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Ventura F, Drommi M, Barranco R, Vellone VG. Sudden death in a newborn from cerebral venous sinus thrombosis resulting from meningitis. Med Leg J 2024:258172241250193. [PMID: 39075857 DOI: 10.1177/00258172241250193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Septic cerebral venous sinus thrombosis is a rare but often fatal complication caused by bacterial meningitis and paranasal sinusitis.We report a particular case of the sudden and unexpected death of a six-day-old infant from unrecognised acute meningitis that caused a thrombotic occlusion of the venous sinuses (with the particular involvement of the torcular Herophili at the confluence of sinuses) resulting in subdural haemorrhage.This case report alerts paediatricians and neonatologists to the importance of promptly considering a possible diagnosis of meningitis without delay to avoid the fatal complications described here. As in all cases of sudden infant death our case study underlines the need for a thorough autopsy, accompanied by histological analysis, in order to identify the causes of the underlying pathological mechanisms causing death and to ensure an adequate differential diagnosis.
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Affiliation(s)
- Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Italy
- Legal Medicine Unit, IRCCS-Ospedale Policlinico San Martino Teaching Hospital, Genova, Italy
| | - Martina Drommi
- Department of Legal and Forensic Medicine, University of Genova, Italy
| | - Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Italy
| | - Valerio G Vellone
- Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Italy
- Fetal and Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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2
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Papadimitriou K, Mehta SH, Golub D, White T, Shah K, Patsalides A. Eclipse balloon-assisted straight sinus thrombectomy: A novel technique. Interv Neuroradiol 2024:15910199241238277. [PMID: 38454635 DOI: 10.1177/15910199241238277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Cerebral venous sinus thrombosis comprises 0.5% of all strokes and usually affects young adults. Straight sinus involvement is relatively rare, and it is associated with poor prognosis. Intravenous anticoagulation is considered the first line of treatment. Endovascular approaches such as direct catheter thrombolysis, balloon-assisted thrombolysis, and mechanical thrombectomy may be more efficient and should be considered in cases in which there is involvement of the deep venous system, declining neurological status, or less invasive treatment options have failed. In this work, we describe a novel technique of ECLIPSE 2L balloon (Balt, Irvine, CA) assisted mechanical thrombectomy for straight sinus thrombosis and a review of dural sinus thrombosis management.
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Affiliation(s)
| | - Shyle H Mehta
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Danielle Golub
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Timothy White
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Kevin Shah
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
| | - Athos Patsalides
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
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AlSerehi AA, Al Mufarrih BM, Abu‐Shaheen A, Saleh A, AlSheef M. Safety of pregnancy after cerebral venous thrombosis: A case-control study. Health Sci Rep 2024; 7:e1872. [PMID: 38361798 PMCID: PMC10867792 DOI: 10.1002/hsr2.1872] [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: 08/27/2023] [Revised: 12/31/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024] Open
Abstract
Background and Aims Since pregnancy is considered one of the major risk factors of cerebral venous thrombosis (CVT), the safety of pregnancy in women of childbearing age and a previous history of CVT, is concerning in terms of prevention, family planning, and management. This study aims to estimate the prevalence of pregnancies among women of childbearing age with previous CVT, evaluate the pregnancy-associated risk of CVT recurrence, and explore the maternal and fetal outcomes among CVT women in comparison with pregnant women without a history of CVT. Methods A retrospective, case-control study was conducted at the Obstetrics Departments of King Fahad Medical City Hospital, Saudi Arabia. It included all women with a history of CVT diagnosed in the last 5 years (cases), as well as CVT history-free pregnant women (control). The prevalence of pregnancy after CVT was estimated and the prepartum and postpartum parameters of the two groups were compared. Results Fifty women with CVT and 100 controls were included. Among the 50 CVT cases, 28 (56.0%) have been pregnant. The incidence of pre-eclampsia was significantly more frequent in CVT women (7.1% vs. 0.0%, p = 0.047); however, only one case of deep vein thrombosis (3.6%) was reported in CVT patients versus none in controls (p = 0.219). CVT women delivered at a lower gestational age (mean [SD] = 36.9 [3.5] weeks) compared with controls (38.3 [1.4] weeks) (p = 0.006). No significant differences in other pregnancy or delivery outcomes were observed between the two groups. Conclusion More than half of women of childbearing age with a history of CVT opt for pregnancy after the CVT episode, with no major additional risk for pre or postpartum complications.
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Affiliation(s)
- Amal A. AlSerehi
- Women's Specialist Hospital, King Fahad Medical CityRiyadh Second Health ClusterRiyadhSaudi Arabia
| | | | - Amani Abu‐Shaheen
- Research Center, King Fahad Medical CityRiyadh Second Health ClusterRiyadhSaudi Arabia
| | - Ahmed Saleh
- Research Center, King Fahad Medical CityRiyadh Second Health ClusterRiyadhSaudi Arabia
| | - Mohammed AlSheef
- Thrombosis Clinics, King Fahad Medical CityRiyadh Second Health ClusterRiyadhSaudi Arabia
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4
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Borhani-Haghighi A, Hooshmandi E. Cerebral venous thrombosis: a practical review. Postgrad Med J 2024; 100:68-83. [PMID: 37978050 DOI: 10.1093/postmj/qgad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023]
Abstract
The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases.
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Affiliation(s)
- Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
- Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia
| | - Etrat Hooshmandi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz 7193635899, Iran
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Patwardhan A, Gupta M, Philip M, Rangarajan A, Joshi T, Alladi S, Kulkarni GB, Ramakrishnan S. Clinicoradiological Features and Long-term Cognitive and Functional Outcome in Patients with Deep Cerebral Venous Thrombosis. Ann Indian Acad Neurol 2024; 27:34-39. [PMID: 38495239 PMCID: PMC10941899 DOI: 10.4103/aian.aian_792_23] [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: 09/02/2023] [Revised: 09/16/2023] [Accepted: 10/07/2023] [Indexed: 03/19/2024] Open
Abstract
Background Deep cerebral venous thrombosis (DCVT) can have long-term functional and cognitive sequelae. Although literature exists on cognitive impairment after arterial stroke, cognitive sequelae after cerebral venous thrombosis (CVT) are much less studied. Methods Clinical records of 29 patients diagnosed with DCVT were reviewed. The Modified Telephonic Interview for Cognitive Status (TICS-M) was adapted and validated in the regional language (Kannada) and applied to 18 patients with DCVT, at a mean follow-up duration of 5.32 years. Screening for depression was done via telephonic Patient Health Questionnaire-9 (PHQ-9)-Kannada version, and functional status was screened by applying the modified Rankin Scale (mRS). Results DCVT had a mortality rate of 10.34% due to acute complications. mRS scores of 0-1 were achieved at follow-up in all patients who survived. Receiver operating characteristic (ROC) analysis revealed a cutoff of ≤44.5 (maximum score of 49) for the diagnosis of cognitive impairment via TICS-M (Kannada version) in DCVT patients. Evidence of cognitive dysfunction was seen in eight patients (42.10%), and three patients (16.66%) had evidence of depression. Conclusions Survivors of acute DCVT can potentially have long-term cognitive sequelae. Screening for cognitive dysfunction, depression, and functional status can be effectively done using telephonically applied scales that are adapted to the local language. Neuropsychological evaluation and early cognitive rehabilitation can be initiated for patients in whom deficits are identified on cognitive screening.
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Affiliation(s)
- Ameya Patwardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manisha Gupta
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anush Rangarajan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Tarachand Joshi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Mishra AK, Shukla R, Chaurasia RN, Verma A. Descriptive Study of Headache as the Most Common Presenting Feature of Cerebral Venous Thrombosis. Cureus 2023; 15:e43007. [PMID: 37674961 PMCID: PMC10477085 DOI: 10.7759/cureus.43007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To study the etiology and clinical characteristics of cerebral venous thrombosis (CVT) patients with a detailed description of headache as a presenting feature. INTRODUCTION CVT is an infrequent type of stroke with protean clinical manifestations. The most common presenting symptom in CVT is headache (>85%), followed by seizures and focal neurological deficits. METHODS A total of 32 consecutive and confirmed patients of CVT were recruited after obtaining informed consent. CVT was diagnosed based on clinical and imaging parameters. Data regarding etiology, clinical symptoms, and signs with special mention of headache pattern, onset, site, character, severity (based on the visual analog scale), aggravating and relieving factors, as well as sinus involvement were recorded. RESULTS A total of 32 patients (16 males and 16 females) with a mean age of 31.56 (SD = 14.31) years were recruited, out of which 31 patients (96.87%) presented with headaches. The mode of onset of headache was acute in 19.35%, sub-acute in 67.75%, and chronic in 12.9% of patients. Location was holocranial in 38.71%, hemicranial in 29.03%, frontal in 22.58%, and occipital in 9.68% of patients. Headache was severe in 38.7% and moderate in 61.3% of patients. Character was throbbing in 67.74%, heaviness in 25.8%, and band-like in 6.46% of patients. Headache was aggravated on bending forward in 58.06%, movement in 35.48%, coughing in 32.26%, straining in 25.8%, and standing in 16.12% of patients. The relieving factors of headache were lying down in 45.16%, sleeping in 45.16%, and sitting quietly in 9.86% of patients. CONCLUSION CVT should be suspected in patients presenting with new-onset holocranial or hemicranial headaches of increasing intensity, thereby requiring early imaging and appropriate management.
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Affiliation(s)
- Ashutosh K Mishra
- Department of Neurology, All India Institute of Medical Sciences, Raebareli, IND
| | - Ruchi Shukla
- Department of Ophthalmology, All India Institute of Medical Sciences, Raebareli, IND
| | - Rameshwar N Chaurasia
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Archana Verma
- Department of Neurology, All India Institute of Medical Sciences, Raebareli, IND
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Theologou R, Nteveros A, Artemiadis A, Faropoulos K. Rare Causes of Cerebral Venus Sinus Thrombosis: A Systematic Review. Life (Basel) 2023; 13:life13051178. [PMID: 37240823 DOI: 10.3390/life13051178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/15/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) is a rare manifestation of thrombosis commonly caused by thrombophilia, hormonal-related factors, non-cerebral malignancy, and hematologic diseases. The aim of this review was to identify and summarize rare CVST cases. Methods: A literature search of the Medline database was performed in November 2022. CVST cases of a common cause were excluded. Demographic and clinical data were extracted. Eligible cases were categorized into inflammatory, primary CNS tumors, post-operative/traumatic, and idiopathic groups to allow statistical group comparisons. Results: 76 cases were analyzed. Idiopathic CVST was most frequently reported followed by inflammatory, post-traumatic/operative and primary CNS tumor causes. The intracranial hemorrhage rate was 23.7% and it was found to increase in the inflammatory group (45.8%). Anticoagulation was used in the majority of cases and it was significantly related to better outcomes. A low rate of anticoagulation use (43.8%) was found among CVST cases in the post-operative/traumatic group. The overall mortality rate was 9.8%. 82.4% of patients showed significant early improvement. Conclusions: Most rare CVST cases were either of idiopathic or inflammatory origin. Interestingly, hemorrhage occurred often he idiopathic CVST cases. A low rate of anticoagulation use in neurosurgical CVST cases after trauma or head surgery was observed.
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Affiliation(s)
| | - Antonios Nteveros
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
| | - Artemios Artemiadis
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus
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Dinç Y, Ozpar R, Hakyemez B, Bakar M. Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:426-432. [PMID: 37257462 DOI: 10.1055/s-0043-1767822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important. OBJECTIVE This study aims to determine the risk factors for intracranial herniation in patients with CVST. METHODS A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study. RESULTS Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 ± 13.23 and 44.13 ± 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages. CONCLUSION This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy.
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Affiliation(s)
- Yasemin Dinç
- Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye
| | - Rıfat Ozpar
- Uludağ University, Faculty of Medicine, Department of Radiology, Bursa, Türkiye
| | - Bahattin Hakyemez
- Uludağ University, Faculty of Medicine, Department of Radiology, Bursa, Türkiye
| | - Mustafa Bakar
- Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye
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9
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Yousaf M, Khan QA, Anthony MR, Badshah A, Abdi P, Farkouh C, Hadi FA, Jan R, Khan A, Iram S. Snakebite Induced Cerebral Venous Sinus Thrombosis: A Case
Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231165750. [PMID: 37033678 PMCID: PMC10074634 DOI: 10.1177/11795476231165750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/07/2023] [Indexed: 04/07/2023]
Abstract
Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but highly fatal
neurological condition mostly caused by prothrombotic conditions like
antiphospholipid syndrome, factor V Leiden, and G20210A prothrombin
polymorphism. Snake bites are a rare cause of cerebral venous sinus
thrombosis that must be recognized and treated promptly to improve
survival. Case presentation: We present a case of a 25-year-old male who developed headaches and seizures
following a Viper snake bite. The diagnosis was made based on a magnetic
resonance venogram (MRV) showing transverse sinus thrombosis with sigmoid
sinus stenosis. Initially, the patient was treated with antivenom and
supportive treatment for disseminated intravascular coagulation (DIC). After
the diagnosis of CVST, the patient was treated with rivaroxaban and
levetiracetam. The patient improved within 1 week of treatment and was
advised to follow up in 3 months. Conclusion: A high index of suspicion for cerebral venous sinus thrombosis is required if
the patient presents with headaches, seizures, or abnormal vision following
a snake bite. Early diagnosis and management can prevent further
neurological damage.
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Affiliation(s)
| | - Qaisar Ali Khan
- Khyber Teaching Hospital MTI KTH,
Peshawar, Pakistan
- Qaisar Ali Khan, Khyber Teaching Hospital
MTI KTH, Peshawar 25120, Pakistan.
| | | | | | - Parsa Abdi
- Memorial University, St. Johns, NL,
Canada
| | | | | | - Rukhsar Jan
- DHQ and Teaching Hospital KDA, Kohat,
Pakistan
| | - Arooba Khan
- Khyber Teaching Hospital MTI KTH,
Peshawar, Pakistan
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Khan M, Arauz A, Uluduz D, Barboza MA, Duman T, Cano-Nigenda V, Awan S, Wasay M. Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis. Cerebrovasc Dis 2022; 52:393-400. [PMID: 36566747 DOI: 10.1159/000527155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/09/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) associated with pregnancy and puerperium has long been recognized, with poor information in terms of functional outcomes. Our objective was to analyze risk factors, clinical, imaging, and laboratory variables to predict functional outcome and death in this population. METHODS CVT registries from three referral centers from Pakistan, Turkey, and Mexico, recruiting prospective cases, were combined for CVT associated with pregnancy or puerperium. Datasets and variables were standardized. Demographic characteristics, presentation, risk factors, and functional outcomes in pregnancy/puerperium-related CVT were analyzed. Binary logistic regression was used to assess predictors of outcome. The main outcome was modified Rankin score >2 at 30 days and mortality at 30 days. RESULTS Five hundred fifty-three cases (median age 28 years [IQR 23-34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified. Predictors of poor outcome (mRS >2) were encephalopathy (OR 12.8, p < 0.001), cases from Mexican origin (OR 3.1, p = 0.004), fever/puerperal infection (OR 2.7, p = 0.02), and anemia (OR 2.2, p = 0.01). Cases from Mexican origin (OR 12.0, p = 0.003) and Encephalopathy (OR 7.7, p < 0.001), presented with the highest mortality association in the final adjusted model. DISCUSSION/CONCLUSION In CVT associated with pregnancy and puerperium, encephalopathy, fever/puerperal infection, and anemia are associated with bad functional outcomes, meanwhile encephalopathy and cases from Mexican origin with higher mortality in the acute (30-days) of CVT onset. Anemia and infection are potential reversible predictors of poor outcome that clinicians should be aware of in order to prevent poor outcomes in these patients.
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Affiliation(s)
- Maria Khan
- Rashid Hospital, Dubai, United Arab Emirates
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico
| | - Derya Uluduz
- Neurology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica
| | - Taskin Duman
- Department of Neurology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico
| | - Safia Awan
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Mohammad Wasay
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
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11
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Evaluating the diagnostic value of multi-detector brain CT angiography in diagnosing acute cerebral venous thrombosis. Sci Rep 2022; 12:18685. [PMID: 36333349 PMCID: PMC9636138 DOI: 10.1038/s41598-022-21743-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare type of venous thromboembolism mostly affecting young adults. Despite improved imaging studies, the diagnosis is usually delayed by several days. An average diagnostic delay of seven days from the onset of symptoms is still reported for this condition, and it is crucial for radiologists to detect this potentially lethal condition in routine imaging studies. In this study we aimed to investigate the diagnostic value of multi-detector brain CTA in diagnosing acute CVT. We searched our Picture Archiving and Communicating System (PACS) of our tertiary-level academic hospital between March 2016 and March 2019, and collected all patients for whom both contrast-enhanced MRV and brain CTA were acquired at the same admission. A total of 242 patients were found on our PACS database who met our criteria. In the blinded multidetector-row computed tomographic angiography (MDCTA) evaluation, there was a sensitivity of 96.1%, specificity of 98.6% and accuracy of 98.3% for MDCTA in detecting CVST. In the emergency settings, and in centers in which MRI scanners are not available, MDCTA can be used instead of CE-MRV for diagnosis of CSVT with a good sensitivity and specificity.
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12
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Capecchi M, Abbattista M, De Simone P, Artoni A, Gianniello F, Bucciarelli P, Paolucci A, Martinelli I. Direct oral anticoagulants for the treatment of cerebral vein thrombosis. Thromb Res 2022; 220:153-155. [DOI: 10.1016/j.thromres.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
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DORUKOĞLU M, ÇİFTÇİ AYKAÇ Ş, ÖZGİRAY E, GÜLER A, ERASLAN C. Deep cerebral venous thrombosis case giving impression of a cerebral tumor. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1167404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cerebral venous thrombosis is a rare disease that can lead to morbidity and mortality. It can be seen in all age groups, most commonly between the ages of 30-40. Cerebral venous thrombosis patients may present with various clinical findings including headache, nausea, papilledema and less commonly seizures, encephalopathy, intracranial hemorrhage, multiple cranial nerve involvements.
Variable presentation of patients creates difficulties in diagnosis. In this article, a patient who had a headache for 10 days and was first thought to have a thalamic tumor MRI but was found to have thrombosis in the internal cerebral veins as a result of detailed radiological examinations.
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14
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Guo Y, Doycheva D. Analysis of clinical misdiagnosis literature on cerebral venous sinus thrombosis. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis. Life (Basel) 2022; 12:life12050717. [PMID: 35629384 PMCID: PMC9145675 DOI: 10.3390/life12050717] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 01/05/2023] Open
Abstract
(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.
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Ruan CY, Gao BL, Pang HL, Zhang K, Zhang YH, Wei LP, Li TX, Wang ZL. Postpartum cerebral arterial dissections: Clinical features and treatment. Medicine (Baltimore) 2021; 100:e27798. [PMID: 34964745 PMCID: PMC8615341 DOI: 10.1097/md.0000000000027798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022] Open
Abstract
Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections.One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed.A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%).Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.
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Affiliation(s)
- Chun-Yun Ruan
- Luoyang Central Hospital, Zhengzhou University, China
| | - Bu-Lang Gao
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Hong-Li Pang
- Luoyang Central Hospital, Zhengzhou University, China
| | - Kun Zhang
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Yao-Hui Zhang
- Luoyang Central Hospital, Zhengzhou University, China
| | - Li-Ping Wei
- Luoyang Central Hospital, Zhengzhou University, China
| | - Tian-Xiao Li
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Zi-Liang Wang
- Henan Provincial People's Hospital, Zhengzhou University, China
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Gazioglu S, Dinc G. Cerebral venous sinus thrombosis in pregnancy and puerperium. Acta Neurol Belg 2021; 121:967-972. [PMID: 32761494 DOI: 10.1007/s13760-020-01459-3] [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: 04/28/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is more common in women than in men, possibly due to gender-specific risk factors in young adults. The purpose of this study was to investigate whether the clinical and radiological findings, other risk factors, and clinical course of CVST associated with pregnancy and puerperium differ from those of other CVST cases. We retrospectively reviewed patients diagnosed with CVST in our hospital between September 2007 and December 2019. The risk factors, clinical and radiological characteristics, and follow-up data for female patients with CVST were compared between cases associated with pregnancy and puerperium with those of other cases. A total of 50 female patients with CVST were included in the study. Twenty-four (48%) cases occurred during pregnancy and puerperium. The mean age of the pregnant or puerperal patients was lower than that of the other patients (p = 0.007). There was no significant difference between the groups in terms of clinical and neuroradiological findings or presence of any additional risk factors including hereditary thrombophilia. There was also no difference in terms of in-hospital mortality rates and modified Rankin Scale (mRS) scores at 6 months between the groups. The clinical presentation of CVST and the frequencies of the presence of other risk factors including genetic thrombophilia in pregnant and puerperal patients were similar to those of non-pregnant female patients. Screening for additional risk factors, especially genetic thrombophilia, should therefore not be neglected in CVST occurring during pregnancy and puerperium.
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Abuserewa ST, Duff R. Transverse Sinus Thrombosis Secondary to Internal Jugular Vein Abnormalities. Cureus 2021; 13:e15747. [PMID: 34285853 PMCID: PMC8286797 DOI: 10.7759/cureus.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/03/2022] Open
Abstract
Cerebral sinus venous thrombosis (CSVT) is a rare disorder that presents with highly variable neurological manifestations ranging from headache, confusion, seizures, coma to stroke-like symptoms. It predominantly affects young adults and children, with female predilection. We are presenting a case of 59-year-old female with left-sided transverse and sigmoid sinus thrombosis most likely secondary to dehydration on top of chronically diminutive left transverse sinus and internal jugular vein.
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Affiliation(s)
| | - Richard Duff
- Pulmonary and Critical Care Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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19
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Weimar C. [Diagnosis and therapy of cerebral venous and sinus thrombosis]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:182-194. [PMID: 33858026 DOI: 10.1055/a-1323-1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although cerebral venous and sinus thrombosis (CVST) is a rare cerebrovascular disease, it is being diagnosed with increasing frequency due to increased clinical awareness, better imaging capabilities, and higher survival rates in patients with predisposing conditions. This article shows how the diagnosis can be made effectively and what therapeutic options exist in the acute phase and secondary prophylaxis.
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Abstract
Cerebral venous thrombosis (CVT) is a rare form of deep venous thrombosis (DVT), yet a leading cause of stroke in young adults, with an incidence that seems to be increasing in recent years. Risk factors for CVT overlap with those of DVT in other locations, with the addition of local risk factors, such as infections, head trauma and neurosurgery. The clinical presentation is highly variable, hence the diagnosis of CVT may be delayed or overlooked. Early recognition and timely initiation of anticoagulant treatment are of essence, while decompressive surgery can be lifesaving for patients with impending transtentorial herniation. Concomitant intracranial hemorrhage is not a contraindication to anticoagulant treatment. Endovascular treatment may be suggested for selected patients who deteriorate despite anticoagulant treatment. In this review we will provide an extensive and contemporary discussion of the incidence, pathophysiology, risk factors, clinical presentation, neuroimaging and management of CVT, in accordance with recent guidelines. Additionally, we will summarize the latest data with regards to direct oral anticoagulants (DOACs) treatment in CVT.
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Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel - .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel - .,Department of Medicine and Surgery, University of Insubria, Varese, Italy -
| | - Samuela Pegoraro
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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21
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Gogu AE, Jianu DC, Dumitrascu V, Ples H, Stroe AZ, Docu Axelerad D, Docu Axelerad A. MTHFR Gene Polymorphisms and Cardiovascular Risk Factors, Clinical-Imagistic Features and Outcome in Cerebral Venous Sinus Thrombosis. Brain Sci 2020; 11:E23. [PMID: 33375456 PMCID: PMC7824001 DOI: 10.3390/brainsci11010023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) as a severe neurological emergency, is represented by variable conditions in its clinic presentation, onset, risk factors, neuroimagistic features and outcome. The genetic polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene C677T and A1298C was associated with CVST. We aimed to characterize the prevalence of MTHFR gene polymorphisms associated with cardiovascular risk factors in the group of patients with CVST. Also, we studied additional causes associated with CVST including local infections, general infections, obstetric causes (pregnancy, puerperium) and head injury. This is a retrospective study including 114 patients which referred to our hospital between February 2012-February 2020. The protocol included demographic (age, sex), clinical, neuroimagistic features, paraclinic (genetic polymorphism of MTHFR, factor V G1691A-Leiden, prothrombin G20210A, PAI-1 675 4G/5G; Homocysteine level, the lipid profile, blood glucose and Glycohemoglobin HbA1c, high- sensitive C- reactive protein- hsCRP) data, as well as treatment and outcome. The mean age was 37.55 years with a female predominance (65.79%). In the first group of patients with inherited thrombophilia (60 cases; 52.63%) we found genetic mutation includes MTHFR C677T (38.59%) and A1298C (14.03%), factor V G1691A- Leiden (15.78%), prothrombin G20210A (2.63%), PAI-1 675 4G/5G (42.98%), and hyperhomocysteinemia (35.08%). At the second group with other etiology of CVST, except thrombophilia, we included 54 patients (47.36%). The most common sites of thrombosis were the superior sagittal sinus (52.63%). Headache was the most common symptom (91.22%) and seizures were the main clinical presentation (54.38%). The MTHFR polymorphism was significantly correlated with higher total cholesterol (TC) (p = 0.023), low- density lipoprotein cholesterol (LDL) (p = 0.008), homocysteine level (tHcy) (p < 0.001). Inside the first group with MTHFR polymorphism we have found a significant difference between the levels of homocysteine at the patients with MTHFR C677T versus MTHFR A1298C polymorphism (p < 0.001). The high-sensitive C-reactive protein (hsCRP) was increased in both groups of patients, but the level was much higher in the second group (p = 0.046). Mortality rate was of 2.63%. Demographic, clinical and neuroimagistic presentation of CVST in our study was similar with other studies on the matter, with a high frequency of thrombophilia causes. MTHFR gene polymorphisms (C677T and A1298C) are increased in prevalence in CVST. PAI-1 675 4G/5G gene mutation seems to be involved in CVST etiology. Plasma C-reactive protein level and hyperhomocysteinemia should be considered as a prognostic factor in CVST.
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Affiliation(s)
- Anca Elena Gogu
- Department of Neurology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (A.E.G.); (D.C.J.)
| | - Dragos Catalin Jianu
- Department of Neurology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (A.E.G.); (D.C.J.)
| | - Victor Dumitrascu
- Department of Pharmacology, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
| | - Horia Ples
- Department of Neurosurgery, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
| | - Alina Zorina Stroe
- Department of Neurology, General Medicine Faculty, “Ovidius” University, 900470 Constanta, Romania;
| | - Daniel Docu Axelerad
- Department of Sport, Faculty of Physical Education and Sport, “Ovidius” University, 900470 Constanta, Romania;
| | - Any Docu Axelerad
- Department of Neurology, General Medicine Faculty, “Ovidius” University, 900470 Constanta, Romania;
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22
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Treatment of unusual thrombotic manifestations. Blood 2020; 135:326-334. [PMID: 31917405 DOI: 10.1182/blood.2019000918] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
Venous thrombosis rarely occurs at unusual sites such as cerebral, splanchnic, upper-extremity, renal, ovarian, or retinal veins. Clinical features, symptoms, and risk factors of rare thrombotic manifestations are heterogeneous and in large part differ from those typical of the commonest manifestations of venous thrombosis at the lower extremities. The therapeutic approach also varies widely according to the affected site, whether cerebral, abdominal, or extraabdominal. To date, anticoagulant therapy for thrombosis at unusual sites is generally accepted, but the optimal therapeutic approach remains challenging. This review is focused on the treatment of unusual thrombotic manifestations as reported in the most recent guidelines and according to the updated scientific literature.
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Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, Tao Y, Liu H, Zhao J, Xia Z, Xu Y, Song B. Prognostic value of systemic immune-inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol 2020; 5:368-373. [PMID: 32586971 PMCID: PMC7804059 DOI: 10.1136/svn-2020-000362] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/28/2020] [Accepted: 05/03/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the prognosis values of systemic immune–inflammation index (SII) in non-chronic cerebral venous sinus thrombosis (CVST). Methods patients with CVST, admitted to the First Affiliated Hospital of Zhengzhou University, were retrospectively identified from January 2013 to December 2018. We selected patients in acute/subacute phase from database. Functional outcomes of patients were evaluated with the modified Rankin Scale (mRS)—mRS 3–6 as poor outcomes and mRS 6 as death. The overall survival time was defined as the date of onset to the date of death or last follow-up date. Survival analysis was described by the Kaplan-Meier curve and Cox regression analysis. Multivariate logistic regression analysis assessed the relationship between SII and poor functional outcome. The area under the Receiver Operating Curve curve (AUC) was estimated to evaluate the ability of SII in prediction. Results A total of 270 patients were included and their duration of follow-up was 22 months (6–66 months), of whom 31 patients had poor outcomes and 24 patients dead. Cox regression analysis showed that SII (HR=1.304, 95% CI: 1.101 to 1.703, p=0.001) was a predictor of death in non-chronic CVST. Patients with higher SII presented lower survival rates (p=0.003). The AUC of SII was 0.792 (95% CI: 0.695 to 0.888, p=0.040) with a sensitivity of 69.6% and specificity of 80.1%. Subgroups analysis demonstrated that SII was an important predictor of poor outcomes in male (OR=1.303, 95% CI: 1.102 to 1.501, p=0.011) and pregnancy/puerperium female (OR=1.407, 95% CI: 1.204 to 1.703, p=0.034). Conclusions SII was a potential predictor in the poor prognosis of patients with acute/subacute CVST, especially in male and pregnancy/puerperium female.
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Affiliation(s)
- Shen Li
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Kai Liu
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yuan Gao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Lu Zhao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Rui Zhang
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Hui Fang
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yongli Tao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Hongbing Liu
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Jiawei Zhao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Zongping Xia
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yuming Xu
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Bo Song
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
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24
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Abstract
Pregnancy outcome in women with previous cerebral vein thrombosis (CVT) on antithrombotic prophylaxis with low-molecular weight heparin (LMWH) is largely unknown. Aims of this study were to evaluate the risk of recurrent VTE, bleeding and pregnancy outcome in a cohort of pregnant women on LMWH after a first episode of CVT. To estimate the efficacy of LMWH in the prevention of obstetrical complications we compared pregnancies before (without LMWH) with pregnancies after (with LMWH) CVT in 25 women. Two recurrent thrombosis (3.2%, 95% CI 0.9-10.9%) and no bleeding episodes were observed in 63 pregnant women on LMWH. The risk of miscarriage was 13.5% (95% CI 6.1-24.8%) and that of late obstetrical complications 19.2% (95% CI 10.2-31.6%), independently of previous history of obstetrical complications and carriership of thrombophilia abnormalities. A double prevalence of terminations was observed in patients with thrombophilia than in those without. In conclusion, women with previous CVT on LMWH prophylaxis during pregnancy have a low risk of recurrent thrombosis and bleeding, but an increased risk of obstetrical complications.
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Affiliation(s)
- Maria Abbattista
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Milan, Italy
| | - Marco Capecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Milan, Italy
| | - Ida Martinelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Milan, Italy.
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25
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26
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Katsuragi S, Suzuki R, Toyoda K, Neki R, Miyamoto S, Iihara K, Takahashi J, Ikeda T, Yoshimatsu J. Stroke during pregnancy and puerperium among Japanese women: a single-center registry. J Matern Fetal Neonatal Med 2019; 34:2957-2964. [PMID: 31575321 DOI: 10.1080/14767058.2019.1675626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Stroke is one of the major causes of maternal death. This study aimed to analyze the maternal and fetal outcomes of stroke occurred during pregnancy and puerperium. METHODS We conducted a retrospective analysis of patients admitted to our perinatology center between 1982 and 2012 with a diagnosis of acute cerebral stroke during pregnancy or within 6 weeks postpartum. RESULTS Thirty-four patients were registered and all the patients had never been diagnosed as stroke nor detected cerebrovascular abnormalities before the current pregnancies. They were divided into 8 ischemic strokes (ISs) and 26 intracranial hemorrhage group. In the hemorrhage group, there was a spontaneous abortion and two patients chose artificial abortions to avoid rehemorrhage, and there were another three intrauterine fetal deaths (IUFDs) in the acute stage of maternal stroke. More patients in hemorrhage group delivered in preterm than in IS group for the treatment of stroke, 10/23 (43%) versus 0/8 (0%), p < .05. More patients in hemorrhage group had low Glasgow Coma Scale (GCS) (3-8) than in IS group at the onset of the stroke, 12/26 (46%) versus 0/8 (0%), p < .05. There were three maternal deaths and 6/23 (26%) were neurologically dependent in hemorrhage group in the chronic stage, whereas 87% were independent in IS group, p < .05. CONCLUSIONS Hemorrhagic stroke was more common etiology of stroke related to pregnancy than IS in this study. Intensive and multidisciplinary care was needed especially in hemorrhagic stroke related to pregnancy as in the hemorrhagic stroke the fetal survival rate was lower, and maternal conscious levels at the onset of the stroke and neurological outcomes in the chronic stage were worse than IS.
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Affiliation(s)
- Shinji Katsuragi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan
| | - Rieko Suzuki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Reiko Neki
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - Jun Yoshimatsu
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan
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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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28
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Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost 2018; 16:1918-1931. [PMID: 29923367 DOI: 10.1111/jth.14210] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Indexed: 01/25/2023]
Abstract
The cerebral venous system is an unusual site of thrombosis, with a particularly high incidence in young adults. This incidence has increased in past decades because of the improvement of neuroradiological techniques. Risk factors for cerebral venous sinus thrombosis overlap with those of other venous thromboembolism sites; however, some are specific for this particular anatomical district. Prognosis is favorable in most cases if diagnosis is made rapidly and treatment is promptly initiated, even if acute complications or chronic invalidity still occur in a quarter of patients. The mainstay of treatment is anticoagulation, which is necessary in order to block clot propagation and obtain recanalization. Intracranial bleeding does not contraindicate anticoagulation. Endovascular procedures are reserved for patients with a particularly severe presentation or rapidly declining neurological symptoms despite appropriate anticoagulation, although data from clinical trials are lacking. Specifically, this review addresses the epidemiology, clinical presentation and course, risk factors, and treatment of cerebral venous sinus thrombosis, with a special focus on the pediatric population.
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Affiliation(s)
- M Capecchi
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - M Abbattista
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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Sugiura K, Ojima T, Urano T, Kobayashi T. The incidence and prognosis of thromboembolism associated with oral contraceptives: Age-dependent difference in Japanese population. J Obstet Gynaecol Res 2018; 44:1766-1772. [PMID: 29998477 PMCID: PMC6175086 DOI: 10.1111/jog.13706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/20/2018] [Indexed: 12/01/2022]
Abstract
Aim We analyzed the incidence and prognosis of thromboembolism associated with combined oral contraceptives (COCs) by age groups in Japan. Methods A total of 581 events of venous thromboembolism (VTE) and arterial thromboembolism (ATE) associated with COCs were analyzed from the Pharmaceuticals and Medical Devices Agency database from 2004 to 2013. In a statistical analysis, a good‐prognosis group included recovery cases and a poor‐prognosis group involved unrecovered cases with some sequela and fatal cases. The significant difference between these two groups was calculated by Pearson's chi‐square test, and the age‐specific tendency and the trend of differences in prognosis according to different hormonal contraceptives were examined by Cochran–Armitage trend test. Results A total of 543 events were analyzed except 38 events due to unknown age, in which DVT only was the most frequent, followed by cerebral infarction, PE with DVT, PE only, cerebral vein thromboses. ATE ratio for overall thromboembolism tended to increase with advancing age (P = 0.0041). Good‐prognosis group was common (291 cases in VTE and 83 cases in ATE), followed by poor‐prognosis group (46 cases in VTE and 34 cases in ATE). All ATE cases had a significantly poorer prognosis in comparison with all VTE cases (P < 0.0001). Types of progestin and age difference, however, showed no trend in the differences between good‐prognosis group and poor‐prognosis group (P = 0.3548 and P = 0.6097). Conclusion Thromboembolic events were the most frequent in the 40s. The ATE ratio for overall thromboembolism tended to increase with advancing age. All ATE cases had a significantly poorer prognosis in comparison with all VTE cases.
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Affiliation(s)
- Kazuko Sugiura
- Department of Reproductive Health Nursing/Midwifery, Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Shizuoka, Japan
| | - Tetsumei Urano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Shizuoka, Japan
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Abstract
Venous thromboembolism is a leading cause of maternal death. Because of the low absolute frequency of events, however, outcome-based clinical data are limited. Consequently, clinicians must additionally rely both on published guidelines and on extrapolation of data from studies focused on nonpregnant individuals. The diagnosis and treatment of deep vein thrombosis, pulmonary embolism, and cerebral vein and dural sinus thrombosis are complicated by pregnancy, and often require modifications to standard diagnostic and treatment algorithms outside of pregnancy. Treatment of VTE in pregnant women is in particular need of future research.
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Chang BP, Wira C, Miller J, Akhter M, Barth BE, Willey J, Nentwich L, Madsen T. Neurology Concepts: Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department. Acad Emerg Med 2018; 25:54-64. [PMID: 28646558 PMCID: PMC6415947 DOI: 10.1111/acem.13243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting. METHODS A panel of six board-certified emergency physicians, one with fellowship training in stroke and one with training in sex- and sex-based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors. RESULTS Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals. CONCLUSION Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.
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Affiliation(s)
- Bernard P. Chang
- Department of Emergency Medicine, Columbia University Medical Center
| | - Charles Wira
- Department of Emergency Medicine, Yale-New Haven Medical Center
| | - Joseph Miller
- Department of Emergency Medicine, Henry Ford Medical Center
| | - Murtaza Akhter
- Department of Emergency Medicine, University of Arizona College of Medicine–Phoenix, Maricopa Integrated Health System, Phoenix, AZ
| | - Bradley E. Barth
- Department of Emergency Medicine, University of Kansas Medical Center
| | - Joshua Willey
- Department of Neurology, Stroke Service, Columbia University Medical Center
| | | | - Tracy Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
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Alshoabi SA. Cerebral venous sinus thrombosis: A diagnostic challenge in a rare presentation. Brain Circ 2017; 3:227-230. [PMID: 30276329 PMCID: PMC6057707 DOI: 10.4103/bc.bc_27_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/05/2017] [Accepted: 11/25/2017] [Indexed: 11/23/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon, life-threatening condition with a variable clinical presentation that makes it a challenge of diagnosis. A 39-year-old male patient presented to the hospital with complete loss of conscious and admitted to Medical Intensive Care Unit for investigation without any obvious history that was difficult for diagnosis. In this case, the patient presented with coma that is a rare presentation of CVST with no obvious clinical history and he was male patient that means he is free of all gender-specific risk factors of CVST. The brain computed tomography (CT) scan showed hypodense lesion in the left upper parietal region with no hemorrhage. The lesion was low-signal intensity (SI) on T1WIs and high SI on T2WIs and restricted on diffusion-weighted images like arterial infarctions, but magnetic resonance angiography (MRA) was normal that excluded arterial infarction. Gadolinium-enhanced MR venography (MRV) showed the filling defect of CVST. CVST can be present by a mysterious clinical presentation that makes it as a challenge of diagnosis even by medical imaging by CT and MR imaging (MRI). A combination of MRI and MRV is the best, noninvasive, and nonionizing imaging modality for the diagnosis of CVST.
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Affiliation(s)
- Sultan AbdulWadoud Alshoabi
- Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
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33
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Xu F, Liu C, Huang X. Oral contraceptives caused venous sinus thrombosis complicated with cerebral artery infarction and secondary epileptic seizures: A case report and literature review. Medicine (Baltimore) 2017; 96:e9383. [PMID: 29390539 PMCID: PMC5758241 DOI: 10.1097/md.0000000000009383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Venous sinus thrombosis is a special type of cerebrovascular disease. Its incidence is low and its symptoms are lack of specificity. And its early diagnosis and treatment are very difficult. PATIENT CONCERNS This paper reported a rare case of a 43-year-old female who presented with cerebral venous thrombosis (CVT) complicated with cerebral artery infarction and secondary epileptic seizures due to oral contraceptives. DIAGNOSES The final diagnosis was intracranial venous sinus thrombosis, acute cerebral infarction in the left parietal lobe, intracranial hypertension syndrome, and continuous epilepsy. INTERVENTIONS The patient recovered well after active treatment. OUTCOMES Three months after discharge, the muscle strength of the right limb of the patient was significantly increased, and no recurrence of neurological symptoms occurred. LESSONS In conclusion, early diagnosis, correct evaluation, and standard treatment are still important challenges for CVT. Active treatment is recommended.
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Abstract
Pregnant women are most likely to have primary headaches, such as migraine and tension-type headaches, which can be diagnosed and treated without brain imaging. Primary headaches may even start de novo during pregnancy, especially in the first few months. However, when the headache occurs late in pregnancy or in the peripartum period, secondary causes of headaches need to be considered and evaluated by brain and/or vascular imaging, generally using magnetic resonance techniques. There is considerable overlap between the cerebrovascular complications of pregnancy, including preeclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), and both hemorrhagic and ischemic strokes; although, their imaging may be distinctive. Imaging is necessary to distinguish between arterial and venous pathology causing headache in the peripartum patient, as there can be similar presenting symptoms. Mass lesions, both neoplastic and inflammatory, can enlarge and produce headaches and neurological symptoms late in pregnancy.
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Affiliation(s)
- Maryna Skliut
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 10 Union Square E, Suite 5 D, New York, NY, 10003, USA
| | - Dara G Jamieson
- Weill Cornell Medicine, New York Presbyterian Hospital, 428 East 72nd Street, Suite 400, New York, NY, 10021, USA.
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Rim HT, Jun HS, Ahn JH, Kim JH, Oh JK, Song JH, Cho BM, Chang IB. Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions. J Cerebrovasc Endovasc Neurosurg 2016; 18:185-193. [PMID: 27847760 PMCID: PMC5104841 DOI: 10.7461/jcen.2016.18.3.185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/05/2016] [Accepted: 09/21/2016] [Indexed: 12/05/2022] Open
Abstract
Objective Cerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers. Materials and Methods A retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed. Results Mean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes. Conclusion Mean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident.
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Affiliation(s)
- Hyun Taek Rim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Hyo Sub Jun
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Byung Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
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36
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Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes. Emerg Med Clin North Am 2016; 34:695-716. [PMID: 27741984 DOI: 10.1016/j.emc.2016.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There are a number of dangerous secondary causes of headaches that are life, limb, brain, or vision threatening that emergency physicians must consider in patients presenting with acute headache. Careful history and physical examination targeted at these important secondary causes of headache will help to avoid misdiagnosis in these patients. Patients with acute thunderclap headache have a differential diagnosis beyond subarachnoid hemorrhage. Considering the "context" of headache "PLUS" some other symptom or sign is one strategy to help focus the differential diagnosis.
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37
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Sassi SB, Touati N, Baccouche H, Drissi C, Romdhane NB, Hentati F. Cerebral Venous Thrombosis: A Tunisian Monocenter Study on 160 Patients. Clin Appl Thromb Hemost 2016; 23:1005-1009. [PMID: 27582021 DOI: 10.1177/1076029616665168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Data regarding cerebral venous thrombosis in North Africa are scarce. This study aims to identify the clinical features, risk factors, outcome, and prognosis of cerebral venous thrombosis in Tunisia. METHODS Data of 160 patients with radiologically confirmed cerebral venous thrombosis, hospitalized in Mongi Ben Hmida National Institute of Neurology (Tunis, Tunisia), were retrospectively collected and analyzed. RESULTS The mean age was 37.3 years with a female predominance (83.1%). The mode of onset was subacute in most cases (56.2%). Headache was the most common symptom (71.3%), and focal neurologic symptoms were the main clinical presentation (41.8%). The most common sites of thrombosis were the superior sagittal sinus (65%) and the lateral sinus (60.6%). More than 1 sinus was involved in 114 (71.2%) patients. Parenchymal lesions observed in 85 (53.1%) patients did not correlate with cerebral venous thrombosis extent. Major risk factors were obstetric causes (pregnancy and puerperium) found in 46 (38.6% of women aged <50 years) patients, followed by anemia (28.1%) and congenital or acquired thrombophilia (16.2%). Mortality rate was of 6.6%. Good outcome at 6 months (modified Rankin Scale ≤2) was observed in 105 (87.5%)of 120 patients available for follow-up. Predictors of poor outcome were altered consciousness and elevated plasma C-reactive protein levels. CONCLUSION Clinical and radiologic presentation of cerebral venous thrombosis in Tunisia was quite similar to other parts of the world with, however, a particularly high frequency of obstetric causes. Plasma C-reactive protein level should be considered as a prognostic factor in CVT.
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Affiliation(s)
- Samia Ben Sassi
- 1 Department of Neurology, Mongi Ben Hmida National Institute of Neurology, Tunis El Manar University, Tunis, Tunisia
| | - Nahla Touati
- 1 Department of Neurology, Mongi Ben Hmida National Institute of Neurology, Tunis El Manar University, Tunis, Tunisia
| | - Hela Baccouche
- 2 Department of Hematology, La Rabta Hospital, Tunis, Tunisia
| | - Cyrine Drissi
- 3 Department of Neuroradiology, Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia
| | | | - Fayçal Hentati
- 1 Department of Neurology, Mongi Ben Hmida National Institute of Neurology, Tunis El Manar University, Tunis, Tunisia
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38
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Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is rare and involves thrombosis of the veins and sinuses of the brain, most commonly the superior sagittal sinus. Approximately 5 CVT cases occur per 1 million persons in western countries. CVT causes 0.5% of strokes. Early diagnosis is crucial to prevent such outcomes as hydrocephalus, intracranial hypertension, and further seizures. Standard medical treatment of CVT consists of low-molecular-weight heparin and endovascular thrombolysis. Small case reports have found that the newer oral anticoagulants can be used for CVT treatment; however, they are associated with increased risk of bleeding and other adverse effects. REVIEW SUMMARY CVT can be triggered by an imbalance of the body's homeostasis or reduced action of the intrinsic antithrombotic mechanism. Factors influencing this change include infection, brain tumor, inflammatory conditions, genetic thrombophilias, head trauma that causes intracranial bleeding, and certain medications. CVT may cause brain infarction and increased intracranial pressure. Sometimes, idiopathic intracranial hypertension presents as the only clinical manifestation. Confirmation of the diagnosis typically is through neuroimaging. Current CVT treatment depends on disease extent and severity. CONCLUSIONS CVT is a rare neurological disease with potentially serious implications and high neurological morbidity and mortality rates. Understanding the role of risk factors-such as genetic or acquired thrombophilia, pregnancy, use of oral contraceptives, and hyperhomocysteinemia-in CVT development is important. Although heparin and warfarin have been used for more than 50 years, newer oral anticoagulants (eg, dabigatran, rivaroxaban, apixaban) might offer an alternative to traditional therapy.
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39
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Arai N, Tabuse M, Nakamura A, Miyazaki H. Malignant isolated cortical vein thrombosis with type II protein S deficiency: a case report. BMC Neurol 2016; 16:69. [PMID: 27193638 PMCID: PMC4870743 DOI: 10.1186/s12883-016-0597-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 05/12/2016] [Indexed: 12/03/2022] Open
Abstract
Background The incidence of cerebral venous thrombosis (CVT) is low, and in particular, isolated cortical vein thrombosis (ICVT) is very rare. The diagnosis of ICVT is difficult by using conventional computed tomography (CT) and magnetic resonance imaging (MRI). However, with appropriate treatment, ICVT has a good prognosis. Case presentation Herein, we present a rare case of a 40-year-old woman with ICVT and type II protein S (PS) deficiency, who experienced a stroke. She initially presented with generalized convulsions. A CT scan showed intracerebral hemorrhage (ICH) in the left temporoparietal region. However, her condition rapidly deteriorated and she went into a coma approximately 20 h after admission. A second CT scan revealed significant ICH expansion and transfalcine herniation. Decompressive hemicraniectomy with duraplasty was performed, and ICVT was confirmed owing to abnormal vascular tone and black appearance of the cortical vein. She underwent anticoagulation therapy and rehabilitation, and gradually recovered. Conclusion We experienced an extremely rare case of isolated cortical vein thrombosis related with type II PS deficiency. CT-digital subtraction angiography is a useful supportive technique in the diagnosis of ICVT. Decompressive hemicraniectomy is effective for hemorrhage extension cases, and ICVT with hemorrhage might require early anticoagulation therapy.
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Affiliation(s)
- Nobuhiko Arai
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan.
| | - Masanao Tabuse
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan
| | - Akiyoshi Nakamura
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan
| | - Hiromichi Miyazaki
- Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa, 254 0065, Japan
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40
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Goh KG, Shanthi V. The Importance of Early Recognition of Cerebral Venous Sinus Thrombosis: A Case Report. Malays J Med Sci 2015; 22:98-102. [PMID: 28239275 PMCID: PMC5295744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/02/2014] [Indexed: 06/06/2023] Open
Abstract
A 33-year-old lady presented to the emergency department (ED) of Kuala Lumpur Hospital with subacute onset of headaches, irritability, and vomiting. Neurological examination revealed a restless agitated patient, poor responses to verbal commands with a Glasgow Coma Scale of 14/15, photophobia, blurred nasal margins with generalised weakness, hyperreflexia, and downgoing plantars. Computed tomography (CT) of the brain showed evidence of biparietal infarction with an empty delta sign. Urgent magnetic resonance imaging and venography (MRI/MRV) of the brain in the ED showed evidence of thrombosis of the superior sagittal sinus extending to the torcular herophili, straight sinus, transverse sinuses, sigmoid sinuses, and proximal internal jugular veins. The precipitating factor for the thrombosis was possibly oral contraceptive pill usage, which she had been taking for a month. She was treated aggressively with anticoagulation. The patient subsequently improved symptomatically and achieved full neurological recovery. In this patient, early recognition of the clinical symptoms and a CT scan with confirmation by MRI/MRV of the brain enabled the prompt diagnosis and treatment of cerebral venous sinus thrombosis with a good clinical outcome.
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Affiliation(s)
- Kian Guan Goh
- Faculty of Medicine, University Malaya Medical Centre, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
| | - Viswanathan Shanthi
- Department of Neurology, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
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Sparaco M, Feleppa M, Bigal ME. Cerebral Venous Thrombosis and Headache - A Case-Series. Headache 2015; 55:806-14. [DOI: 10.1111/head.12599] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Marco Sparaco
- Division of Neurology, Department of Neurosciences; Benevento Italy
| | - Michele Feleppa
- Division of Neurology, Department of Neurosciences; Benevento Italy
| | - Marcelo E. Bigal
- Global Clinical Development; Migraine and Headaches; Teva Pharmaceuticals; Frazer PA USA
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42
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Gariel F, Berge J, Dousset V. Neurological recovery after coma related to diffuse cerebral venous sinus thrombosis. Interest in thrombi-aspiration with Penumbra system. Interv Neuroradiol 2015; 21:218-21. [PMID: 25943847 DOI: 10.1177/1591019915582000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We report a young man with a history of deep coma secondary to an extensive superior sagittal sinus thrombosis despite full systemic anticoagulation. Endovascular treatment combining a 5 Max ACE reperfusion catheter (Penumbra) and Solitaire (Covidien) retrieval device permitted revascularization of the superior sagittal sinus with restoration of anterograde venous flow. This treatment led to the disappearance of cytotoxic edema on MRI and to a neurological improvement with a modified Rankin scale score of 2 after two months. Our experience shows that this technique provides a useful and safe tool after failure of anticoagulation in cerebral venous sinus thrombosis.
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Affiliation(s)
- Florent Gariel
- Department of Diagnostic and Therapeutic Neuro-Imaging, CHU de Bordeaux, France
| | - Jerome Berge
- Department of Diagnostic and Therapeutic Neuro-Imaging, CHU de Bordeaux, France
| | - Vincent Dousset
- Department of Diagnostic and Therapeutic Neuro-Imaging, CHU de Bordeaux, University of Bordeaux, France
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43
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Schoen JC, Campbell RL, Sadosty AT. Headache in pregnancy: an approach to emergency department evaluation and management. West J Emerg Med 2015; 16:291-301. [PMID: 25834672 PMCID: PMC4380381 DOI: 10.5811/westjem.2015.1.23688] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/11/2014] [Accepted: 01/09/2015] [Indexed: 12/24/2022] Open
Abstract
Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, and pituitary apoplexy. Preeclampsia, a serious condition unique to pregnancy, must also be considered. A high index of suspicion for carbon monoxide toxicity should be maintained. Primary headaches should be a diagnosis of exclusion. When advanced imaging is indicated, magnetic resonance imaging (MRI) should be used, if available, to reduce radiation exposure. Contrast agents should be avoided unless absolutely necessary. Medical therapy should be selected with careful consideration of adverse fetal effects. Herein, we present a review of the literature and discuss an approach to the evaluation and management of headache in pregnancy
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Affiliation(s)
- Jessica C Schoen
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Ronna L Campbell
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Annie T Sadosty
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
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44
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Geisbüsch C, Lichy C, Richter D, Herweh C, Hacke W, Nagel S. [Clinical course of cerebral sinus venous thrombosis. Data from a monocentric cohort study over 15 years]. DER NERVENARZT 2014; 85:211-20. [PMID: 24469382 DOI: 10.1007/s00115-013-4000-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Thrombosis of cerebral veins or sinuses (CVST) is a rare condition. In a monocentric retrospective cohort study the clinical characteristics, risk factors, radiological findings as well as course and prognosis of patients over the past 15 years were examined. METHODS Between January 1998 and March 2013 all patients who were treated as inpatients for CVST at the department of neurology of the University of Heidelberg were systematically registered in a database. Along with all relevant clinical data the modified Rankin scale (MRS) was used to measure the clinical severity. A follow-up visit was performed at three time points. The odds ratios (OR) were calculated to establish predictors of good outcome (MRS 0-2), mortality at discharge and at follow-up. Significant variables after univariate analysis were tested for independency in a multivariate logistic regression model. RESULTS A total of 143 patients were included in the study. The median age was 43 years (range 17-74 years) and 67.4 % of patients were female. The most common symptoms were headache (70.6 %), seizures (50.4 %) and paresis (37.8 %). The most prominent clinical risk factor was oral contraception (40.4 %). The two most common localizations of thrombosis were the transversal sinus with the sigmoid sinus (66.4 %) and the sagittal superior sinus (47.6 %). On admission 42.7 % of patients suffered additionally from intracerebral hemorrhage and 12.6 % from congestive infarction. Of the patients 9.5 % (10 out of 105) showed a pathologically reduced activated protein C (APC) resistance and 8.4 % (6 out of 94) a prothrombin mutation. All patients were initially treated with heparin and 88.7 % were switched to cumarin during the course of the disease. The median duration of anticoagulation was 15.75 months (range 1-121 months). On discharge 77.7 % had a good outcome and the in-hospital mortality was 4.7 %. The median time to follow-up in 108 patients was 36 months (range 3-132 months), 74.1 % of patients had a good outcome (MRS 0-2) and 18.5 % died. Independent predictors of in-hospital mortality were MRS on admission (OR 2.2, 95 % CI 1.03-4.7) and of mortality at follow-up the presence of a malignant disease (OR 50.2, 6-423) and intracerebral hemorrhage on admission (OR 10.3, 1.7-62.6). DISCUSSION The results of this study are in line with previously published data on CVST. The most prominent clinical risk factors for CVST were female gender and oral contraception. At discharge from hospital and 3 years after CVST approximately 75 % of patients achieved a good clinical outcome. A severe clinical syndrome and the presence of an intracerebral hemorrhage on admission were independent predictors of mortality.
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Affiliation(s)
- C Geisbüsch
- Neurologische Klinik, Universität Heidelberg, INF 400, 69120, Heidelberg, Deutschland
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45
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Park DS, Moon CT, Chun YI, Koh YC, Kim HY, Roh HG. Clinical characteristics of cerebral venous thrombosis in a single center in Korea. J Korean Neurosurg Soc 2014; 56:289-94. [PMID: 25371777 PMCID: PMC4219185 DOI: 10.3340/jkns.2014.56.4.289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the clinical characteristics of cerebral venous thrombosis (CVT) in a single center in Korea. METHODS A total of 36 patients were diagnosed with CVT from August 2005 to May 2013. The patient data regarding age, sex, disease stage, pathogenesis, location, laboratory findings, radiological findings, and treatment modalities were retrospectively collected. The results were compared with those of previous studies in other countries. RESULTS The patient group comprised 21 men and 15 women with a mean age of 46.9 years (ranging from three months to 77 years). The most common cause was a prothrombotic condition (8 patients, 22.2%). Within the patient group, 13 patients (36.1%) had a hemorrhagic infarction, whereas 23 (63.9%) had a venous infarction without hemorrhage. By location, the incidence of hemorrhagic infarction was the highest in the group with a transverse and/or sigmoid sinus thrombosis (n=9); however, the proportion of hemorrhagic infarction was higher in the cortical venous thrombosis group (75%) and the deep venous thrombosis group (100%). By pathogenesis, the incidence of hemorrhagic infarction was the highest in the prothrombotic group (n=6), which was statistically significant (p=0.016). CONCLUSION According to this study, CVT was more prevalent in men, and the peak age group comprised patients in the sixth decade. The most common cause was a prothrombotic condition. This finding was comparable with reports from Europe or America, in which CVT was more common in younger women. Hemorrhagic infarction was more common in the prothrombotic group (p=0.016) than in the non-prothrombotic group in this study.
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Affiliation(s)
- Dong Sun Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Chang Taek Moon
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Young Il Chun
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Young-Cho Koh
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
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46
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Cerebral venous thrombosis-a primer for the haematologist. Blood Rev 2014; 29:45-50. [PMID: 25282690 DOI: 10.1016/j.blre.2014.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/01/2014] [Accepted: 09/02/2014] [Indexed: 11/21/2022]
Abstract
Cerebral venous thrombosis (CVT) is a condition that can affect all age groups and can often be difficult to diagnose and treat. The difficulties in diagnosis are mainly due to the non-specific presenting features of CVT, which can range from isolated headache and visual or auditory problems, to serious symptoms such as hemiparesis and coma. Therefore, it can present to various specialists including general physicians, obstetricians and neurologists. In recent years, more widespread use of cerebral imaging has led to the diagnosis being made more often. Since thrombosis is the key component, haematologists are consulted in the management of these patients including for identification of a causative factor for CVT. In this regard, the pivotal International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) has shed more light on its epidemiology and management options. This review aims to provide guidance to haematologists when faced with a patient with CVT, based on the currently available evidence.
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47
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Evaluation of cerebral venous thrombosis secondary to oral contraceptive use in adolescents. Neurol Sci 2014; 36:149-53. [PMID: 25092566 DOI: 10.1007/s10072-014-1914-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/30/2014] [Indexed: 12/30/2022]
Abstract
Our goal was to evaluate the clinical patterns, additional risk factors, treatment and outcome of cerebral venous thrombosis (CVT) related to adolescent oral contraceptive pill (OCP) usage. We evaluated 22 patients with CVT related to OCPs admitted to Firat and Dicle University Hospitals from January 2008 to January 2013. We assessed the clinical features, risk factors, imaging results and prognosis. Magnetic resonance imaging (MRI) and magnetic resonance were the preferred procedures for the diagnosis of CVT. MRI revealed parenchymal lesions in 11 (50 %) patients, and the remaining patients had normal MRIs. The sinuses most frequently affected by thrombosis were the superior sagittal sinus and the transverse sinus. The additional risk factors identified for CVT were antiphospholipid syndrome, protein C deficiency, protein C and S deficiency, factor V Leiden associated with heterozygous antithrombin III deficiency, methylenetetrahydrofolate reductase and prothrombin gene mutations. CVT may be overlooked in adolescents because it is more common among middle-aged and elderly adults. CVT should be suspected in the presence of neurological symptoms in adolescents, especially in those using OCPs.
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Alvis-Miranda HR, Milena Castellar-Leones S, Alcala-Cerra G, Rafael Moscote-Salazar L. Cerebral sinus venous thrombosis. J Neurosci Rural Pract 2014; 4:427-38. [PMID: 24347950 PMCID: PMC3858762 DOI: 10.4103/0976-3147.120236] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
| | | | | | - Luis Rafael Moscote-Salazar
- Department of Neurological Endovascular Therapy, Instituto Nacional de Neurologia y Neurocirugía; Stroke Unit, Hospital Ángeles del Pedregal, Mexico City, Mexico
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Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1545-88. [PMID: 24503673 PMCID: PMC10152977 DOI: 10.1161/01.str.0000442009.06663.48] [Citation(s) in RCA: 622] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. CONCLUSIONS To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.
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Sidhom Y, Mansour M, Messelmani M, Derbali H, Fekih-Mrissa N, Zaouali J, Mrissa R. Cerebral venous thrombosis: clinical features, risk factors, and long-term outcome in a Tunisian cohort. J Stroke Cerebrovasc Dis 2014; 23:1291-5. [PMID: 24462460 DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/09/2013] [Accepted: 10/24/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data from African countries regarding diagnosis, prognosis, management, and outcome of patients with cerebral venous thrombosis (CVT) are limited. The aim of the present study is to characterize clinical presentation, predisposing factors, neuroimaging findings, and outcomes of the disease in the Tunisian population. METHODS This is a prospective study including patients referred to the Neurology Department of the Military Hospital of Tunis between January 2009 and December 2012. The diagnosis of CVT was confirmed in all patients using magnetic resonance imaging and magnetic resonance venography. The demographic, clinical, radiological, and outcome data were recorded and analyzed. Median follow-up was 16 months (range 6 months to 4 years). Primary outcome was death or dependency as assessed by modified Rankin score more than 2 at the end of follow-up. RESULTS This study included 41 patients with CVT. Mean age was 41.24 years, predominantly women (68%). The mode of onset was acute in 10 patients (24%), subacute in 26 (64%), and chronic in 5 (12%). The most common presenting features were headache, observed in 83% of the patients, followed by seizures, focal motor deficits, papilledema, and mental status changes. Lateral (56%) and superior longitudinal (51%) sinuses were the most commonly involved. Multiple sinuses were involved in 46% of cases. Nineteen patients (46%) had a D-dimer level more than 500 ng/mL. Major causes of CVT were thrombophilia (56%), either genetic or acquired, obstetric and gynecological (50%), and septic (34%). Outcome was favorable in 83% of patients. At the end of follow-up, 32 patients (78%) had complete recovery (modified Rankin Scale [mRs] score 0-1), 2 (5%) had partial recovery (mRs score 2), and 4 (10%) were dependent (mRs score 3-5). One patient (2.5%) had a recurrent sinus thrombosis. CONCLUSIONS Our Tunisian population presented distinct risk factors profile with high frequency of thrombophilia, infections, and postpartum state. Oral contraceptive use is not a major risk factor in our population. The overall prognosis was good.
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Affiliation(s)
- Youssef Sidhom
- Neurology Department, Military Hospital, Tunis, Tunisia.
| | - Malek Mansour
- Neurology Department, Military Hospital, Tunis, Tunisia
| | | | - Hajer Derbali
- Neurology Department, Military Hospital, Tunis, Tunisia
| | | | - Jamel Zaouali
- Neurology Department, Military Hospital, Tunis, Tunisia
| | - Ridha Mrissa
- Neurology Department, Military Hospital, Tunis, Tunisia
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