of Experimental Diagnostic and Specialty Medicine, Neuroradiology Unit, S.Orsola-Malpighi University Hospital of Bologna, Bologna, ITA
| | - Rita Rinaldi
- Neurology Unit, S.Orola-Malpighi University Hospital of Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, ITA
| | - Elisabetta Favaretto
- Department of Angiology and Blood Coagulation, Angiology and Blood Coagulation Unit, S.Orsola-Malpighi University Hospital of Bologna, Bologna, ITA
| | - Luca Favero
- Department of Health Management, S.Orsola-Malpighi University Hospital of Bologna, Bologna, ITA
| | - Michele Russo
- Department of Cardiovascular Diseases, Division of Cardiology, S.Maria delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, ITA
| | - Umberto Pensato
- Department of Biomedical and Neuromotor Sciences, Univesity of Bologna, Bologna, ITA
| | - Matteo Benini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITA
| | - Valentina Barone
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ITA
| | - Maria Guarino
- Neurology Unit, S.Orsola-Malpighi University Hospital of Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, ITA
| |
Collapse
|
69
|
Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente Fernández L, de la Torre Colmenero JD, Tejada Meza H, Vesperinas Castro A, Sánchez Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2021:S0213-4853(21)00116-X. [PMID: 34511275 DOI: 10.1016/j.nrl.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/29/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P=.03), focal deficits (P=.001), and encephalopathy (P <.001) showing a statistically significant association with poor prognosis (mRS> 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
Collapse
Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España.
| | | | - C Aguirre
- Hospital La Princesa, Madrid, España
| | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, España
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, España
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, España
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | | | | | - L Llul
- Hospital Clínic, Barcelona, España
| | - J Egido
- Hospital Clínico San Carlos, Madrid, España
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, España
| |
Collapse
|
70
|
[Vascular emergencies in pregnant patients : Peripartum hemorrhage, thromboembolic events and hypertensive diseases in pregnancy]. Anaesthesist 2021; 70:895-908. [PMID: 34495345 DOI: 10.1007/s00101-021-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 10/20/2022]
Abstract
In developed countries, peripartum hemorrhage, thromboembolic events and hypertensive pregnancy disorders are the most frequent complications in pregnancy. They pose a significant challenge for the interdisciplinary team of gynecology and anesthesiology. Untreated, these pregnancy-related complications result in a fulminant course. Close consultation between the specialist departments and knowledge of the area of responsibility are essential. In the case of acute bleeding the anesthesiologist is responsible for maintaining adequate circulatory conditions and management of hemostasis. Thromboembolic events require immediate anticoagulation and focused diagnostics. Thereby, both the fetal and the maternal risks must be weighed up. The hypertensive diseases in pregnancy have a very high risk of complications. In addition to symptomatic treatment in the intensive care unit, the optimal time of delivery must be determined by an interdisciplinary consensus. This is the only causal treatment option possible.
Collapse
|
71
|
Kisilevsky E, Yu E, Margolin E. Papilledema and Extensive Dural Sinus Thrombosis Due to JAK2 Mutation. J Neuroophthalmol 2021; 41:e307-e308. [PMID: 33105413 DOI: 10.1097/wno.0000000000001096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eli Kisilevsky
- Department of Ophthalmology and Vision Science (EK, EM), and Medical Imaging (EY), University of Toronto, Toronto, Canada ; and Division of Neurology (EM), Department of Medicine, Toronto, Canada
| | | | | |
Collapse
|
72
|
Abstract
PURPOSE OF REVIEW Early diagnosis of central nervous system (CNS) infections is crucial given high morbidity and mortality. Neuroimaging in CNS infections is widely used to aid in the diagnosis, treatment and to assess the response to antibiotic and neurosurgical interventions. RECENT FINDINGS The Infectious Diseases Society of America (IDSA) guidelines have clear recommendations for obtaining a computerized tomography of the head (CTH) prior to lumbar puncture (LP) in suspected meningitis. In the absence of indications for imaging or in aseptic meningitis, cranial imaging is of low utility. In contrast, cranial imaging is of utmost importance in the setting of encephalitis, bacterial meningitis, ventriculitis, bacterial brain abscess, subdural empyema, epidural abscess, neurobrucellosis, neurocysticercosis, and CNS tuberculosis that can aid clinicians with the differential diagnosis, source of infection (e.g., otitis, sinusitis), assessing complications of meningitis (e.g., hydrocephalus, venous sinus thrombosis, strokes), need for neurosurgical interventions and to monitor for the response of therapy. Novel imaging techniques such as fast imaging employing steady-state acquisition (FIESTA), susceptibility-weighted imaging (SWI), and chemical exchange saturation transfer (CEST) contrast are briefly discussed. SUMMARY Though the radiological findings in CNS infections are vast, certain patterns along with clinical clues from history and examination often pave the way to early diagnosis. This review reiterates the importance of obtaining cranial imaging when necessary, and the various radiological presentations of commonly encountered CNS infections.
Collapse
|
73
|
Thakur KT, Tamborska A, Wood GK, McNeill E, Roh D, Akpan IJ, Miller EC, Bautista A, Claassen J, Kim CY, Guekht A, Pardo CA, Williams O, García-Azorín D, Prasad K, Schmutzhard E, Michael BD, Chou SHY, Winkler AS, Solomon T, Elkind MS. Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions. J Neurol Sci 2021; 427:117532. [PMID: 34134058 PMCID: PMC8178065 DOI: 10.1016/j.jns.2021.117532] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vaccine induced immune mediated thrombocytopenia or VITT, is a recent and rare phenomenon of thrombosis with thrombocytopenia, frequently including cerebral venous thromboses (CVT), that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2·S Johnson and Johnson (Janssen/J&J). The evaluation and management of suspected cases of CVT post COVID-19 vaccination are critical skills for a broad range of healthcare providers. METHODS A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists. FINDINGS Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist, including inflammatory marker measurements, PF4 assays, and non-heparin anticoagulation.
Collapse
Affiliation(s)
- Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA.
| | - Arina Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK; Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK
| | - Greta K Wood
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, UK
| | - Emily McNeill
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - David Roh
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Imo J Akpan
- Department of Hematology/Oncology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Eliza C Miller
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Alyssa Bautista
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Carla Y Kim
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry & Russian National Research Medical University, Moscow, Russia
| | - Carlos A Pardo
- Divisions of Neuroimmunology and Neuroinfectious Disorders & Advanced Clinical Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olajide Williams
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Kameshwar Prasad
- Rajendra Institute of Medical Sciences, Ranchi 834009, Jharkhand, India
| | - Erich Schmutzhard
- Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Benedict D Michael
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital/Harvard University, Boston, MA, USA
| | - Sherry H-Y Chou
- Department of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany; Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Mitchell S Elkind
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
74
|
Rizk JG, Gupta A, Sardar P, Henry BM, Lewin JC, Lippi G, Lavie CJ. Clinical Characteristics and Pharmacological Management of COVID-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia With Cerebral Venous Sinus Thrombosis: A Review. JAMA Cardiol 2021; 6:1451-1460. [PMID: 34374713 DOI: 10.1001/jamacardio.2021.3444] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance The COVID-19 pandemic saw one of the fastest developments of vaccines in an effort to combat an out-of-control pandemic. The 2 most common COVID-19 vaccine platforms currently in use, messenger RNA (mRNA) and adenovirus vector, were developed on the basis of previous research in use of this technology. Postauthorization surveillance of COVID-19 vaccines has identified safety signals, including unusual cases of thrombocytopenia with thrombosis reported in recipients of adenoviral vector vaccines. One of the devastating manifestations of this syndrome, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), is cerebral venous sinus thrombosis (CVST). This review summarizes the current evidence and indications regarding biology, clinical characteristics, and pharmacological management of VITT with CVST. Observations VITT appears to be similar to heparin-induced thrombocytopenia (HIT), with both disorders associated with thrombocytopenia, thrombosis, and presence of autoantibodies to platelet factor 4 (PF4). Unlike VITT, HIT is triggered by recent exposure to heparin. Owing to similarities between these 2 conditions and lack of high-quality evidence, interim recommendations suggest avoiding heparin and heparin analogues in patients with VITT. Based on initial reports, female sex and age younger than 60 years were identified as possible risk factors for VITT. Treatment consists of therapeutic anticoagulation with nonheparin anticoagulants and prevention of formation of autoantibody-PF4 complexes, the latter being achieved by administration of high-dose intravenous immunoglobin (IVIG). Steroids, which can theoretically inhibit the production of new antibodies, have been used in combination with IVIG. In severe cases, plasma exchange should be used for clearing autoantibodies. Monoclonal antibodies, such as rituximab and eculizumab, can be considered when other therapies fail. Routine platelet transfusions, aspirin, and warfarin should be avoided because of the possibility of worsening thrombosis and magnifying bleeding risk. Conclusions and Relevance Adverse events like VITT, while uncommon, have been described despite vaccination remaining the most essential component in the fight against the COVID-19 pandemic. While it seems logical to consider the use of types of vaccines (eg, mRNA-based administration) in individuals at high risk, treatment should consist of therapeutic anticoagulation mostly with nonheparin products and IVIG.
Collapse
Affiliation(s)
- John G Rizk
- Arizona State University, Edson College, Phoenix, Arizona
| | - Aashish Gupta
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Partha Sardar
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Brandon Michael Henry
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John C Lewin
- National Coalition on Health Care, Washington, DC
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| |
Collapse
|
75
|
Rezoagli E, Bonaventura A, Coutinho JM, Vecchié A, Gessi V, Re R, Squizzato A, Pomero F, Bonzini M, Ageno W, Dentali F. Incidence Rates and Case-Fatality Rates of Cerebral Vein Thrombosis: A Population-Based Study. Stroke 2021; 52:3578-3585. [PMID: 34372672 PMCID: PMC10082066 DOI: 10.1161/strokeaha.121.034202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral vein thrombosis (CVT) incidence is estimated to be >10 per 1 000 000 per year. Few population-based studies investigating case-fatality rates (CFRs) and pyogenic/nonpyogenic CVT incidence are available. We assessed trends in CVT incidence between 2002 and 2012, as well as adjusted in-hospital CFRs and incidence of hospital admissions for pyogenic/nonpyogenic CVT in a large Northwestern Italian epidemiological study. METHODS Primary and secondary discharge diagnoses of pyogenic/nonpyogenic CVT were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 325, 671.5, and 437.6. Age, sex, vital status at discharge, length of hospital stay, and up to 5 secondary discharge diagnoses were collected. Concomitant presence of intracerebral hemorrhage (ICH) was registered, and comorbidities were assessed through the Charlson comorbidity index. RESULTS A total of 1718 patients were hospitalized for CVT (1147 females-66.8%; 810 pyogenic and 908 nonpyogenic CVT, 47.1% and 52.9%, respectively), with 134 patients (7.8%) experiencing a concomitant ICH. The overall incidence rate for CVT was 11.6 per 1 000 000 inhabitants with a sex-specific rate of 15.1 and 7.8 per 1 000 000 in females and males, respectively. CVT incidence significantly increased in women during time of observation (P=0.007), with the highest incidence being at 40 to 44 years (27.0 cases per 1 000 000). In-hospital CFR was 3%, with no difference between pyogenic/nonpyogenic CVT. Patients with concomitant ICH had a higher in-hospital CFR compared with patients without ICH (7.5% versus 2.7%; odds ratio, 2.96 [95% CI, 1.45-6.04]). In-hospital CFR progressively increased with increasing Charlson comorbidity index (P=0.003). Age (odds ratio, 1.03 [95% CI, 1.02-1.05]), Charlson comorbidity index ≥4 (odds ratio, 4.33 [95% CI, 1.29-14.52]), and ICH (odds ratio, 3.05 [95% CI, 1.40-6.62]) were independent predictors of in-hospital mortality. CONCLUSIONS In a large epidemiological study, CVT incidence was found to be comparable to the one registered in population-based studies reported after the year 2000. CVT incidence increased among women over time. In-hospital CFR was low, but not negligible, in patients with concomitant ICH. Age, ICH, and a high number of comorbidities were independent predictors of in-hospital mortality. Pyogenic CVT was not a predictor of in-hospital CFR, although its high proportion was not confirmed by internal validation.
Collapse
Affiliation(s)
- Emanuele Rezoagli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (E.R.).,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy (E.R.)
| | - Aldo Bonaventura
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy (A.B., A.V., V.G.).,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Italy (A.B.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (J.M.C.)
| | - Alessandra Vecchié
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy (A.B., A.V., V.G.)
| | - Vera Gessi
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy (A.B., A.V., V.G.)
| | - Roberta Re
- Presidio Ospedaliero S. Andrea, ASL VC, Vercelli, Italy (R.R.)
| | | | - Fulvio Pomero
- Internal Medicine, Michele e Pietro Ferrero, Verduno, Cuneo, Italy (F.P.)
| | - Matteo Bonzini
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Policlinico Fundation, Italy (M.B.)
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese/Como, Italy. (W.A., F.D.)
| | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese/Como, Italy. (W.A., F.D.)
| |
Collapse
|
76
|
Kanazawa T, Karatsu K, Kuramae T, Ishihara M. Severe lateral sinus thrombosis during the postpartum period that required decompressive craniectomy. BMJ Case Rep 2021; 14:14/8/e245308. [PMID: 34353843 PMCID: PMC8344304 DOI: 10.1136/bcr-2021-245308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tokunori Kanazawa
- Department of Neurosurgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Kosuke Karatsu
- Department of Neurosurgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Takumi Kuramae
- Department of Neurosurgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Masayuki Ishihara
- Department of Neurosurgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| |
Collapse
|
77
|
Petrović J, Švabić T, Zidverc-Trajković J, Stanarčević P, Jovanović D, Mijajlović M. Cerebral venous thrombosis: a retrospective unicentric analysis of clinical and neuroimaging characteristics. Neurol Sci 2021; 43:1839-1847. [PMID: 34347215 DOI: 10.1007/s10072-021-05514-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/18/2021] [Indexed: 01/30/2023]
Abstract
Thrombosis of dural sinuses and/or cerebral veins (CVT) is an uncommon form of stroke, usually affecting young individuals. It has a variable clinical presentation ranging from mild cases presenting only headaches, to severe cases featuring encephalopathy, coma or status epilepticus. A retrospective cross-sectional study of patients treated in the outpatient department and in-hospital during the period from 2014 to 2020 at the Neurology Clinic-University Clinical Centre of Serbia was conducted. Forty-nine patients (24 men; 25 women) were included in the study. Twenty-three patients (46.9%) suffered a subacute form of CVT (48 h-4 weeks), 19 (38.8%) presented with an acute form (< 48 h) and 7 (14.3%) with a chronic form (> 4 weeks). Around 75% of patients reported headaches during disease course. Focal neurological deficit (FND) was observed in 27 (55.1%) patients. Patients who did not report headaches (22.4%) presented with more severe symptoms (seizures and coma). More than 70% of patients had no radiologically evident brain parenchymal lesion. The most frequent locations of CVT were transverse sinus (79.6%), sigmoid sinus (44.9%) and superior sagittal sinus (36.7%). Thrombosis of more than one sinus/vein occurred in 33 (67.3%) patients. Hereditary thrombophilia was observed in 9 (18.4%) patients, 11 (22.4%) patients had some type of infection and 20% of women reported OCT usage. As much as 25% of cases remained without evident risk factors. The most common symptom in our cohort was acute unilateral throbbing headache of high intensity, while patients without headaches had more severe symptoms.
Collapse
Affiliation(s)
- Jovan Petrović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Švabić
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jasna Zidverc-Trajković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Dejana Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milija Mijajlović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia.
| |
Collapse
|
78
|
Elalamy I, Gerotziafas G, Alamowitch S, Laroche JP, Van Dreden P, Ageno W, Beyer-Westendorf J, Cohen AT, Jimenez D, Brenner B, Middeldorp S, Cacoub P. SARS-CoV-2 Vaccine and Thrombosis: An Expert Consensus on Vaccine-Induced Immune Thrombotic Thrombocytopenia. Thromb Haemost 2021; 121:982-991. [PMID: 33946120 PMCID: PMC8322589 DOI: 10.1055/a-1499-0119] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/30/2022]
Abstract
Historically, the vaccination strategies developed in the second half of the 20th century have facilitated the eradication of infectious diseases. From the onset of COVID-19 pandemic to the end of April 2021, more than 150 million cases and 3 million deaths were documented worldwide with disruption of the economic and social activity, and with devastating material, physical, and psychological consequences. Reports of unusual and severe thrombotic events, including cerebral and splanchnic venous thrombosis and other autoimmune adverse reactions, such as immune thrombocytopenia or thrombotic microangiopathies in connection with some of the SARS-CoV-2 vaccines, have caused a great deal of concern within the population and the medical community. This report is intended to provide practical answers following an overview of our knowledge on these thrombotic events that are extremely rare but have serious consequences. Vaccine hesitancy threatens to reverse the progress made in controlling vaccine-preventable diseases. These adverse events must be put into perspective with an objective analysis of the facts and the issues of the vaccination strategy during this SARS-CoV-2 pandemic. Health care professionals remain the most pertinent advisors and influencers regarding vaccination decisions; they have to be supported to provide reliable and credible information on vaccines. We need to inform, reassure, and support our patients when the prescription is made. Facing these challenges and observations, a panel of experts express their insights and propose a tracking algorithm for vaccinated patients based on a 10-point guideline for decision-making on what to do and not to do.
Collapse
Affiliation(s)
- Ismail Elalamy
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Grigoris Gerotziafas
- Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Sonia Alamowitch
- AP-HP, Service des Urgences cérébro-vasculaires, Hôpital Pitié-Salpétrière, Paris, France
- Centre de recherche de Saint Antoine, INSERM, UMRS 938, Sorbonne Université Paris, France
| | - Jean-Pierre Laroche
- Service de médecine vasculaire, hôpital Saint-Éloi, CHU de Montpellier, Montpellier cedex 5, France
- Médipôle, 1139, chemin du Lavarin, Avignon, France
| | - Patrick Van Dreden
- Research Group “Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
| | - Walter Ageno
- Department of Emergency Medicine and Thrombosis Center, Ospedale di Circolo and Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Haematology and Haemostaseology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander T. Cohen
- Department of Haematological Medicine, Guys and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| | - David Jimenez
- Respiratory Department, Ramon y Cajal Hospital (IRYCIS), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Benjamin Brenner
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut National de la Santé et de la Recherche Médicale, INSERM, Paris, France
- CNRS, FRE3632, Paris, France
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Université, UPMC Univ Paris 06, Paris, France
| |
Collapse
|
79
|
Isolated thrombosis of cortical veins - Clinical and radiological correlation. J Clin Neurosci 2021; 91:369-377. [PMID: 34373054 DOI: 10.1016/j.jocn.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Isolated cortical venous thrombosis (ICVT) is a relatively rare clinical entity with non-specific clinical presentations. Anatomical variations in cortical veins and the lack of a gold standard imaging feature make the diagnosis of ICVT challenging. Headache and seizures were the most common presentations. The Vein of Trolard followed by superficial middle cerebral vein (SMCV) were the most commonly involved. Susceptibility Weighted Imaging (SWI) cord sign was observed in 100% of the cases. CT cord sign and filling defects on contrast enhanced CT were evident in 46.7% and 10% of the cases, respectively. Notably, in the absence of filling defect visualized on contrast CT, MRI, replacement of flow void was the surrogate marker for the ICVT. A high index of clinical suspicion, a thorough understanding of neurovascular anatomy, multiparametric, multiplanar MRI protocol is required to diagnose this rare entity. A serpiginous blooming structure within the subarachnoid space identifiable in less than two contiguous sections on SWI in the vicinity of haemorrhagic infarction should alert the clinician to the imaging possibility of ICVT.
Collapse
|
80
|
ERDEM AB, ÇELİKEL E, YILMAZ M, KARAPINARLI B, KAYA UB. Investigation of sinus vein thrombosis cases detected in the emergency department. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.911964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
81
|
Arauz A, Barboza MA, Quintero LC, Cantu C, Chiquete E, Serrano F. Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy. Neurologia 2021; 38:S0213-4853(21)00072-4. [PMID: 34253412 DOI: 10.1016/j.nrl.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
Collapse
Affiliation(s)
- A Arauz
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - M A Barboza
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico; Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica.
| | - L C Quintero
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - E Chiquete
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - F Serrano
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| |
Collapse
|
82
|
Hakma Z, Gofman N, Brown D, Fitzgerald E. Tofacitinib-Associated Cerebral Venous Sinus Thrombosis. ACG Case Rep J 2021; 8:e00632. [PMID: 34307712 PMCID: PMC8294923 DOI: 10.14309/crj.0000000000000632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Tofacitinib is a Janus kinase inhibitor indicated to treat adult patients with moderately to severely active ulcerative colitis (UC). Although thrombosis is a known adverse event of tofacitinib, there are no reports specific to cerebral venous sinus thrombosis (CVST). We present a report of a patient presenting with a CVST several months after starting tofacitinib. Initially, this 60-year-old man with poorly controlled UC who previously had a nonthrombotic hemorrhage was found to have venous sinus thromboses of the right transverse and sigmoid sinuses. Hematological workup did not reveal any underlying hypercoagulable conditions, aside from UC. This is the first report of a patient with CVST likely resulting from the Janus kinase inhibitor tofacitinib. This case report should prompt compilation of all thrombotic events in patients receiving tofacitinib.
Collapse
|
83
|
[Diagnostic and treatment recommendations from the FACME ad-hoc expert working group on the management of cerebral venous sinus thrombosis associated with COVID-19 vaccination]. Neurologia 2021; 36:451-461. [PMID: 34049738 PMCID: PMC8101796 DOI: 10.1016/j.nrl.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Cases of cerebral venous sinus thrombosis have been reported in individuals vaccinated against COVID-19 with non-replicating adenoviral vector vaccines. We issue our recommendations on the diagnosis and management of patients presenting this complication. METHOD The multidisciplinary working group, led by the Spanish Federation of Medical and Scientific Associations and including representatives of several scientific societies, reviewed the available evidence from the literature and reports of the European Medicines Agency. We establish a definition for suspected cases and issue diagnostic and treatment recommendations regarding vaccine-induced immune thrombotic thrombocytopaenia. RESULTS We define suspected cases as those cases of cerebral venous sinus thrombosis occurring between 3 and 21 days after the administration of non-replicating adenoviral vector vaccines, in patients with a platelet count below 150,000/μL or presenting a decrease of 50% with respect to the previous value. Findings suggestive of vaccine-induced immune thrombotic thrombocytopaenia include the presence of antibodies to platelet factor 4, D-dimer levels 4 times greater than the upper limit of normal, and unexplained thrombosis. The recommended treatment includes intravenous administration of non-specific human immunoglobulin or alternatively plasmapheresis, avoiding the use of heparin, instead employing argatroban, bivalirudin, fondaparinux, rivaroxaban, or apixaban for anticoagulation, and avoiding platelet transfusion. CONCLUSIONS Non-replicating adenoviral vector vaccines may be associated with cerebral venous sinus thrombosis with thrombocytopaenia; it is important to treat the dysimmune phenomenon and the cerebral venous sinus thrombosis.
Collapse
|
84
|
Diagnostic and treatment recommendations from the FACME ad-hoc expert working group on the management of cerebral venous sinus thrombosis associated with COVID-19 vaccination. Neurologia 2021; 36:451-461. [PMID: 34112621 PMCID: PMC8164341 DOI: 10.1016/j.nrleng.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Cases of cerebral venous sinus thrombosis have been reported in individuals vaccinated against COVID-19 with non-replicating adenoviral vector vaccines. We issue our recommendations on the diagnosis and management of patients presenting this complication. METHODS The multidisciplinary working group, led by the Spanish Federation of Medical and Scientific Associations (FACME) and including representatives of several scientific societies, reviewed the available evidence from the literature and reports of the European Medicines Agency. We establish a definition for suspected cases and issue diagnostic and treatment recommendations regarding vaccine-induced immune thrombotic thrombocytopaenia. RESULTS We define suspected cases as those cases of cerebral venous sinus thrombosis occurring between 3 and 21 days after the administration of non-replicating adenoviral vector vaccines, in patients with a platelet count below 150 000/μL or presenting a decrease of 50% with respect to the previous value. Findings suggestive of vaccine-induced immune thrombotic thrombocytopaenia include the presence of antibodies to platelet factor 4, D-dimer levels 4 times greater than the upper limit of normal, and unexplained thrombosis. The recommended treatment includes intravenous administration of non-specific human immunoglobulin or alternatively plasmapheresis, avoiding the use of heparin, instead employing argatroban, bivalirudin, fondaparinux, rivaroxaban, or apixaban for anticoagulation, and avoiding platelet transfusion. CONCLUSIONS Non-replicating adenoviral vector vaccines may be associated with cerebral venous sinus thrombosis with thrombocytopaenia; it is important to treat the dysimmune phenomenon and the cerebral venous sinus thrombosis.
Collapse
|
85
|
Ciccone A. SARS-CoV-2 vaccine-induced cerebral venous thrombosis. Eur J Intern Med 2021; 89:19-21. [PMID: 34090750 PMCID: PMC8148433 DOI: 10.1016/j.ejim.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 12/13/2022]
Abstract
The nosological entity of the cerebral venous thrombosis caused by the SARS-CoV-2 vaccination differs from the common cerebral venous thrombosis in that it is due to immune thrombocytopenia triggered by vaccination. Cerebral venous thrombosis is one of several manifestations of this type of immune thrombocytopenia. Albeit many general aspects of management of cerebral venous thrombosis are similar, immune thrombocytopenia requires a specific therapeutic approach, which is not normally adopted for cerebral venous thrombosis due to other causes, therefore its early recognition is essential.
Collapse
Affiliation(s)
- Alfonso Ciccone
- Department of Neurology with neurosurgical activity and stroke unit, ASST di Mantova, Mantova, Italy.
| |
Collapse
|
86
|
Ghosh R, Roy D, Mandal A, Pal SK, Chandra Swaika B, Naga D, Pandit A, Ray BK, Benito-León J. Cerebral venous thrombosis in COVID-19. Diabetes Metab Syndr 2021; 15:1039-1045. [PMID: 34015627 PMCID: PMC8128714 DOI: 10.1016/j.dsx.2021.04.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Initially, novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) was considered primarily a respiratory pathogen. However, with time it has behaved as a virus with the potential to cause multi-system involvement, including neurological manifestations. Cerebral venous sinus thrombosis (CVT) has increasingly been reported in association with coronavirus infectious disease of 2019 (COVID-19). Here, we have shed light upon CVT and its possible mechanisms in the backdrop of the ongoing COVID-19 pandemic. METHODS In this review, data were collected from PubMed, EMBASE and Web of Science, until March 30, 2021, using pre-specified searching strategies. The search strategy consisted of a variation of keywords of relevant medical subject headings and keywords, including "COVID-19", "SARS-CoV-2", "coronavirus", and "cerebral venous sinus thrombosis". RESULTS COVID-19 has a causal association with a plethora of neurological, neuropsychiatric and psychological effects. CVT has gained particular importance in this regard. The known hypercoagulable state in SARS-CoV-2 infection is thought to be the main mechanism in COVID-19 related CVT. Other plausible mechanisms may include vascular endothelial dysfunction and altered flow dynamics. CONCLUSIONS Although there are no specific clinical characteristics, insidious or acute onset headache, seizures, stroke-like, or encephalopathy symptoms in a patient with, or who has suffered COVID-19, should prompt the attending physician to investigate for CVT. The treatment of COVID-19 associated CVT does not differ radically from the therapy of CVT without the infection, i.e. urgent initiation of parenteral unfractionated heparin or low molecular weight heparin followed by conventional or mostly newer oral anticoagulants.
Collapse
Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Arpan Mandal
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Shyamal Kanti Pal
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Bikash Chandra Swaika
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Dinabandhu Naga
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Alak Pandit
- Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain.
| |
Collapse
|
87
|
Furie KL, Cushman M, Elkind MSV, Lyden PD, Saposnik G. Diagnosis and Management of Cerebral Venous Sinus Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia. Stroke 2021; 52:2478-2482. [PMID: 33914590 DOI: 10.1161/strokeaha.121.035564] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Karen L Furie
- Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.)
| | - Mary Cushman
- Larner College of Medicine, University of Vermont, Burlington (M.C.)
| | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons, Columbia University, NY (M.S.V.E.)
| | | | - Gustavo Saposnik
- St. Michael's Hospital, University of Toronto, ON, Canada (G.S.)
| | | |
Collapse
|
88
|
Shahjouei S, Tsivgoulis G, Farahmand G, Koza E, Mowla A, Vafaei Sadr A, Kia A, Vaghefi Far A, Mondello S, Cernigliaro A, Ranta A, Punter M, Khodadadi F, Naderi S, Sabra M, Ramezani M, Amini Harandi A, Olulana O, Chaudhary D, Lyoubi A, Campbell BCV, Arenillas JF, Bock D, Montaner J, Aghayari Sheikh Neshin S, Aguiar de Sousa D, Tenser MS, Aires A, Alfonso MDL, Alizada O, Azevedo E, Goyal N, Babaeepour Z, Banihashemi G, Bonati LH, Cereda CW, Chang JJ, Crnjakovic M, De Marchis GM, Del Sette M, Ebrahimzadeh SA, Farhoudi M, Gandoglia I, Gonçalves B, Griessenauer CJ, Murat Hanci M, Katsanos AH, Krogias C, Leker RR, Lotman L, Mai J, Male S, Malhotra K, Malojcic B, Mesquita T, Mir Ghasemi A, Mohamed Aref H, Mohseni Afshar Z, Moon J, Niemelä M, Rezai Jahromi B, Nolan L, Pandhi A, Park JH, Marto JP, Purroy F, Ranji-Burachaloo S, Carreira NR, Requena M, Rubiera M, Sajedi SA, Sargento-Freitas J, Sharma VK, Steiner T, Tempro K, Turc G, Ahmadzadeh Y, Almasi-Dooghaee M, Assarzadegan F, Babazadeh A, Baharvahdat H, Cardoso FB, Dev A, Ghorbani M, Hamidi A, Hasheminejad ZS, Hojjat-Anasri Komachali S, Khorvash F, Kobeissy F, Mirkarimi H, Mohammadi-Vosough E, Misra D, Noorian AR, Nowrouzi-Sohrabi P, Paybast S, Poorsaadat L, Roozbeh M, Sabayan B, Salehizadeh S, Saberi A, Sepehrnia M, Vahabizad F, Yasuda TA, Ghabaee M, Rahimian N, Harirchian MH, Borhani-Haghighi A, Azarpazhooh MR, Arora R, Ansari S, Avula V, Li J, Abedi V, Zand R. SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group. Stroke 2021; 52:e117-e130. [PMID: 33878892 PMCID: PMC8078130 DOI: 10.1161/strokeaha.120.032927] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.
Collapse
Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.)
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Ashkan Mowla
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.).,Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Switzerland (A.V.S.)
| | - Arash Kia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York City, NY (A.K.)
| | - Alaleh Vaghefi Far
- Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy (S. Mondello)
| | | | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Martin Punter
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Faezeh Khodadadi
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Soheil Naderi
- Department of Neurosurgery (S.N.), Tehran University of Medical Sciences, Iran
| | - Mirna Sabra
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy)
| | - Mahtab Ramezani
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Ali Amini Harandi
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Oluwaseyi Olulana
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Durgesh Chaudhary
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Aicha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint-Denis, France (A.L.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.)
| | - Juan F Arenillas
- Department of Neurology, University of Valladolid, Spain (J.F.A., M.D.L.A.)
| | - Daniel Bock
- Department of Cardiology, Klinikum Frankfurt Höchst, Germany (D.B.)
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J. Montaner)
| | | | - Diana Aguiar de Sousa
- Department of Neurology (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S.)
| | - Matthew S Tenser
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Ana Aires
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | | | - Orkhan Alizada
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | | | - Gelareh Banihashemi
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | - Leo H Bonati
- Department of Neurology and Stroke Unit, University Hospital Basel, Switzerland (L.H.B.)
| | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC (J.J.C.)
| | - Miljenko Crnjakovic
- Intensive Care Unit, Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia (M.C.)
| | - Gian Marco De Marchis
- Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland (G.D.M.)
| | | | | | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Iran (M.F.)
| | | | - Bruno Gonçalves
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | - Christoph J Griessenauer
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Mehmet Murat Hanci
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.).,Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K.)
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany (C.K.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Lev Lotman
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Jeffrey Mai
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, DC (J. Mai)
| | - Shailesh Male
- Department of Neurosurgery, Vidant Medical Center, Greenville, NC (S. Male)
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Branko Malojcic
- Department of Neurology, TIA Clinic, University Hospital Centre Zagreb, Zagreb School of Medicine, University of Zagreb, Croatia (B.M.)
| | - Teresa Mesquita
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | | | - Hany Mohamed Aref
- Department of Neurology, Ain Shams University, Cairo, Egypt (H.M.A.)
| | - Zeinab Mohseni Afshar
- Infection Disease Research Center, Kermanshah University of Medical Sciences, Iran (Z.M.A.)
| | - Jusun Moon
- Department of Neurology, National Medical Center, Seoul, South Korea (J. Moon)
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Lawrence Nolan
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, South Korea (J.-H.P.)
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Sakineh Ranji-Burachaloo
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | - Nuno Reis Carreira
- Department of Internal Medicine (N.E.C.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Seyed Aidin Sajedi
- Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Iran (S.A.S.)
| | - João Sargento-Freitas
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal (J.S.-F.)
| | - Vijay K Sharma
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore (V.K.S.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.).,Department of Neurology, Heidelberg University Hospital, Germany (T.S.)
| | - Kristi Tempro
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | | | - Mostafa Almasi-Dooghaee
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Divisions of Vascular and Endovascular Neurosurgery (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran
| | | | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Iran (A.B.)
| | - Humain Baharvahdat
- Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Iran (H.B.)
| | | | - Apoorva Dev
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran
| | - Ava Hamidi
- Neurology Ward, Gheshm Hospital, Iran (A.H.)
| | - Zeynab Sadat Hasheminejad
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | | | - Fariborz Khorvash
- Neurology Department, Isfahan University of Medical Sciences, Iran (F. Khorvash)
| | - Firas Kobeissy
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy).,Program of Neurotrauma, Neuroproteomics and Biomarker Research, University of Florida (F. Kobeissy)
| | | | | | - Debdipto Misra
- Steele Institute of Health and Innovation, Geisinger Health System, PA (D.M.)
| | - Ali Reza Noorian
- Department of Neurology, Southern California Permanente Medical Group, Irvine, CA (A.R.N.)
| | | | - Sepideh Paybast
- Department of Neurology, Bou Ali Hospital, Qazvin University of Medical Sciences, Iran (S.P.)
| | - Leila Poorsaadat
- Department of Neurology, Arak University of Medical Sciences, Iran (L.P.)
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Roozbeh)
| | - Behnam Sabayan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (B.S.)
| | - Saeideh Salehizadeh
- Neurology Department, Salahadin Ayubi Hospital, Baneh, Iran (S. Salehizadeh)
| | - Alia Saberi
- Neurology Department, Poursina Hospital, Rasht, Guilan, Iran (S.A.S.N., A.S.)
| | - Mercedeh Sepehrnia
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | - Fahimeh Vahabizad
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | | | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Nasrin Rahimian
- Department of Neurology, Yasrebi Hospital, Kashan, Iran (N.R.)
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | | | | | - Rohan Arora
- Department of Neurology, Long Island Jewish Forest Hills, Queens, NY (R.A.)
| | - Saeed Ansari
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.)
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| |
Collapse
|
89
|
Ferrante E, Trimboli M, Petrecca G, Allegrini F. Cerebral venous thrombosis in spontaneous intracranial hypotension: A report of 8 cases and review of the literature. J Neurol Sci 2021; 425:117467. [PMID: 33894614 DOI: 10.1016/j.jns.2021.117467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/30/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial hypotension (SIH) raises difficult practical questions regarding the management of the two conditions. The first-line therapy for CVT is anticoagulation (AC); however, its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma, must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous system recanalization and good prognosis in SIH/CVT patients treated with epidural blood patch (EBP), the main treatment option for SIH, have been already described. METHODS We reviewed our cases of SIH complicated by CVT among a cohort of 445 SIH patients observed and treated during the last years. All published case reports and case series reporting patients with SIH and CVT were also ascertained and reviewed. RESULTS Eight (2%) out of 445 patients suffering with SIH, were also diagnosed with CVT. All patients observed had orthostatic headache, three of them experienced a change in their headache pattern over the SIH course. Six out of eight patients received both AC and EBP treatments. Two patients were treated using only AC or EBP. A bilateral subdural haematoma enlargement after 1 month of AC was observed in one case. Complete CVT recanalization after treatment was obtained in three patients, including two with multiple CVT at baseline; partial CVT recanalization was achieved in two patients. Three patients experienced no CVT recanalization. After 6-48 months' follow-up all patients were still asymptomatic. CONCLUSIONS The use of AC therapy should be weighed against the intracranial haemorrage risk and should be monitored carefully if initiated. Effective and prompt EBP, even without AC therapy, might lead to a good prognosis in selected cases.
Collapse
Affiliation(s)
- Enrico Ferrante
- Neurology Department, AOR San Carlo, Potenza (IT), Italy; Neurology Department, Alto Vicentino Hospital, AULSS 7 Pedemontana, Santorso (IT), Italy; Neurology Department, Niguarda Ca Granda Hospital, Milan (IT), Italy.
| | - Michele Trimboli
- Neurology Department, AOR San Carlo, Potenza (IT), Italy; Institute of Neurology Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro (IT), Italy.
| | | | - Francesco Allegrini
- Anesthesiology and Intensive Care Department, AOR San Carlo, Potenza (IT), Italy
| |
Collapse
|
90
|
Baduro Y, Ferro JM. Cerebral Venous Thrombosis in Sub-Saharan Africa: A Systematic Review. J Stroke Cerebrovasc Dis 2021; 30:105712. [PMID: 33812172 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The clinical epidemiology of cerebral venous thrombosis (CVT) in Sub-Saharan Africa is unknown. Such information may be relevant for service planning, prevention and for adapting existing CVT management guidelines to that zone of the World. AIMS Systematic review to describe the demography, associated conditions, clinical and neuroimaging features, treatment and outcome of CVT in Sub-Saharan Africa. SUMMARY OF REVIEW We searched MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials.gov and reference lists of included studies for studies reporting original data on CVT in sub-Saharan Africa. We included 20 observational studies describing 287 CVT patients, 11 case reports (13 patients) and 9 case series (274 patients). All studies had a high risk of bias. In case series 58.6 % of the patients were female, the most common associated condition was infection (63.1%), followed by oral contraceptives (7.3%), pregnancy/puerperium (6.2 %), and prothrombotic conditions (2.2%). CT was the most common method to diagnose CVT (85%). Ninety-nine percent (101/102) of patients reported in case series after the year 2000 were anticoagulated. In case series, 21/210 with information (10 %) patients died in the acute phase, while 60/129 with information (46.5%) recovered without sequels. CONCLUSIONS The low number of reported CVT cases from Sub-Saharan Africa suggests that CVT is either infrequent, not diagnosed or not reported. Infection is the most common risk factor. Most CVT cases were confirmed by CT alone. Almost all patients reported after year 2000 received anticoagulation. Death rate was higher than in high income countries.
Collapse
Affiliation(s)
- Yanina Baduro
- Serviço de Neurologia, Hospital Central de Maputo, Maputo, Mozambique
| | - José M Ferro
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital Santa Maria- CHULN, Lisboa, Portugal; Faculdade de Medicina, Universidade de Lisboa.
| |
Collapse
|
91
|
Alamlih L, Abdulgayoom M, Menik Arachchige SN, Shah MH, Zahid M. Chronic Headache and Cerebral Venous Sinus Thrombosis Due to Varicella Zoster Virus Infection: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927699. [PMID: 33727523 PMCID: PMC7983319 DOI: 10.12659/ajcr.927699] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient: Male, 20-year-old Final Diagnosis: Cerebral venous sinus thrombosis • varicella zoster virus infection Symptoms: Fever • headache • skin rash Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Rheumatology
Collapse
Affiliation(s)
- Laith Alamlih
- Rheumatology Section, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | | | | | | | - Muhammad Zahid
- Department of Medicine, Hamad General Hospital, Doha, Qatar.,Weill-Cornell Medicine, Doha, Qatar
| |
Collapse
|
92
|
Spadaro A, Scott KR, Koyfman A, Long B. Cerebral venous thrombosis: Diagnosis and management in the emergency department setting. Am J Emerg Med 2021; 47:24-29. [PMID: 33765589 DOI: 10.1016/j.ajem.2021.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon neurologic emergency associated with significant morbidity and mortality that can be difficult to differentiate from other conditions. It is important for the emergency clinician to be familiar with this disease as it requires a high index of suspicion, and early diagnosis and management can lead to improved outcomes. OBJECTIVE This narrative review provides an evidence-based update concerning the presentation, evaluation, and management of CVT for the emergency clinician. DISCUSSION CVT is due to thrombosis of the cerebral veins resulting in obstruction of venous outflow and increased intracranial pressure. Early recognition is important but difficult as the clinical presentation can mimic more common disease patterns. The most common patient population affected includes women under the age of 50. Risk factors for CVT include pregnancy, medications (oral contraceptives), inherited thrombophilia, prior venous thromboembolic event, malignancy, recent infection, and neurosurgery. CVT can present in a variety of ways, but the most common symptom is headache, followed by focal neurologic deficit, seizure, and altered mental status. Imaging studies such as computed tomography (CT) venography or magnetic resonance (MR) venography should be obtained in patients with concern for CVT, as non-contrast CT will be normal or have non-specific findings in most patients. Treatment includes anticoagulation, treating seizures and elevated ICP aggressively, and neurosurgical or interventional radiology consultation in select cases. CONCLUSIONS CVT can be a challenging diagnosis. Knowledge of the risk factors, patient presentation, evaluation, and management can assist emergency clinicians.
Collapse
Affiliation(s)
- Anthony Spadaro
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Kevin R Scott
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| |
Collapse
|
93
|
Guendouz C, Quenardelle V, Riou-Comte N, Welfringer P, Wolff V, Zuily S, Jager L, Humbertjean Selton L, Mione G, Pop R, Gory B, Richard S. Pathogeny of cerebral venous thrombosis in SARS-Cov-2 infection: Case reports. Medicine (Baltimore) 2021; 100:e24708. [PMID: 33725828 PMCID: PMC7969213 DOI: 10.1097/md.0000000000024708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Pathogeny of thrombosis in COVID-19 is related to interaction of SARS-Cov-2 with vascular wall through the angiotensin converting enzyme 2 (ACE2) receptor. This induces 2 pathways with immunothrombosis from activated endothelium (cytokine storm, leukocyte and platelet recruitment, and activation of coagulation extrinsic pathway), and rise of angiotensin II levels promoting inflammation. While thrombosis is widely described in COVID-19 patients admitted in intensive care unit, cerebrovascular diseases remains rare, in particular cerebral venous thrombosis (CVT). PATIENT CONCERNS We describe 2 cases of women admitted during the spring of 2020 for intracranial hypertension signs, in stroke units in Great-east, a French area particularly affected by COVID-19 pandemia. DIAGNOSES Cerebral imaging revealed extended CVT in both cases. The first case described was more serious due to right supratentorial venous infarction with hemorrhagic transformation leading to herniation. Both patients presented typical pneumonia due to SARS-Cov-2 infection, confirmed by reverse transcription polymerase chain reaction on a nasopharyngeal swab in only one. INTERVENTIONS The first patient had to undergo decompressive craniectomy, and both patients were treated with anticoagulation therapy. OUTCOMES Favorable outcome was observed for 1 patient. Persistent coma, due to bi thalamic infarction, remained for the other with more serious presentation. LESSONS CVT, as a serious complication of COVID-19, has to be searched in all patients with intracranial hypertension syndrome. Data about anticoagulation therapy to prevent such serious thrombosis in SARS-Cov-2 infection are lacking, in particular in patients with mild and moderate COVID-19.
Collapse
Affiliation(s)
- Cécile Guendouz
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERMU1116, Nancy
| | | | - Nolwenn Riou-Comte
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERMU1116, Nancy
| | | | - Valérie Wolff
- Stroke Unit, Strasbourg University Hospital, EA3072, Strasbourg
| | - Stéphane Zuily
- Université de Lorraine, Inserm, DCAC and CHRU-Nancy, Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Nancy
| | | | | | - Gioia Mione
- Department of Neurology, CHRU-Nancy, Stroke Unit, Nancy
| | - Raoul Pop
- Department of Interventional Neuroradiology, University Hospital of Strasbourg, Strasbourg
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, INSERM U1254, IADI, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERMU1116, Nancy
| |
Collapse
|
94
|
Ye Y, Ding J, Liu S, Huang S, Li Z, Yang J, Huang J. Impacts on Thrombus and Chordae Willisii During Mechanical Thrombectomy in the Superior Sagittal Sinus. Front Neurol 2021; 12:639018. [PMID: 33746891 PMCID: PMC7970025 DOI: 10.3389/fneur.2021.639018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022] Open
Abstract
The anatomical structures of the superior sagittal sinus (SSS) are usually damaged during mechanical thrombectomy (MT), and MT procedure could lead to new thrombosis in the sinuses. However, the mechanism remains unclear. We aimed to investigate the risks of embolism and assess the damage to chordae willisii (CW)-associated MT using a stent passing across the thrombus. A contrast-enhanced in vitro model was used to mimick MT in the SSS. The thrombus was removed with a stent. The emboli generated during the procedure were collected and measured. The residual thrombus area after the MT was measured by J Image software. The damage of CW was evaluated by an endoscope. Three procedural experiments were carried out on each cadaveric sample. The average numbers of visible emboli particles in experiments 1, 2, and 3 were 11.17 ± 2.17, 9.00 ± 2.07, and 5.00 ± 2.96, respectively. The number of large size particles produced by experiment 1 was significantly higher than that of the other experiments. The thrombus area measured after experiment 3 was larger than that of experiments 1 and 2. The number of minor damage cases to CW was 55 (90.16%), and there were six serious damage cases (9.84%). The use of stent resulted in no significant increase in damage to CW after the three experimental procedures. A large amount of thrombi particles was produced during MT, and multiple MT procedures on the same sample can increase residual thrombus area. Moreover, the stent caused minor damages to the CW in SSS.
Collapse
Affiliation(s)
- Yuanliang Ye
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Jiuyang Ding
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Shoutang Liu
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Shaoming Huang
- Department of Anatomy, Guangxi Medical University, Nanning, China
| | - Zhu Li
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Jianqing Yang
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, China
| | - Jiang Huang
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| |
Collapse
|
95
|
Evaluating thunderclap headache. Curr Opin Neurol 2021; 34:356-362. [PMID: 33661161 DOI: 10.1097/wco.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). There has been no consensus guideline regarding the diagnostic workup. This review aims to provide an update on the evaluation of TCH. RECENT FINDINGS The most important update in the 2019 American College of Emergency Physicians guideline for evaluation of acute headache in the emergency department is that negative noncontrast brain computed tomography (CT) findings within 6 h from ictus essentially excludes SAH. Additionally, the updated guideline recommends that after a negative brain CT, CT angiogram is a reasonable alternative to lumbar puncture if clinical suspicion of an intracranial source of SAH is high. An important update of reversible vasoconstriction syndrome (RCVS), the second most common etiology of TCH, is the RCVS2 score development based on clinical and radiological features, providing high specificity and sensitivity for distinguishing RCVS from other intracranial arteriopathies. SUMMARY Although the evaluation of TCH is exhaustive, the potentially catastrophic consequence of a missed diagnosis of sentinel headache justifies the efforts. Awareness of the clinical features and application of diagnostic tools specific for different pathological conditions can facilitate the diagnostic workup.
Collapse
|
96
|
Baldini T, Asioli GM, Romoli M, Carvalho Dias M, Schulte EC, Hauer L, Aguiar De Sousa D, Sellner J, Zini A. Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. Eur J Neurol 2021; 28:3478-3490. [PMID: 33426733 PMCID: PMC8014715 DOI: 10.1111/ene.14727] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection predisposes patients to arterial and venous thrombosis. This study aimed to systematically review the available evidence in the literature for cerebral venous thrombosis (CVT) in association with coronavirus disease-2019 (COVID-19). METHODS We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases to identify cases of COVID-19-associated CVT. The search period spanned 1 January 2020 to 1 December 2020, and the review protocol (PROSPERO-CRD42020214327) followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Identified studies were evaluated for bias using the Newcastle-Ottawa scale. A proportion meta-analysis was performed to estimate the frequency of CVT among hospitalized COVID-19 patients. RESULTS We identified 57 cases from 28 reports. Study quality was mostly classified as low. CVT symptoms developed after respiratory disease in 90%, and the mean interval was 13 days. CVT involved multiple sites in 67% of individuals, the deep venous system was affected in 37%, and parenchymal hemorrhage was found in 42%. Predisposing factors for CVT beyond SARS-CoV-2 infection were present in 31%. In-hospital mortality was 40%. Using data from 34,331 patients, the estimated frequency of CVT among patients hospitalized for SARS-CoV-2 infection was 0.08% (95% confidence interval [CI]: 0.01-0.5). In an inpatient setting, CVT accounted for 4.2% of cerebrovascular disorders in individuals with COVID-19 (cohort of 406 patients, 95% CI: 1.47-11.39). CONCLUSIONS Cerebral venous thrombosis in the context of SARS-CoV-2 infection is a rare, although there seems to be an increased relative risk. High suspicion is necessary, because the diagnosis of this potentially life-threatening condition in COVID-19 patients can be challenging. Evidence is still scarce on the pathophysiology and potential prevention of COVID-19-associated CVT.
Collapse
Affiliation(s)
- Tommaso Baldini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
| | - Gian Maria Asioli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
| | - Michele Romoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.,Neurology Clinic, University of Perugia-S. Maria della Misericordia Hospital, Perugia, Italy
| | - Mariana Carvalho Dias
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHLN, University of Lisbon, Lisbon, Portugal
| | - Eva C Schulte
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Virology, Technical University of Munich, Munich, Germany
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Diana Aguiar De Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHLN, University of Lisbon, Lisbon, Portugal
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
| |
Collapse
|
97
|
Juli C, Amalia L, Gamayani U, Atik N. D-Dimer Level Associates with the Incidence of Focal Neurological Deficits in Cerebral Venous Thrombosis Patients. J Blood Med 2020; 11:449-455. [PMID: 33364867 PMCID: PMC7751576 DOI: 10.2147/jbm.s283633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose D-dimer is one of the main coagulation factors that plays a role in some diseases. Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease with various clinical presentations, and the D-dimer might contribute to its clinical progress. Our study's objective was to explore the association between D-dimer level and focal neurological deficits in selected CVT patients. Patients and Methods The patients' data were retrospectively enrolled if they showed venous thrombus features in the digital subtraction angiography examination. Data collected were then evaluated using appropriate statistical tests. Results In a total of 30 patients, 24 patients had focal neurological deficits with abnormal D-dimer (mean 1.13±1.359 mg/L). We continued analysis to determine the association between the visual analog scale (VAS), a tool to measure the patient's pain, and coagulation factors. There was no significant association between the VAS score and all the coagulation factors. Interestingly, a positive association was found between focal neurological deficits and abnormal D-dimer levels (p=0.009). Conclusion The abnormality of D-dimer levels in CVT's patients associates with the incidence of focal neurological deficits.
Collapse
Affiliation(s)
- Cep Juli
- Department of Neurology, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Lisda Amalia
- Department of Neurology, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Uni Gamayani
- Department of Neurology, Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Nur Atik
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
98
|
Krajíčková D, Král J, Herzig R, Klzo Ľ, Krajina A, Havelka J, Šimůnek L, Vyšata O, Van Quang T, Bar M, Vališ M. Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis. Sci Rep 2020; 10:21633. [PMID: 33303787 PMCID: PMC7728772 DOI: 10.1038/s41598-020-78434-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022] Open
Abstract
We aimed was to assess the factors influencing therapy choice and clinical outcome after 3-4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3-4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0-1). Multivariate logistic regression analysis was used for statistical evaluation. After 3-4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.
Collapse
Affiliation(s)
- Dagmar Krajíčková
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Jiří Král
- Department of Neurology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic.,Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, 656 91, Brno, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Ľudovít Klzo
- Department of Radiology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Antonín Krajina
- Department of Radiology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Jaroslav Havelka
- Department of Radiology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic
| | - Libor Šimůnek
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Oldřich Vyšata
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Tran Van Quang
- Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University, 160 00, Prague, Czech Republic
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic
| | - Martin Vališ
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic.
| |
Collapse
|
99
|
Yuan L, Yuan J, Sun Y, Wang Y. The Anticoagulant Therapy for Otogenic Sigmoid Sinus Thrombophlebitis: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 101:NP379-NP382. [PMID: 33236644 DOI: 10.1177/0145561320976405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sigmoid sinus thrombophlebitis is a severe and potentially fatal intracranial complication of acute otitis media and middle ear cholesteatoma. Early administration of broad-spectrum antibiotics and immediate radical mastoidectomy are the recommended standard treatments; however anticoagulant therapy is always an option worthy of clinical consideration. Here, we report a case of middle ear cholesteatoma complicated with sigmoid sinus thrombophlebitis in a patient who received anticoagulant therapy for 1 year before the operation because of the coronavirus disease 2019 pandemic.
Collapse
Affiliation(s)
- Lanlai Yuan
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yuan
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yanjun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
100
|
Ding R, Ou W, Chen C, Liu Y, Li H, Zhang X, Chai H, Ding X, Wang Q. Endoplasmic reticulum stress and oxidative stress contribute to neuronal pyroptosis caused by cerebral venous sinus thrombosis in rats: Involvement of TXNIP/peroxynitrite-NLRP3 inflammasome activation. Neurochem Int 2020; 141:104856. [PMID: 32980492 DOI: 10.1016/j.neuint.2020.104856] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/06/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke, which is life-threatening in severe cases. However, considerably less attention has been concentrated on the mechanism of neural cell damage after CVST. This study aims to investigate the role of endoplasmic reticulum stress, oxidative stress, and pyroptosis in a well-established rodent model of CVST. Rat brains were harvested at 0 h, 6 h, days 1, days 3, days 7, and days 14 post-CVST for measurement of corresponding indexes. Endoplasmic reticulum stress sensors (including protein kinase RNA-like ER kinase (PERK) and inositol-requiring enzyme-1α (IRE1α)), oxidative stress markers (thioredoxin-interacting protein (TXNIP) and peroxynitrite), NLRP3, caspase p20, IL-1β, and gasdermin D (GSDMD, an indicator of pyroptosis) were separately evaluated by Western-blot and Immunohistochemistry/Immunofluorescence. Co-immunoprecipitation and Fluorescent double-labeling were employed to probe into the relationship between TXNIP/peroxynitrite and NLRP3 inflammasome. In the damaged cortex region, profuse p-PERK, p-IRE1α, TXNIP were produced and predominantly localized in neurons accompanied by a small amount expressed in microglia and astrocytes. The levels of 3-nitrotyrosine (3-NT, as a footprint of peroxynitrite), NLRP3, caspase p20, IL-1β, and GSDMD were distinctly elevated post-CVST and cellular localization of peroxynitrite, NLRP3, caspase p20, and IL-1β was largely observed in neurons and/or microglia. Importantly, sites of enhanced TXNIP and 3-NT immunoreactivity were colocalized with increased NLRP3 staining, indicating the involvement of TXNIP and peroxynitrite in NLRP3 inflammasome activation and subsequent pyroptosis. Besides, co-immunoprecipitation also hinted that there might be an interaction or causality between TXNIP/peroxynitrite and NLRP3 inflammasome. We concluded that endoplasmic reticulum stress and oxidative stress may jointly lead to neuronal NLRP3 inflammasome activation and pyroptosis after CVST.
Collapse
Affiliation(s)
- Rui Ding
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Weiyang Ou
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
| | - Chengwei Chen
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Yaqi Liu
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Haiyan Li
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xifang Zhang
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China
| | - Huihui Chai
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xiaowen Ding
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Qiujing Wang
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China.
| |
Collapse
|