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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.
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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.
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102
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Wong AK, Wong RH. Successful treatment of superior sagittal sinus thrombosis after translabyrinthine resection of metastatic neuroendocrine tumor: A case report and review of literature. Surg Neurol Int 2020; 11:410. [PMID: 33365173 PMCID: PMC7749965 DOI: 10.25259/sni_656_2020] [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: 09/18/2020] [Accepted: 11/07/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Postoperative cerebral venous sinus thrombosis (pCVST) after resection of cerebellopontine angle and posterior fossa tumor resections occur almost exclusively in the lateral venous sinuses and are generally asymptomatic. Thrombus extension and involvement of the superior sagittal sinus (SSS) – a serious and potentially devastating complication – are rarely described and, as such, successful treatment for which is still poorly understood. We report a case of pCVST involving the SSS after translabyrinthine approach for resection of a metastatic neuroendocrine tumor (NET), and the first that was successfully treated with anticoagulation therapy. Case Description: A 40-year-old man presented with headaches, diminished right-sided hearing, and ataxia was found to have a large right-sided cerebellopontine angle (CPA) lesion with extra-axial and possible intraparenchymal invasion. A retrosigmoid craniotomy for debulking and diagnosis was undertaken. Postoperative imaging revealed patent venous sinuses. Pathology confirmed NET. Further imaging revealed a likely pancreatic primary lesion. The patient then underwent subsequent translabyrinthine approach for definitive surgical resection. Postoperative imaging again revealed patent venous sinuses. The patient subsequently developed headaches on postoperative day 10 and was found to have pCVST involving the ipsilateral internal jugular to the SSS. The patient was started on therapeutic heparin with significant improvement in pCVST and symptoms. Conclusion: Extensive pCVST involving the SSS after CPA and posterior fossa tumor resections is extremely rare. Initial management with anticoagulation can yield promising results and should be initiated early in the clinical course unless otherwise contraindicated.
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Affiliation(s)
- Andrew K Wong
- Department of Neurosurgery, Rush University Medical Center, Chicago, United States
| | - Ricky H Wong
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, United States
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103
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Dakay K, Cooper J, Bloomfield J, Overby P, Mayer SA, Nuoman R, Sahni R, Gulko E, Kaur G, Santarelli J, Gandhi CD, Al-Mufti F. Cerebral Venous Sinus Thrombosis in COVID-19 Infection: A Case Series and Review of The Literature. J Stroke Cerebrovasc Dis 2020; 30:105434. [PMID: 33190109 PMCID: PMC7833244 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105434] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2, the virus responsible for novel Coronavirus (COVID-19) infection, has recently been associated with a myriad of hematologic derangements; in particular, an unusually high incidence of venous thromboembolism has been reported in patients with COVID-19 infection. It is postulated that either the cytokine storm induced by the viral infection or endothelial damage caused by viral binding to the ACE-2 receptor may activate a cascade leading to a hypercoaguable state. Although pulmonary embolism and deep venous thrombosis have been well described in patients with COVID-19 infection, there is a paucity of literature on cerebral venous sinus thrombosis (cVST) associated with COVID-19 infection. cVST is an uncommon etiology of stroke and has a higher occurrence in women and young people. We report a series of three patients at our institution with confirmed COVID-19 infection and venous sinus thrombosis, two of whom were male and one female. These cases fall outside the typical demographic of patients with cVST, potentially attributable to COVID-19 induced hypercoaguability. This illustrates the importance of maintaining a high index of suspicion for cVST in patients with COVID-19 infection, particularly those with unexplained cerebral hemorrhage, or infarcts with an atypical pattern for arterial occlusive disease.
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Affiliation(s)
- Katarina Dakay
- Department of Neurosurgery, New York Medical College, 100 Woods Rd, Valhalla, NY 10595, United States.
| | - Jared Cooper
- Department of Neurosurgery, New York Medical College, 100 Woods Rd, Valhalla, NY 10595, United States.
| | | | - Philip Overby
- Department of Neurology, New York Medical College, United States; Department of Pediatrics, New York Medical College, United States.
| | - Stephan A Mayer
- Department of Neurosurgery, New York Medical College, 100 Woods Rd, Valhalla, NY 10595, United States; Department of Neurology, New York Medical College, United States
| | - Rolla Nuoman
- Department of Neurology, New York Medical College, United States; Department of Pediatrics, New York Medical College, United States.
| | - Ramandeep Sahni
- Department of Neurology, New York Medical College, United States.
| | - Edwin Gulko
- Department of Diagnostic Imaging, Division of Neuroradiology, New York Medical College, United States.
| | - Gurmeen Kaur
- Department of Neurosurgery, New York Medical College, 100 Woods Rd, Valhalla, NY 10595, United States.
| | - Justin Santarelli
- Department of Neurosurgery, New York Medical College, 100 Woods Rd, Valhalla, NY 10595, United States.
| | - Chirag D Gandhi
- Department of Neurosurgery, New York Medical College, 100 Woods Rd, Valhalla, NY 10595, United States.
| | - Fawaz Al-Mufti
- Department of Neurosurgery, New York Medical College, 100 Woods Rd, Valhalla, NY 10595, United States; Department of Neurology, New York Medical College, United States.
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104
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Cerebral venous thrombosis in Argentina: clinical presentation, predisposing factors, outcomes and literature review. J Stroke Cerebrovasc Dis 2020; 29:105145. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
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105
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Wang Y, Zhao C, Huang D, Sun B, Wang Z. Stent retriever thrombectomy combined with long-term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis. Exp Ther Med 2020; 20:66. [PMID: 32963596 PMCID: PMC7490800 DOI: 10.3892/etm.2020.9194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/10/2020] [Indexed: 01/21/2023] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare disease associated with high disability and mortality rates. A subset of patients do not respond to standard anticoagulation therapy, leading to the progression of CVST with hemorrhagic stroke, which represents a major challenge for its treatment. Severe hemorrhagic (SH)-CVST is life-threatening due to large hematoma, edema and/or cerebral hernia. Anticoagulation or thrombolytic therapy alone may lead to further aggravation of the hematoma. Stent retriever thrombectomy combined with long-term local thrombolysis (SRT-LLT) has been used in certain centers for those refractory cases or patients with new intracranial hemorrhage. However, to date, no studies on SRT-LLT treatment specifically for SH-CVST have been performed. The aim of the present retrospective study was to specifically evaluate the effectiveness of SRT-LLT in SH-CVST. Between December 2013 and November 2018, SRT-LLT was performed at our center in 8 patients with hemorrhagic CVST who did not respond to intravenous anticoagulation. The clinical characteristics, results of the radiological evaluation, details on the surgical procedure and clinical outcomes were assessed. The patients were administered systemic intravenous anticoagulation as the initial treatment following admission. SRT-LLT was performed when their condition deteriorated with a high risk of a fatal outcome within a short time period. SRT-LLT was performed in 8 patients, with successful recanalization confirmed by angiography. In 4 of the patients, complete recanalization was achieved, whereas in the remaining 4, recanalization was partial. There were no intraoperative complications. Two patients developed rebleeding after surgery, but they all gradually recovered. There were no treatment-associated fatalities. Therefore, SRT-LLT appears to be a feasible, safe and effective option for SH-CVST and it may be used as rescue therapy for carefully selected patients with SH-CVST.
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Affiliation(s)
- Yihua Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Cuiping Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Dezhang Huang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Bin Sun
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Zhigang Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
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106
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Sullinger DP, Cho SM, Farrokh S. Prolonged Intra-Sinus Alteplase Infusion in Severe Case of CVST. J Pharm Pract 2020; 35:140-147. [PMID: 32924755 DOI: 10.1177/0897190020958260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon condition accounting for 0.5-1% of all strokes. It occurs more commonly in women, particularly in the age group of 20-40 years of age due to pregnancy and oral contraceptive use. Systemic anticoagulation is recommended as first line treatment but 10-20% of patients deteriorate despite medical treatment and require surgical or endovascular interventions. We summarize a 41-year-old female with a past medical history of acute disseminated encephalomyelitis who presented with headaches and worsening mental status. Further workup confirmed inferior sagittal sinus thrombus with intraventricular hemorrhage for which she was initiated on heparin continuous infusion. Due to worsening of clot burden and cerebral edema, a right frontal external ventricular drain was placed in addition to medical management of elevated ICP. Intravenous heparin infusion was stopped intermittently for such procedures. However, even when heparin was continued, sub-therapeutic and supra-therapeutic ranges were commonly observed, making anticoagulation management challenging. A new left-sided EVD had to be placed after increased IVH and worsening of hydrocephalus due to clotting. Due to patient's clinical worsening, a microcatheter was placed in the straight sinus and continuous alteplase via intra-sinus catheter was initiated at a rate of 1 mg/hour. This was continued for 72 hours in addition to the continuous heparin infusion. Additionally, she received intraventricular alteplase 1 mg x 3 doses for IVH. Unfortunately, she continued to deteriorate despite maximal medical therapy. She was made comfort care and expired.
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Affiliation(s)
- Danine P Sullinger
- Critical Care and Surgery Pharmacy, 1501Johns Hopkins Hospital, Baltimore MD, USA
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesia and Critical Care Medicine, USA
| | - Salia Farrokh
- Critical Care and Surgery Pharmacy, 1501Johns Hopkins Hospital, Baltimore MD, USA
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107
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Trapani S, Stivala M, Lasagni D, Rosati A, Indolfi G. Otogenic Lateral Sinovenous Thrombosis in Children: A Case Series from a Single Centre and Narrative Review. J Stroke Cerebrovasc Dis 2020; 29:105184. [PMID: 32912560 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105184] [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: 06/11/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
Abstract
AIM We aimed to describe otogenic lateral sinovenous thrombosis (OLST), a rare, potentially life-threatening complication of otomastoiditis. METHODS Children diagnosed with OLST in a tertiary-care Hospital from 2014 to 2019 was retrospectively selected. Clinical and radiological features, timing of diagnosis, treatment and outcome are reported. RESULTS Seven children (5 males) were studied. Fever and neurological symptoms (headache, lethargy, diplopia, dizziness and papilledema) were always present. Otalgia and/or otorrhea were found in 6 children; none had signs of mastoiditis. Diagnosis was reached after 7 days (median) from clinical onset. Brain CT-scan was performed in 5 children being diagnostic for 3. Venography-MRI detected OLST and mastoiditis in all cases without parenchymal lesions. Treatment was based on intravenous rehydration, antibiotic and low-molecular weight heparin; acetazolamide was added in 3 children. Mastoidectomy and ventriculoperitoneal-shunting were selectively performed. Patients were discharged after 26 days (median). Follow-up neuroimaging showed sinus recanalization after a median time of 6 months. CONCLUSION A multidisciplinary approach is needed to optimize diagnostic-therapeutic protocols of pediatric OLST.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, Paediatric Unit, Meyer Children's University Hospital, Viale Pieraccini 24, Florence 50139, Italy.
| | - Micol Stivala
- Paediatric Unit, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy.
| | - Donatella Lasagni
- Paediatric Unit, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy.
| | - Anna Rosati
- Child Neurology Unit, Meyer Children's Hospital, Viale Pieraccini, 24 Florence 50139, Italy.
| | - Giuseppe Indolfi
- Professor NEUROFARBA Department, Meyer Children's Hospital, Viale Pieraccini 24, Florence 50139, Italy.
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108
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Sugiyama Y, Tsuchiya T, Tanaka R, Ouchi A, Motoyama A, Takamoto T, Hara N, Yanagawa Y. Cerebral venous thrombosis in COVID-19-associated coagulopathy: A case report. J Clin Neurosci 2020; 79:30-32. [PMID: 33070913 PMCID: PMC7377797 DOI: 10.1016/j.jocn.2020.07.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 12/15/2022]
Abstract
COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China in December 2019, and is ongoing pandemic. While a majority of patients with SARS-CoV-2 infection shows asymptomatic or mild disease, hospitalized patients can develop critical condition, such as pneumonia, sepsis, and respiratory failure. Some cases deteriorate into sever systemic disease and multiorgan failure. Many patients of severe COVID-19 show hypercoagulable state and complicate with venous thromboembolism and atrial thrombosis. We herein reported a case of COVID-19 who developed cerebral venous thrombosis (CVT) co-incidence with pulmonary thromboembolism (PTE). A 56-year-old Japanese man was presented with fever and malaise and diagnosed with COVID-19. He was treated with ciclesonide and azithromycin, but his respiratory condition deteriorated. Thus, systemic corticosteroids and favipiravir were initiated and these treatments resulted in afebrile state, improving malaise and respiratory failure. However, he suddenly developed severe headache and vomiting with increased concentration of D-dimer. Brain CT and MRI showed typical images of CVT in the left transvers sinus and CT pulmonary angiography showed PE. Administration of unfractionated heparin followed by edoxaban treatment reduced the levels of D-dimer and improved his clinical presentation and thrombosis. Monitoring coagulopathy is important in COVID-19 patients and in case of venous thromboembolism, including cerebral venous system, appropriate anticoagulant therapy should be initiated.
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Affiliation(s)
- Yohsuke Sugiyama
- Department of Respiratory Medicine, National Hospital Organization Kobe Medical Center, Japan.
| | - Takaaki Tsuchiya
- Department of Respiratory Medicine, National Hospital Organization Kobe Medical Center, Japan
| | - Ryota Tanaka
- Stroke Center and Division of Neurology, Department of Medicine, Jichi Medical University, Japan
| | - Aiko Ouchi
- Department of Respiratory Medicine, National Hospital Organization Kobe Medical Center, Japan
| | - Arata Motoyama
- Department of Radiology, National Hospital Organization Kobe Medical Center, Japan
| | - Takeshi Takamoto
- Department of Neurosurgery, National Hospital Organization Kobe Medical Center, Japan
| | - Natsumi Hara
- Department of Respiratory Medicine, National Hospital Organization Kobe Medical Center, Japan
| | - Yoshitaka Yanagawa
- Department of Respiratory Medicine, National Hospital Organization Kobe Medical Center, Japan
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109
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Yeo LLL, Lye PPS, Yee KW, Cunli Y, Ming TT, Ho AFW, Sharma VK, Chan BPL, Tan BYQ, Gopinathan A. Deep Cerebral Venous Thrombosis Treatment. Clin Neuroradiol 2020; 30:661-670. [DOI: 10.1007/s00062-020-00920-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022]
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110
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Komro J, Findakly D. Cerebral Venous Sinus Thrombosis in Adults with Prothrombotic Conditions: A Systematic Review and a Case from Our Institution. Cureus 2020; 12:e7654. [PMID: 32411555 PMCID: PMC7217592 DOI: 10.7759/cureus.7654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare condition characterized by elevated intracranial pressure due to impaired cerebral venous drainage, potentially leading to life-threatening consequences. We searched the PubMed electronic database for ‘cerebral venous sinus thrombosis’ and ‘prothrombotic’ cases reported in adults (19+ years) and conducted a systematic review for the published literature in the English language pooled with a case from our institution. Data were analyzed regarding patient demographics, risk factors, clinical features, treatment modalities, and outcomes when available. Thirty cases of CVST were identified (29 case reports, of whom two were described in a case series, and the one case from our institution). The patients’ mean age was 39 years (range: 19 - 65). The male: female ratio was 1.14:1. The majority (73.3%) had at least one preexisting risk factor, with prescription drug use being the most common risk factor (33.3%) shared among all patients. Most patients (83.3%) presented with at least two symptoms. The most common presenting symptoms were headache (70%), gastrointestinal disturbance (50%), and seizures (40%). Focal deficits (36.7%), vision disturbances (30%), and altered consciousness (20%) were the remaining presenting complaints. Twelve cases (40%) commented on papilledema, with 10 (83.3%) having papilledema present. Anticoagulation abnormalities were examined in 26 cases (86.7%), out of which four cases (15.4%) had isolated protein S (PS) deficiency, three cases (11.5%) had isolated antithrombin III (ATIII) deficiency, and one case (3.8%) had isolated protein C (PC) deficiency. The most common initial imaging modality (22 cases, 73.3%), and most commonly used overall (23 cases, 76.7%), was computed tomography (CT). Magnetic resonance imaging (MRI) was the second most common imaging modality for initial use (five cases, 16.7%), diagnosis or confirmation of CVST (eight cases, 26.7%), and overall (21 cases, 70%). Heparin treatment was involved in the treatment of 18 cases (60%), and warfarin treatment was used in 10 cases (33.3%). Heparin-warfarin combination treatment was utilized in eight cases (26.7%). Most patients survived (28 cases, 93.3%), while the two remaining patients died secondary to brain death from the CVST (6.7%). The findings from this study highlight the clinical characteristics of CVST. Therefore, this study aims to increase awareness of this rare entity. Physicians should maintain a high index of suspicion in order to diagnose patients presenting in the proper clinical context, given this case shares various forms of presentations with other common clinical conditions but requires long-term anticoagulation.
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Affiliation(s)
- Jack Komro
- Internal Medicine, Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, USA
| | - Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
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111
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Riva N, Ageno W. Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions. J Clin Med 2020; 9:E743. [PMID: 32164214 PMCID: PMC7141239 DOI: 10.3390/jcm9030743] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/03/2020] [Accepted: 03/08/2020] [Indexed: 02/07/2023] Open
Abstract
Cerebral vein thrombosis (CVT) and splanchnic vein thrombosis (SVT) are two manifestations of venous thromboembolism (VTE) at unusual sites. They have an incidence at least 25-50 times lower than usual site VTE, but represent true clinical challenges. Recent evidence on the epidemiology, risk factors, prognosis, and treatment of CVT and SVT has been published in the last two decades, thus contributing to a better understanding of these diseases. The improvement in imaging techniques and a higher degree of clinical suspicion may have led to the observed increased frequency, whereas a better knowledge of provoking mechanisms could have contributed to reducing the proportion of events classified as unprovoked or idiopathic (13%-21% of CVT, 15%-27% of SVT). Few small randomized clinical trials and a number of observational studies, although hampered by heterogeneous therapeutic approaches, shed light on the safety and effectiveness of anticoagulant therapy in these populations. However, there are still some grey areas that warrant future research. In this narrative review, we discuss recent advances and therapeutic challenges in CVT and SVT.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida MSD2080, Malta;
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida MSD2080, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
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112
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Yang S, You R, Wu W, Wei Z, Hong M, Peng Z. Dural Arteriovenous Fistula Complicated with Cerebral Venous Sinus Thrombosis. World Neurosurg 2020; 134:348-352. [PMID: 31639507 DOI: 10.1016/j.wneu.2019.10.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is always confused with dural arteriovenous fistula (DAVF) in clinical practice; however, both of them are very rare cerebral vascular diseases. In this report, we provide one case of DAVF combined with CVST. CASE DESCRIPTION A 75-year-old woman complained of headache with nausea and vomiting for 4 days. Magnetic resonance venography revealed filling defect in the torcular, left transverse, and sigmoid sinus, which strongly suggested sinus thrombosis. The patient underwent anticoagulation treatment for 9 days. However, the manifestation was not alleviated, magnetic resonance imaging detected the lesion was enlarged, and the midline shifted to the left. Digital subtraction angiography examination detected that one fistula classified as Borden type IA was fed by the left superficial temporal artery and drained into the left transverse and sigmoid sinus. Endovascular embolization with ethylene vinyl alcohol was conducted. CONCLUSIONS Follow-up at 6 months indicated that the patient recovered without any sequelae.
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Affiliation(s)
- Sujuan Yang
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Rongjiao You
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Weifeng Wu
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhisheng Wei
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Mingfan Hong
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhongxing Peng
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
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113
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Risk factors for early-onset seizures in patients with cerebral venous sinus thrombosis: A meta-analysis of observational studies. Seizure 2019; 72:33-39. [DOI: 10.1016/j.seizure.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/13/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
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114
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Maksimova MY, Dubovitskaya Y, Krotenkova MV, Shabalina AA. Prothrombogenic polymorphic variants of hemostatic and folate metabolism genes In patients with aseptic cerebral venous thrombosis. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2019. [DOI: 10.24075/brsmu.2019.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cerebral venous sinus thrombosis (CVT) becomes the cause of stroke in less than 1% of patients. In 20-30% of patients, the cause of thrombosis remains unclear, and thrombosis is considered idiopathic. Inherited hypercoagulable conditions significantly increase the risk of CVT. The aim of the study was to evaluate the frequency of prothrombogenic polymorphic variants of hemostatic and methionine-homocysteine metabolism genes alleles and genotypes in patients with aseptic CVT. Fifty one patients aged 18–75 with aseptic CVT were examined. The control group included 36 healthy volunteers. Neuroimaging methods included brain MRI in standard modes (T1, T2, T2 d-f (FLAIR), DWI) and MR venosinusography. All patients were surveyed to identify carriers of prothrombogenic polymorphic variants of hemostatic and folate metabolism genes alleles and genotypes. Prothrombogenic polymorphic variants of hemostatic genes were detected in 94% of patients, and the variants of the methionine-homocysteine metabolism genes were observed in 86% of patients. The differences between distributions of alleles and genotypes 5G6754G of the PAI-1 gene, G103T of the FXIIIA1 gene, A66G of the MTRR gene, A2756G of the MTR gene in the group of patients with CVT and in the control group were significant. Allele 4G, genotypes 4G/4G and 5G/4G of 5G6754G polymorphism of the PAI-1 gene; allele T of G103Т polymorphism of the FXIIIA1 gene; allele G and genotype A/G of A66G polymorphism of the MTRR gene; allele G and genotype A/G of A2756G polymorphism of the MTR gene correlated with aseptic CVT. It was concluded that the gene polymorphisms 5G6754G (PAI-1), G103T (FXIIIA1), A66G (MTRR) and A2756G (MTR) carriage increased the risk of aseptic CVT and did not affect the thrombosis clinical manifestations.
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115
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Deskur A, Zawada I, Błogowski W, Starzyńska T. Cerebral venous sinus thrombosis in a young patient with ulcerative colitis: A case report. Medicine (Baltimore) 2019; 98:e17428. [PMID: 31593096 PMCID: PMC6799827 DOI: 10.1097/md.0000000000017428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Cerebral venous sinus thrombosis (CVST) represents one of the most alarming forms of hemostatic abnormalities that may occur in patients with inflammatory bowel diseases (IBDs). PATIENT CONCERNS Here we report a case of a 25-year-old male with ulcerative colitis, who developed such thromboembolic complication during flare of the disease. CVST in our patient was clinically manifested by headache and nausea. DIAGNOSIS Angio-magnetic resonance imaging scan of the head revealed segments of contrast filling defects/absence indicating right dural venous sinus thrombosis of the transverse sinus. INTERVENTION Immediate treatment with low-molecular-weight heparin has been introduced and led to full remission of symptoms and total recanalization of the thrombotic cerebral regions. OUTCOMES Currently (over 2 years after diagnosis) the patient is in remission of the disease, and no further thromboembolic complications have been observed. LESSONS Our case study highlights the clinical difficulties and challenges associated with diagnosis and treatment of CVST, as well as presents the current state of knowledge about this complication among patients with IBDs. Physicians taking care of IBD patients should be aware of this alarming hemostatic abnormality.
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Affiliation(s)
- Anna Deskur
- Department of Gastroenterology, Pomeranian Medical University, Szczecin
| | - Iwona Zawada
- Department of Gastroenterology, Pomeranian Medical University, Szczecin
| | - Wojciech Błogowski
- Department of Internal Medicine, University of Zielona Góra, Zielona Góra, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Pomeranian Medical University, Szczecin
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116
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Kenet G, Cohen O, Bajorat T, Nowak-Göttl U. Insights into neonatal thrombosis. Thromb Res 2019; 181 Suppl 1:S33-S36. [DOI: 10.1016/s0049-3848(19)30364-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 02/07/2023]
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117
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Li B, Heldner MR, Arnold M, Coutinho JM, Zuurbier SM, Meijers JCM, Kohler HP, Schroeder V. Coagulation Factor XIII in Cerebral Venous Thrombosis. TH OPEN 2019; 3:e227-e229. [PMID: 31338488 PMCID: PMC6645911 DOI: 10.1055/s-0039-1693487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/07/2019] [Indexed: 11/02/2022] Open
Affiliation(s)
- Bojun Li
- Department for BioMedical Research (DBMR), Experimental Haemostasis Group, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, University Hospital Inselspital, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Inselspital, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Susanna M Zuurbier
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, The Netherlands
| | - Hans P Kohler
- Department for BioMedical Research (DBMR), Experimental Haemostasis Group, University of Bern, Bern, Switzerland
| | - Verena Schroeder
- Department for BioMedical Research (DBMR), Experimental Haemostasis Group, University of Bern, Bern, Switzerland
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118
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Lu G, Shin JH, Song Y, Lee DH. Stenting of symptomatic lateral sinus thrombosis refractory to mechanical thrombectomy. Interv Neuroradiol 2019; 25:714-720. [PMID: 31132906 DOI: 10.1177/1591019919852168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Endovascular mechanical thrombectomy for the treatment of cerebral venous sinus thrombosis is not always successful. We present our experience of using self-expanding stents to facilitate effective recanalization of persistent lateral sinus thrombosis refractory to endovascular mechanical thrombectomy. METHODS Data from patients who underwent endovascular mechanical thrombectomy for the treatment of acute symptomatic cerebral venous sinus thrombosis between August 2015 and July 2018 were evaluated. Patient demographics, procedural techniques, devices used and follow-up outcomes were assessed. RESULTS A total of 14 patients underwent endovascular mechanical thrombectomy during the study period. Of these, stenting of the occluded sinus was performed in five patients with extensive sinus thrombosis after conventional endovascular mechanical thrombectomy. Three of the five patients had a variable degree of venous infarction and/or hemorrhage before treatment. The target lesion was located in the right lateral sinus in all five patients. Due to the length of the involved sinus, two stents were required in one patient and three stents in two patients. The only procedure-related complication was an asymptomatic tearing of the sinus wall in one patient. Stent patency could not be maintained in two patients due to stent buckling within the jugular foramen segment and an inability to maintain antiplatelet medication. Modified Rankin Scale scores at 2-16 months were zero in two patients, one in two patients, and five in one patient. CONCLUSIONS Stenting for the thrombotic occlusion of the lateral sinus is a feasible rescue method to overcome unsuccessful endovascular mechanical thrombectomy. However, currently available stenting systems may be unsuitable for use in the intracranial dural sinus system.
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Affiliation(s)
- Guangdong Lu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea.,Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jae Ho Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
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119
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Yang X, Wu F, Liu Y, Duan J, Meng R, Chen J, Li D, Fan Z, Fisher M, Yang Q, Ji X. Predictors of successful endovascular treatment in severe cerebral venous sinus thrombosis. Ann Clin Transl Neurol 2019; 6:755-761. [PMID: 31020000 PMCID: PMC6469256 DOI: 10.1002/acn3.749] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/08/2022] Open
Abstract
Objective The objective of this study was to evaluate the thrombus characteristics affecting the extent of recanalization to identify patients with severe cerebral venous sinus thrombus (CVT) more likely to benefit from endovascular therapy. Methods Severe CVT patients scheduled for endovascular treatment were prospectively recruited into the study. Each thrombosed venous segment was evaluated regarding complete or partial recanalization based on digital subtraction angiography (DSA) after treatment. Magnetic resonance black‐blood thrombus imaging (MRBTI) was performed 1 day before endovascular treatment. The signal‐to‐noise ratio (SNR) of the clot, age of the clot, and baseline volume of the clot were compared between the complete and partial recanalization groups. A logistic regression analysis was performed to identify the association between these clot characteristics and recanalization status. Results Twenty‐one CVT patients undergoing endovascular therapy were prospectively included. There were 110 thrombosed segments, 54 of these segments were completely recanalized after endovascular treatment. An acute clot sign (ACS) was found in 39 segments and a subacute clot sign (SCS) was found in 71 segments. There was no significant difference on baseline volume of the clot (1638.8 ± 1432.2 mm3 vs. 1957.5 ± 2056.1 mm3, P > 0.05) between the complete and partial recanalization groups. Logistic regression analysis showed that ACS on MRBTI was associated with complete recanalization (P < 0.001, odds ratio = 3.937, 95% confidence interval, 1.6–9.5). Interpretation ACS can be used to predict complete recanalization in patients undergoing endovascular treatment. MRBTI provides a robust method to define clot composition and is potentially useful in selecting the most appropriate CVT patients for endovascular treatment.
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Affiliation(s)
- Xiaoxu Yang
- Department of Radiology Xuanwu Hospital Beijing China
| | - Fang Wu
- Department of Radiology Xuanwu Hospital Beijing China
| | - Yuehong Liu
- Department of Radiology Xuanwu Hospital Beijing China
| | - Jiangang Duan
- Department of Emergency Xuanwu Hospital Beijing China
| | - Ran Meng
- Department of Neurology Xuanwu Hospital Beijing China
| | - Jian Chen
- Department of Neurosurgery Xuanwu Hospital Beijing China
| | - Debiao Li
- Biomedical Imaging Research Institute Cedars Sinai Medical Center Los Angeles California
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute Cedars Sinai Medical Center Los Angeles California
| | - Marc Fisher
- Neurology Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Qi Yang
- Department of Radiology Xuanwu Hospital Beijing China.,Biomedical Imaging Research Institute Cedars Sinai Medical Center Los Angeles California
| | - Xunming Ji
- Department of Neurosurgery Xuanwu Hospital Beijing China
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Dural arteriovenous fistula mimicking temporal arteritis. Clin Neurol Neurosurg 2018; 176:44-46. [PMID: 30504098 DOI: 10.1016/j.clineuro.2018.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 08/12/2018] [Accepted: 11/25/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Dural arteriovenous fistula (dAVF) is a very rare disease characterized by an abnormal vascular communication between arteries and veins in dural mater. It frequently presents with intracranial haemorrhage. Common presenting symptoms are headache and seizures. CASE REPORT Here we report a case of dAVF in which the patient's symptoms mimic a temporal arteritis in a 23-year-old woman. She presented with painful mass at forehead for 9 months with frontotemporal headache. Magnetic resonance imaging demonstrated dural arteriovenous fistula. CONCLUSION Since both diseases have different prognosis but similar presentation, it is important to ensure that there is no dural arteriovenous fistula in patient with suspected temporal arteritis.
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Liu K, Pei L, Gao Y, Zhao L, Fang H, Bunda B, Fisher L, Wang Y, Li S, Li Y, Guan S, Guo X, Xu H, Xu Y, Song B. Dehydration Status Predicts Short-Term and Long-Term Outcomes in Patients with Cerebral Venous Thrombosis. Neurocrit Care 2018; 30:478-483. [DOI: 10.1007/s12028-018-0628-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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