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Zhou LW, Yu AYX, Ngo L, Hill MD, Field TS. Incidence of Cerebral Venous Thrombosis: A Population-Based Study, Systematic Review, and Meta-Analysis. Stroke 2023; 54:169-177. [PMID: 36337058 DOI: 10.1161/strokeaha.122.039390] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Studying the baseline incidence of cerebral venous thrombosis (CVT) prior to COVID-19 and the limitations of how this has been previously reported in the literature will help improve understanding of this disease and how risks may have changed in the post-COVID era. METHODS We examined CVT incidence using linked administrative data in British Columbia, Canada (population 5.2 million). To contextualize our findings, we also examined CVT incidence in the published literature and searched MEDLINE and EMBASE for article titles and abstracts up to Nov 2, 2021 on CVT incidence in adults. We performed abstract screening and full-text review prior to data extraction and explored associations between CVT incidence and year of study, geographic location, and study quality with meta-analyses and meta-regression. A random-effects restricted maximum likelihood model was used. Publication bias was assessed using the Egger tests and using visual inspection of the funnel plot for symmetry. RESULTS There were 554 unique CVT cases (mean age 50.9 years, 55.4% women) in British Columbia from 2000 to 2017; overall annual incidence was 8.7 (95%CI' 8.0-9.4) per million. Incidence increased over time in men across the entire study period, and from 2011 to 2017 in women. We identified 22 other studies on CVT incidence before 2020 (21/23 total studies included in meta-analysis). Annual incidence overall was 12.1 (95% CI' 9.9-14.3) per million with significant between-study heterogeneity (I2 98.8%, Qp-value<0.001). There were no significant associations on meta-regression between incidence and study year, study quality score, or gross national income per capita of the study country. Visual inspection of the funnel plot and a significant Egger test (z=2.8, P<0.01) suggested possible publication bias. CONCLUSIONS Incidence of CVT in Canadian data increased over time but remained lower than in other population-based studies. Significant heterogeneity exists in the literature, which may be subject to publication bias.
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Affiliation(s)
- Lily W Zhou
- Division of Neurology and Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (L.W.Z., T.S.F.)
- Stanford Stroke Center, Stanford University, Palo Alto, CA (L.W.Z.)
| | - Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre (A.Y.X.Y.)
| | - Long Ngo
- Harvard TH Chan School of Public Health (L.N.)
| | - Michael D Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine (M.D.H.)
| | - Thalia S Field
- Division of Neurology and Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (L.W.Z., T.S.F.)
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The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study. J Stroke Cerebrovasc Dis 2022; 31:106468. [PMID: 35523051 PMCID: PMC8947940 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106468] [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: 01/24/2022] [Revised: 03/05/2022] [Accepted: 03/19/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES There are several reports of the association between SARS-CoV-2 infection (COVID-19) and cerebral venous sinus thrombosis (CVST). In this study, we aimed to compare the hospitalization rate of CVST before and during the COVID-19 pandemic (before vaccination program). MATERIALS AND METHODS In this retrospective cohort study, the hospitalization rate of adult CVST patients in Namazi hospital, a tertiary referral center in the south of Iran, was compared in two periods of time. We defined March 2018 to March 2019 as the pre-COVID-19 period and March 2020 to March 2021 as the COVID-19 period. RESULTS 50 and 77 adult CVST patients were hospitalized in the pre-COVID-19 and COVID-19 periods, respectively. The crude CVST hospitalization rate increased from 14.33 in the pre-COVID-19 period to 21.7 per million in the COVID-19 era (P = 0.021). However, after age and sex adjustment, the incremental trend in hospitalization rate was not significant (95% CrI: -2.2, 5.14). Patients > 50-year-old were more often hospitalized in the COVID-19 period (P = 0.042). SARS-CoV-2 PCR test was done in 49.3% out of all COVID-19 period patients, which were positive in 6.5%. Modified Rankin Scale (mRS) score ≥3 at three-month follow-up was associated with age (P = 0.015) and malignancy (P = 0.014) in pre-COVID period; and was associated with age (P = 0.025), altered mental status on admission time (P<0.001), malignancy (P = 0.041) and COVID-19 infection (P = 0.008) in COVID-19 period. CONCLUSION Since there was a more dismal outcome in COVID-19 associated CVST, a high index of suspicion for CVST among COVID-19 positive is recommended.
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Jiang YY, Chen LJ, Wu XJ, Zhou GQ, Mo DC, Li XL, Liu LY, Li JL, Luo M. Efficacy and Safety Assessment of Rivaroxaban for the Treatment of Cerebral Venous Sinus Thrombosis in a Chinese Population. Clin Appl Thromb Hemost 2022; 28:10760296221144038. [PMID: 36503260 DOI: 10.1177/10760296221144038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We aimed to investigate the efficacy and safety of rivaroxaban for acute and long-term management of cerebral venous sinus thrombosis (CVST). This study reviewed CVST-diagnosed patients admitted to the First Affiliated Hospital of Guangxi Medical University from January 2015 to December 2020. The primary outcome was a composite of recurrent thrombosis or major bleeding events. The secondary efficacy outcomes included a disease recovery time (DRT) presenting the time from admission to the endpoint as recovery (the modified Rankin scale [mRS] score [0-1]) within 30 and 90 days, and length of hospital stay (LHS). Patients treated with rivaroxaban (38) and warfarin (45) were enrolled in the final analysis. The primary outcome had no significant difference (5.3% vs 11.1%, P = .576) between the 2 groups. The secondary efficacy outcome regarding the median 30-d DRT was 17 days (95% confidence interval [CI], 14.6-19.4) in the rivaroxaban group, compared with 26.0 days (95% CI, 16.8-35.2) in the warfarin group (hazard ratio, 1.806; 95% CI, 1.051-3.103; log-rank P = .026). Two groups have a significant difference in LHS (P = .041). Patients with cerebral edema, intracerebral hemorrhage, and mild/moderate disability (admission mRS score [2-3]) treated with rivaroxaban recovered faster than those with warfarin (log-rank P < .05). Patients with cerebral edema, intracerebral hemorrhage, and mild/moderate disability treated with rivaroxaban had a shorter recovery time than those treated with warfarin within 1 month from admission, indicating that rivaroxaban a promising convenient therapy for CVST, helping them speedily restore social functions.
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Affiliation(s)
- Yi-Ying Jiang
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li-Jie Chen
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Ju Wu
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guo-Qiu Zhou
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dong-Can Mo
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Ling Li
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liu-Yu Liu
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian-Li Li
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Man Luo
- Department of Neurology, 117742First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, Nanning, China.,Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, China
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Alamri AS, Almuaigel MF, Azra Z, Alshamrani FJ, AlMohish NM, AlSheikh MH. Clinical presentations, radiological characteristics, and biological risk factors of cerebral venous thrombosis at a University Hospital in Saudi Arabia. Saudi Med J 2021; 42:213-218. [PMID: 33563742 PMCID: PMC7989276 DOI: 10.15537/smj.2021.2.25667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe the clinical features and possible etiologies of cerebral vein thrombosis (CVT) in a Saudi Arabian cohort. METHODS A retrospective, observational design was implemented. Data pertaining to 36 patients (19 female and 17 male) with confirmed CVT diagnosis admitted to a hospital in Saudi Arabia between 2008 and 2019 were obtained and analyzed. RESULTS The age of patients ranged between 19 to 82 years, and the mean/median age was 33/29 years. Most commonly reported symptoms were headache ( 72%), unilateral lower limb weakness (39%), and seizures (17%). Papilledema was found in 8% of patients. Thrombotic disorders were identified in 14% and infections were identified in 8% of the patients. Two patients had ulcerative colitis, 2 were diagnosed with Behcet's disease, and 2 women were using oral contraceptive pills. Single sinus thrombosis was detected in only 22% of patients. One patient with diabetic ketoacidosis died. Thrombotic disorder was the most common risk factor, followed by that iron deficiency anemia. CONCLUSION The transverse sinus was the most frequently thrombosed sinus. Iron deficiency anemia emerged as a predisposing preventable condition for CVT, while genetic factors were found to be less important in this cohort.
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Affiliation(s)
- Abdullah S. Alamri
- From the Neurology Department (Alamri, Almuaigel, Alshamrani, Zafar, AlMohish), King Fahad University Hospital, Al Khobar; from the Neurology Department, College of Medicine (Alamri, Alshamrani, Zafar), Imam Abdulrahman Bin Faisal University; and from the Physiology Department (AlSheikh), College of Medicine, Imam Abdulrahman Bin Faisal University, Al Dammam, Kingdom of Saudi Arabia.
| | - Mohammed F. Almuaigel
- From the Neurology Department (Alamri, Almuaigel, Alshamrani, Zafar, AlMohish), King Fahad University Hospital, Al Khobar; from the Neurology Department, College of Medicine (Alamri, Alshamrani, Zafar), Imam Abdulrahman Bin Faisal University; and from the Physiology Department (AlSheikh), College of Medicine, Imam Abdulrahman Bin Faisal University, Al Dammam, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Mohammed F. Almuaigel, Neurology Department, King Fahad University Hospital, Al Khobar, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0001-6161-8179
| | - Zafar Azra
- From the Neurology Department (Alamri, Almuaigel, Alshamrani, Zafar, AlMohish), King Fahad University Hospital, Al Khobar; from the Neurology Department, College of Medicine (Alamri, Alshamrani, Zafar), Imam Abdulrahman Bin Faisal University; and from the Physiology Department (AlSheikh), College of Medicine, Imam Abdulrahman Bin Faisal University, Al Dammam, Kingdom of Saudi Arabia.
| | - Foziah J. Alshamrani
- From the Neurology Department (Alamri, Almuaigel, Alshamrani, Zafar, AlMohish), King Fahad University Hospital, Al Khobar; from the Neurology Department, College of Medicine (Alamri, Alshamrani, Zafar), Imam Abdulrahman Bin Faisal University; and from the Physiology Department (AlSheikh), College of Medicine, Imam Abdulrahman Bin Faisal University, Al Dammam, Kingdom of Saudi Arabia.
| | - Noor M. AlMohish
- From the Neurology Department (Alamri, Almuaigel, Alshamrani, Zafar, AlMohish), King Fahad University Hospital, Al Khobar; from the Neurology Department, College of Medicine (Alamri, Alshamrani, Zafar), Imam Abdulrahman Bin Faisal University; and from the Physiology Department (AlSheikh), College of Medicine, Imam Abdulrahman Bin Faisal University, Al Dammam, Kingdom of Saudi Arabia.
| | - Mona H. AlSheikh
- From the Neurology Department (Alamri, Almuaigel, Alshamrani, Zafar, AlMohish), King Fahad University Hospital, Al Khobar; from the Neurology Department, College of Medicine (Alamri, Alshamrani, Zafar), Imam Abdulrahman Bin Faisal University; and from the Physiology Department (AlSheikh), College of Medicine, Imam Abdulrahman Bin Faisal University, Al Dammam, Kingdom of Saudi Arabia.
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Saadatnia M, Hajiannejad N, Yazdabadi A, Tajmirriahi M, Nasr M. Public Stroke Knowledge, Awareness, and Response to Acute Stroke in Isfahan Iran: What is Less or Misinterpreted in Developing Countries. J Stroke Cerebrovasc Dis 2021; 30:105670. [PMID: 33751991 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/08/2021] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Considering the high burden of stroke in developing countries, it is important for the community to have adequate information and awareness of this disease. In this study, the baseline knowledge of an Iranian population towards stroke has been evaluated. METHOD This study was conducted in a governmental hospital in Isfahan, Iran. The participants were selected from the companions of non-cardio-vascular hospitalized patients. A self-administered questionnaire was designed for gathering information RESULTS: A total of 630 questionnaires were analysed. Hypertension and stress were the most frequently identified risk factors (recognised by 83.7% and 75.8% respectively), while pregnancy, oral contraceptives, and anti-coagulants were the least (recognised by 3.5%, 14.2% and 15.8% respectively). Knowledge of other important risk factors such as cardiac diseases was also relatively low (39.4%). Sudden visual difficulties and irrelevant speech were the least identified warning signs of stroke (45.3% and 34.6% respectively), however, knowledge towards all other warning signs was moderately good (each identified by 60-70%). Importantly only 44.2% of respondents were aware that stroke treatment should be started within the first 3 hours. Participants tended to have moderately good insight of most stroke complications and rehabilitation (60-70%). Urban residence, high level of education and knowing someone with a history of stroke were significant predictors of a higher level of stroke awareness. CONCLUSION The findings of this study indicate that there is a need to improve general knowledge of cardiac and hypercoagulable related risk factors. Furthermore, understanding of the importance of time critical stroke management and the ineffectiveness of traditional medicine needs to be raised in the general community.
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Affiliation(s)
- Mohammad Saadatnia
- Isfahan Neurosciences Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Negar Hajiannejad
- Isfahan Neurosciences Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Anousha Yazdabadi
- Department of Medical Education, University of Melbourne and Eastern Health, Australia.
| | - Marzieh Tajmirriahi
- Hypertension Research Centre, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Marzieh Nasr
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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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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Otite FO, Patel S, Sharma R, Khandwala P, Desai D, Latorre JG, Akano EO, Anikpezie N, Izzy S, Malik AM, Yavagal D, Khandelwal P, Chaturvedi S. Trends in incidence and epidemiologic characteristics of cerebral venous thrombosis in the United States. Neurology 2020; 95:e2200-e2213. [PMID: 32847952 DOI: 10.1212/wnl.0000000000010598] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/12/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To test the hypothesis that race-, age-, and sex-specific incidence of cerebral venous thrombosis (CVT) has increased in the United States over the last decade. METHODS In this retrospective cohort study, validated ICD codes were used to identify all new cases of CVT (n = 5,567) in the State Inpatients Databases (SIDs) of New York and Florida (2006-2016). A new CVT case was defined as first hospitalization for CVT in the SID without prior CVT hospitalization. CVT counts were combined with annual Census data to compute incidence. Joinpoint regression was used to evaluate trends in incidence over time. RESULTS From 2006 to 2016, annual age- and sex-standardized incidence of CVT in cases per 1 million population ranged from 13.9 to 20.2, but incidence varied significantly by sex (women 20.3-26.9, men 6.8-16.8) and by age/sex (women 18-44 years of age 24.0-32.6, men 18-44 years of age 5.3-12.8). Incidence also differed by race (Blacks: 18.6-27.2; Whites: 14.3-18.5; Asians: 5.1-13.8). On joinpoint regression, incidence increased across 2006 to 2016, but most of this increase was driven by an increase in all age groups of men (combined annualized percentage change [APC] 9.2%, p < 0.001), women 45 to 64 years of age (APC 7.8%, p < 0.001), and women ≥65 years of age (APC 7.4%, p < 0.001). Incidence in women 18 to 44 years of age remained unchanged over time. CONCLUSION CVT incidence is disproportionately higher in Blacks compared to other races. New CVT hospitalizations increased significantly over the last decade mainly in men and older women. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or an artifactual increase from improved detection.
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Affiliation(s)
- Fadar Oliver Otite
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore.
| | - Smit Patel
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Richa Sharma
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Pushti Khandwala
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Devashish Desai
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Julius Gene Latorre
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Emmanuel Oladele Akano
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Nnabuchi Anikpezie
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Saef Izzy
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Amer M Malik
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Dileep Yavagal
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Priyank Khandelwal
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
| | - Seemant Chaturvedi
- From the Department of Neurology (F.O.O., J.G.L.), State University of New York Upstate Medical University, Syracuse; Department of Neurology (S.P.), University of Connecticut, Hartford; Department of Neurology (R.S.), Yale University, New Haven, CT; Department of Internal Medicine (P. Khandwala, D.D.), Crozier Chester Medical Center, Chester, PA; Molecular Neuropharmacology Unit (E.O.A.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Department of Healthcare Transformation Initiative (N.A.), University of Texas Health Science Center at Houston; Department of Neurology (S.I.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Department of Neurology (A.M.M., D.Y.), University of Miami Miller School of Medicine, FL; Department of Neurology (P. Khandelwal), Rutgers New Jersey Medical School, Newark; and Department of Neurology (S.C.), University of Maryland, Baltimore
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8
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Clinical and radiological characteristics and predictors of outcome of cerebral venous sinus thrombosis, a hospital-based study. Acta Neurol Belg 2020; 120:845-852. [PMID: 30178180 DOI: 10.1007/s13760-018-1009-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/26/2018] [Indexed: 02/02/2023]
Abstract
Cerebral venous sinus thrombosis is an uncommon cause of stroke, which is more prevalent in Iran and the Middle East. We aimed to assess the etiology, radiologic, and clinical manifestations of cerebral venous sinus thrombosis, specifically the predictors of patients' outcome in Namazi hospital, Shiraz, Iran. In this retrospective study, we included all adult patients with the diagnosis of cerebral venous sinus thrombosis, who were admitted in hospital, from 2012 to 2016. Demographic data, radiologic findings, clinical presentation, risk factors, treatment, and outcome according to modified Rankin Scale (mRS) on discharge were assessed and the factors associated with hospital fatality and poor outcome (mRS > 2) were investigated through univariable and multivariable analyses. Adjusted odds ratio (OR), 95% confidence interval (CI), and p values were reported. Among 174 patients, 128 (73.6%) were female. The mean age was 37.8 ± 11.2. Total of 39 patients (22.4%) had poor discharge outcome and nine patients died in hospital. Older age (OR = 1.041, CI = 1.000-1.08), decreased level of consciousness (OR = 5.46, CI = 2.17-13.72), focal neurologic deficit (OR = 5.63, CI = 2.14-14.77), and expansion of intracranial hemorrhage (ICH) (OR = 9.13, CI = 1.96-42.64) were predictors of poor outcome according to the logistic regression model. Older age (p = 0.02), focal neurologic deficit (p = 0.005), deep venous system thrombosis (p = 0.002), early intracranial hemorrhage (p = 0.049), delayed hemorrhage (p = 0.007) and hemorrhage expansion (p = 0.002), infratentorial hemorrhagic lesions (p = 0.005), and higher CRP (p = 0.011) were associated with hospital fatality. The patients with gynecologic risk factors were at lower risk of hospital death (p = 0.005). Age, decreased consciousness and focal neurological deficit on admission, and expanded intracranial hemorrhage are predictors of poor outcome. The patients who are at higher risk of unfavorable outcome should be recognized and closely monitored.
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9
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Andrade KV, Souza ICD, Balsells MMD, Lima ACS, Moura ERF, Aquino PDS. Factors associated with performing activities of daily living in women after suffering a stroke. Rev Esc Enferm USP 2020; 54:e03560. [PMID: 32756772 DOI: 10.1590/s1980-220x2018041503560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 08/01/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To associate sociodemographic variables and risk factors for stroke to the degree of dependence for performing the activities of daily living of women of childbearing age after suffering a stroke. METHOD A prospective and analytical longitudinal study conducted in three public hospitals in Fortaleza, CE, Brazil. The Modified Barthel Index was used at the time of attending the unit and 3 months after the stroke to assess the degree of disability in the performance of activities of daily living. The chi-squared and likelihood ratio tests were chosen to analyze the association between variables. RESULTS There were 109 women of childbearing age who participated in the study. There was an association between higher degrees of dependence in women from the interior/rural areas, with lower income and black people (p = 0.032, p = 0.043, p = 0.03, respectively). Regarding personal risk factors, there was a greater dependency in women with heart disease (p = 0.040), sedentary (p = 0.030) and alcoholics (p = 0.017). CONCLUSION The results show the factors associated with higher degrees of dependence for performing activities of daily living by women of childbearing age after the occurrence of stroke.
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Affiliation(s)
- Karízia Vilanova Andrade
- Departamento de Enfermagem, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Izabel Cristina de Souza
- Departamento de Enfermagem, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Marianne Maia Dutra Balsells
- Departamento de Enfermagem, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Adman Câmara Soares Lima
- Departamento de Enfermagem, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | - Priscila de Souza Aquino
- Departamento de Enfermagem, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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10
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Fan Y, Yu J, Chen H, Zhang J, Duan J, Mo D, Zhu W, Wang B, Ouyang F, Chen Y, Lan L, Zeng J. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis. Stroke Vasc Neurol 2020; 5:152-158. [PMID: 32409571 PMCID: PMC7337369 DOI: 10.1136/svn-2020-000358] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Aim Cerebral venous sinus thrombosis (CVST) is a less common cerebrovascular disease that predominantly affects young patients. The incidence of CVST is 2–5/10 000 000/year, accounting for 0.5%–1% of all stroke. To reduce mortality and morbidity associated with CVST, Chinese Stroke Association commissioned the authors to write the current guideline on the management of CVST. Methods PubMed (MEDLINE), CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July 2019. Data were synthesised by evidence tables. Each recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow Committees. Levels of evidence grading algorithm of Chinese Stroke Association was used to grade each recommendation. Results This guideline mainly focuses on the diagnostic evaluation, therapeutic strategies and secondary prevention of CVST. CT/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected CVST. Anticoagulation therapy with low-molecular weight heparin should be initiated in patients with CVST immediately. After the acute stage, warfarin is recommended for 3–6 months to prevent the recurrence of CVST and other venous thromboembolic events. Conclusions The guideline summarises the current evidence regarding the management of CVST, and provides references for diagnosis, treatment and secondary prevention of CVST in China.
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Affiliation(s)
- Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hongbing Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jiangang Duan
- Department of Neurology and Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fubing Ouyang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Linfang Lan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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11
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Al-Sulaiman A. Clinical Aspects, Diagnosis and Management of Cerebral Vein and Dural Sinus Thrombosis: A Literature Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:137-145. [PMID: 31543733 PMCID: PMC6734737 DOI: 10.4103/sjmms.sjmms_22_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/10/2019] [Accepted: 07/16/2019] [Indexed: 12/29/2022]
Abstract
Cerebral vein and dural sinus thrombosis (CVST) is an uncommon cause of stroke, but its delayed diagnosis carries significant morbidity and mortality. Several studies have reported higher incidence of CVST than that previously reported. The clinical presentation of CVST varies and can be atypical. Advancement in neuroimaging modalities has made it possible to make an early diagnosis and initiate management with a wide range of therapeutic options, including direct oral anticoagulants and endovascular treatment. This narrative review summarizes the epidemiology, clinical aspects, diagnosis and management of CVST.
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Affiliation(s)
- Abdulla Al-Sulaiman
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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12
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Pan L, Ding J, Ya J, Zhou D, Hu Y, Fan C, Ding Y, Ji X, Meng R. Risk factors and predictors of outcomes in 243 Chinese patients with cerebral venous sinus thrombosis: A retrospective analysis. Clin Neurol Neurosurg 2019; 183:105384. [PMID: 31229936 DOI: 10.1016/j.clineuro.2019.105384] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the risk factors and predictors of outcomes in a cohort of Chinese patients with cerebral venous sinus thrombosis (CVST), so as to provide a reference for customized clinical decision. PATIENTS AND METHODS A total of 243 Chinese patients, diagnosed as a first CVST were enrolled in this retrospective study from March 2013 through April 2017. Risk factors and predictors of outcomes for CVST were summarized and analyzed by Chi-square test and logistic regression analysis. RESULTS Of the 243 cases, obstetric cause (19.8%) was the leading risk factor for CVST, followed by infection (17.7%) and anemia (17.7%). Gender differences in the risk factors for CVST were analyzed, showing that obstetric cause was the top risk factor in female, while hyperhomocysteinemia (22.3%) was the top risk factor in male. In age subgroups, obstetric cause (26.3%) and anemia (17.6%) were more commonly observed in age ≤ 44 years and age > 44 years subgroup, respectively. The ratio of poor outcomes (mRS = 3-6) in this cohort was 23.0%, and central nervous system (CNS) infection was closely related to poor outcomes at discharge (p = 0.023). CONCLUSION The predominant risk factor for CVST, in this Chinese cohort, may still be obstetric cause in female and hyperhomocysteinemia in male. In addition, CNS infection may predict poor outcomes in CVST patients.
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Affiliation(s)
- Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jingyuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yanyu Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Chunqiu Fan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
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13
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Affiliation(s)
- Turgut Tatlisumak
- From the Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T., K.J.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T., K.J.); and Department of Neurology, Helsinki University Hospital, Finland (T.T., J.P.)
| | - Katarina Jood
- From the Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T., K.J.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T., K.J.); and Department of Neurology, Helsinki University Hospital, Finland (T.T., J.P.)
| | - Jukka Putaala
- From the Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (T.T., K.J.); Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T., K.J.); and Department of Neurology, Helsinki University Hospital, Finland (T.T., J.P.)
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