Risk factors for early-onset seizures in patients with cerebral venous sinus thrombosis: A meta-analysis of observational studies

Research progress and future perspectives on electromagnetic wave absorption of fibrous materials

Electromagnetic waves have caused great harm to military safety, high-frequency electronic components, and precision instruments, and so forth, which urgently requires the development of lightweight, high-efficiency, broadband electromagnetic waves (EMW) absorbing materials for protection. As the basic fibrous materials, carbon fibers (CFs) and SiC fibers (SiCf) have been widely applied in EMW absorption due to their intrinsic characteristics of low density, high mechanical properties, high conductivity, and dielectric loss mechanism. Nevertheless, it has remained a great challenge to develop lightweight EMW-absorbing fibrous materials with strong absorption capability and broad frequency range. In this review, the fundamental electromagnetic attenuation mechanisms are firstly introduced. Furthermore, the preparation, structure, morphology, and absorbing performance of CFs and SiCf-based EMW absorbing composites are summarized. In addition, prospective research opportunities are highlighted toward the development of fibrous absorbing materials with the excellent absorption performance.

Late epileptic seizures following cerebral venous thrombosis: a systematic review and meta-analysis

Background

Identifying late epileptic seizures (LS) following cerebral venous thrombosis (CVT) can be useful for prognosis and management. We systematically reviewed the literature to identify risk factors for LS due to CVT.

Methods

We systematically searched PubMed, Scholar, and Scopus databases (May 2021) to identify studies reporting data on prevalence and risk factors for CVT-LS. The methodological quality was assessed with the Ottawa-Newcastle Scale. The risk of developing CVT-LS was summarized in meta-analyses and expressed as odds ratio (OR) and corresponding 95% confidence intervals (CIs) using random-effects models.

Results

Out of the 332 records retrieved, four studies were eventually included with a total of 1309 patients with CVT and 142 (11%) with CVT-LS. The most relevant predictors of CVT-LS were symptomatic seizures (OR 5.66, 95% CI 3.83–8.35), stupor/coma (OR 6.81, 95% CI 1.18–39.20), focal neurologic signs (OR 6.81, 95% CI 1.18–39.2), hemorrhagic component (OR 3.52, 95% CI 2.45–5.06), and superior sagittal sinus involvement (OR 1.52, 95% CI 1.04–2.21).

Conclusion

There are several risk factors for CVT-LS that should be considered in clinical practice. Further high-quality studies are warranted to develop predictive models for individualized risk stratification and prediction of CVT-LS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-022-06148-y.

Predictive Factors for Early-Onset Seizures in Patients With Cerebral Venous Sinus Thrombosis

Seizures are reported to be important factors contributing to poor prognosis in patients with cerebral venous sinus thrombosis (CVST). However, the predictive factors for concurrent early onset seizures in patients with CVST remain unclear. To identify the predictive factors of early seizures in patients with CVST, this study retrospectively evaluated the clinical data of patients diagnosed with CVST at two centers from January 2011 to December 2020 and analyzed the relationship between admission characteristics and early onset seizures. A total of 112 CVST patients (63 men and 49 women; mean age 39.82 ± 15.70 years) were enrolled in this study, of whom 34 (30.36%) had seizures. For patients with seizures, cerebral hemorrhage, cortical vein thrombosis, anterior superior sagittal sinus (SSS) thrombosis, middle SSS thrombosis, CVST score, modified Rankin Scale, National Institute of Health Stroke Scale (NIHSS) score, neutrophil percentage, and D-dimer level were more severe than those without seizures. Logistic regression analysis showed that cerebral hemorrhage (P = 0.002), anterior SSS thrombosis (P = 0.003), NIHSS score ≥5 (P = 0.003), and D-dimer ≥0.88 mg/L (P = 0.004) were all significant predictive factors of early-onset seizures in CVST patients. Combining the four factors further improved the predictive capability with an area under the curve of 0.871 (95% confidence interval = 0.803–0.939). Further large-scale prospective studies are required to confirm these findings.

Predicting the occurrence of early seizures after cerebral venous thrombosis using a comprehensive nomogram

BACKGROUND

Seizure is a common clinical manifestation of cerebral venous thrombosis (CVT). The mortality rate of patients with CVT with seizure is three times higher than that of patients without seizure. The aim of this study was to develop a nomogram to predict the individual probability of acute seizure events in patients with CVT.

METHOD

This was a single-center, retrospective cohort study. We analyzed and compared demographic variables, epidemiological risk factors, clinical presentation, laboratory results and imaging data in a cohort of 142 patients who were diagnosed with CVT in our hospital from January 2013 to December 2018. A nomogram was constructed to predict the risk of early seizure (ES) in these patients according to the multivariable logistic regression analysis results. The concordance index, GiViTi calibration belt and decision curve analysis (DCA) were used to assess nomogram performance.

RESULTS

Forty-three (30.28%) patients experienced seizure within 2 weeks after a CVT diagnosis. Multivariate analysis identified focal neurologic deficit, Glasgow Coma Scale (GCS) scores ≤ 8 on admission, hemorrhagic lesions, superior sagittal sinus thrombosis (SSST) and frontal lobe lesions as independent predictive factors for ES occurrence after CVT. A nomogram was generated based on these predictive factors with the concordance index reaching 0.82, indicating that the clinical tool was well calibrated. DCA showed that the model was useful with a threshold probability in the range of 0-77%.

CONCLUSIONS

We developed the first nomogram that could predict the risk of ES in CVT patients. This effective and convenient tool has shown promising clinical benefit and will assist clinicians in making treatment decisions.

Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: Evaluation, management, and scientific questions

BACKGROUND

Vaccine induced immune mediated thrombocytopenia or VITT, is a recent and rare phenomenon of thrombosis with thrombocytopenia, frequently including cerebral venous thromboses (CVT), that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2·S Johnson and Johnson (Janssen/J&J). The evaluation and management of suspected cases of CVT post COVID-19 vaccination are critical skills for a broad range of healthcare providers.

METHODS

A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists.

FINDINGS

Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist, including inflammatory marker measurements, PF4 assays, and non-heparin anticoagulation.

Acute symptomatic seizures in cerebral venous thrombosis

OBJECTIVE

To identify characteristics, predictors, and outcomes of acute symptomatic seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281 consecutive adult patients with CVT included from 12 hospitals within the International CVT Consortium.

METHODS

We defined ASS as any seizure between symptom onset and 7 days after diagnosis of CVT. We stratified ASS into prediagnosis and solely postdiagnosis ASS. Status epilepticus (SE) was also analyzed separately. We analyzed predictors for ASS and the association between ASS and clinical outcome (modified Rankin Scale) with multivariable logistic regression.

RESULTS

Of 1,281 eligible patients, 441 (34%) had ASS. Baseline predictors for ASS were intracerebral hemorrhage (ICH; adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0-5.5), cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0-4.0), cortical vein thrombosis (aOR 2.1, 95% CI 1.5-2.9), superior sagittal sinus thrombosis (aOR 2.0, 95% CI 1.5-2.6), focal neurologic deficit (aOR 1.9, 95% CI 1.4-2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1-2.5), and female-specific risk factors (aOR 1.5, 95% CI 1.1-2.1). Ninety-three (7%) patients had solely postdiagnosis ASS, best predicted by cortical vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%) patients had SE, independently predicted by ICH, focal neurologic deficits, and cerebral edema/infarction. Neither ASS nor SE was independently associated with outcome.

CONCLUSION

ASS occurred in one-third of patients with CVT and was associated with brain parenchymal lesions and thrombosis of the superficial system. In the absence of prediagnosis ASS, no subgroup was identified with sufficient risk of postdiagnosis ASS to justify prophylactic antiepileptic drug treatment. We found no association between ASS and outcome.

Late seizures in cerebral venous thrombosis

Objective

To examine the incidence, characteristics, treatment, and predictors of late seizures (LS) after cerebral venous thrombosis (CVT), we described these features in a registry of 1,127 patients with CVT.

Methods

We included consecutive adult patients from an international consortium of 12 hospital-based CVT registries. We excluded patients with a history of epilepsy or with <8 days of follow-up. We defined LS as seizures occurring >7 days after diagnosis of CVT. We used multivariable Cox regression to identify predictors of LS.

Results

We included 1,127 patients with CVT. During a median follow-up of 2.0 years (interquartile range [IQR] 1.0–6.3), 123 patients (11%) experienced ≥1 LS (incidence rate for first LS 30 per 1,000 person-years, 95% confidence interval [CI] 25–35). Median time to first LS was 5 months (IQR 1–16 months). Baseline predictors of LS included status epilepticus in the acute phase (hazard ratio [HR] 7.0, 95% CI 3.9–12.6), decompressive hemicraniectomy (HR 4.2, 95% CI 2.4–7.3), acute seizure(s) without status epilepticus (HR 4.1, 95% CI 2.5–6.5), subdural hematoma (HR 2.3, 95% CI 1.1–4.9), and intracerebral hemorrhage (HR 1.9, 95% CI 1.1–3.1). Eighty-five patients (70% of patients with LS) experienced a recurrent seizure during follow-up, despite the fact that 94% received antiepileptic drug treatment after the first LS.

Conclusion

During a median follow-up of 2 years, ≈1 in 10 patients with CVT had LS. Patients with baseline intracranial bleeding, patients with acute symptomatic seizures, and those who underwent decompressive hemicraniectomy were at increased risk of developing LS. The high recurrence risk of LS justifies epilepsy diagnosis after a first LS.

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

PURPOSE

The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST).

METHOD

VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients.

RESULTS

The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter.

CONCLUSIONS

In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.