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Wang L, Zhu X, Li H, Jia B, Xie W, Zhang Y, Wang L, Liu L, Li M. Association between blood urea nitrogen to creatinine ratio and 3-month outcome in patients with acute ischaemic stroke: a retrospective cohort study from a large healthcare system. BMJ Open 2024; 14:e085912. [PMID: 39038861 DOI: 10.1136/bmjopen-2024-085912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVES The blood urea nitrogen to creatinine (BUN/Cr) ratio is associated with early neurological deterioration in acute ischaemic stroke (AIS). However, the predictive value of the BUN/Cr ratio for the AIS prognosis remains unclear. Therefore, we evaluated the correlation between the BUN/Cr ratio and the 3-month outcome in patients with AIS, further testing their dose-response relationship. DESIGN This retrospective cohort study enrolled patients with AIS who were admitted between 1 January 2013 and 31 May 2022. Poor clinical outcome was defined as 3-month Modified Rankin Scale (mRS) >2. Cox proportional HR was used to evaluate the correlation between the BUN/Cr ratio and 3-month outcome. Restricted cubic spline and robust locally weighted regression analyses were conducted to determine the dose-response relationship between the BUN/Cr ratio and the 3-month outcome. RESULTS A total of 4952 eligible patients were included in the study. The patients were divided into three groups according to the tertiles of BUN/Cr ratio (T1, <0.071; T2, 0.071-0.093; and T3, >0.093). After logistic regression adjustment for demographic and clinical characteristics, the BUN/Cr ratio was found to be independently associated with the 3-month outcome in patients with AIS. The restricted cubic spline and locally regression smoothing scatterplot graph showed a strong dose-response relationship between the BUN/Cr ratio and the 3-month outcome in patients with AIS. CONCLUSION A dose-response relationship was observed between the BUN/Cr ratio and the 3-month outcome in patients with AIS, suggesting that the BUN/Cr ratio could serve as a reliable predictor for the AIS prognosis.
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Affiliation(s)
- Liumin Wang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinmei Zhu
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hui Li
- Taikang Community Su Garden, Nanjing, China
| | - Boluo Jia
- Nanjing Qixia District Xigang Community Health Service Center, Nanjing, China
| | - Wen Xie
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yanli Zhang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lina Wang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ling Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Mingquan Li
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Ma H, Gu Y, Bian T, Song H, Liu Z, Ji X, Duan J. Dabigatran etexilate versus warfarin in cerebral venous thrombosis in Chinese patients (CHOICE-CVT): An open-label, randomized controlled trial. Int J Stroke 2024; 19:635-644. [PMID: 38353219 DOI: 10.1177/17474930241234749] [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] [Indexed: 02/27/2024]
Abstract
BACKGROUND The efficacy and safety of dabigatran etexilate for Chinese patients with cerebral venous thrombosis (CVT) has not been well established. METHODS CHOICE-CVT was an exploratory, single-center, randomized, open-label study in the National Center for Neurological Disorders involving Chinese patients with CVT aged 18 to 80 years who were randomly assigned (1:1) to either dabigatran etexilate or warfarin. Oral anticoagulants were initiated after 10-15 days of LMWH. The primary efficacy and safety endpoints included the number of patients with recurrent CVT and/or deep venous thrombosis (DVT) and major clinical bleeding within 180 days. Secondary efficacy endpoints included venous recanalization and change in papilledema at day 180. Secondary safety outcomes comprised death, clinical nonmajor bleeding, and any bleeding. The study was registered with ClinicalTrials.gov under NCT03930940. RESULTS Between October 2017 and February 2023, a total of 89 patients were enrolled and randomly assigned to receive either dabigatran etexilate (n = 44) or warfarin (n = 45). At day 180, the dabigatran etexilate group showed a statistically nonsignificant but likely clinically significant number of patients with recurrent CVT and/or DVT (8 (18.2%; 95% CI, 6.3-30.0) vs 3 (6.7%; 95% CI, 0.0-14.2), p = 0.099, with a power (1-β) of 38.401%) compared with the warfarin group. The dabigatran etexilate group showed a comparable number of patients with clinical major bleeding (0 (0) vs 0 (0) p = 1.000), and clinical nonmajor bleeding (1 (2.3%; 95% CI, 0.0-6.9) vs 1 (2.2%; 95% CI, 0.0-6.7)) but demonstrated a lower risk of any bleeding (1 (2.3%; 95% CI, 0.0-6.9) vs 9 (20.0%; 95% CI, 7.8-32.2)) compared with the warfarin group. Most patients in both groups achieved venous recanalization according to the Modified Qureshi scale (27 (75%; 95% CI, 60.1-89.9) in the dabigatran etexilate group vs 34 (82.9%; 95% CI, 70.9-95.0) in the warfarin group) and exhibited improvement in papilledema as per the Frisén classification (35 (97.2%; 95% CI, 91.6-100.0) in the dabigatran etexilate group vs 37 (88.1%, 95% CI, 77.9-98.3) in the warfarin group). CONCLUSIONS These findings regarding efficacy and safety support the consideration of dabigatran etexilate therapy as a viable treatment option for Chinese patients with CVT.
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Affiliation(s)
- Hongrui Ma
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yaqin Gu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tingting Bian
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Fengtai You'anmen Hospital, Beijing, China
| | - Haiqing Song
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Quealy JB. Mechanical Thrombectomy for Aseptic, Atraumatic, Medically Refractory Cerebral Venous Sinus Thrombosis: a Systematic Review. Clin Neuroradiol 2024; 34:451-463. [PMID: 38329489 DOI: 10.1007/s00062-023-01373-0] [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: 10/02/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) follows a severe clinical course in 13.5% of cases. Practice guidelines recommend endovascular therapy (EVT); no randomised control trials (RCTs) exist comparing EVTs. PURPOSE To determine whether specific EVTs are superior to alternatives. DATA SOURCES CENTRAL, Medline, Embase, five other databases and four clinical trials registers. Grey literature searches, reference checking, citation searching, and author contact. STUDY SELECTION All CVST cases treated with mechanical thrombectomy (MT) were includible. Paediatric, and trauma-related or infection-related thromboses were excluded. DATA ANALYSIS Standard Cochrane review procedures. Primary outcome measures; clinical efficacy (modified Rankin Score, mRS), technical efficacy (recanalisation), and clinical safety (procedure-related complications and death). Subgroup analyses were performed, comparing outcome measures between demographic groups, clinico-radiological severity, interventional strategies, and degrees of recanalisation. DATA SYNTHESIS In this study 124 papers were included (n = 486). All patients underwent MT, with 69.5% of patients receiving concomitant chemolysis. New/expanding intracerebral haemorrhage (ICH) occurred in 5.1%; non-haemorrhagic complications in 1.4%; 10.7% died. Predictors of poor efficacy included age ≥ 55 years, altered mental status (AMS), Glasgow Coma Scale (GCS) < 8. Predictive of poor safety outcomes included pre-existing ICH, deep system thrombosis, and AMS. Complete recanalisation was associated with improved clinical efficacy and safety outcomes. LIMITATIONS The review is based on case reports/series, increasing bias-risk. Myriad of potentially includible studies were necessarily excluded due to lack of requisite details. CONCLUSION Predictors of poor outcomes with medical therapy predict poor outcomes with MT; these measures should not dictate candidacy. Complete recanalisation predicts favorable clinical and safety outcomes. Local chemolysis is safe, improves recanalisation, and should be recommended, provided there is no contraindication. Clot maceration strategies and stent-retriever thrombectomy are associated with superior clinical efficacy and safety endpoints, as compared with balloon angioplasty and rheolysis.
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Affiliation(s)
- John B Quealy
- Department of Internal Medicine, UPMC Aut Even Hospital, Freshford Road, R95D370, Kilkenny, Ireland.
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Amalia L, Ardo RT. Clinical Significance of D-dimer Level and Numeric Rating Scale with Amount of Sinus Involvement in Cerebral Sinus Thrombosis Patients. Int J Gen Med 2024; 17:2143-2149. [PMID: 38766601 PMCID: PMC11102121 DOI: 10.2147/ijgm.s460407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Cerebral venous sinus thrombosis (CVST) is a cerebral vascular disorder that currently occurs quite often and has very varied clinical symptoms. Headache is the main symptom most commonly found in patients with CVST and multiple sinus involvement often have a more severe prognosis and poor clinical outcome. This study aimed to learn the relationship between D-dimer level, numeric rating scale (NRS), and amount of sinus involvement in CVST patients. Methods This study was a retrospective observational analytic study with a cross-sectional approach using medical records and supporting data (D-dimer level and imaging finding) on patients diagnosed with CVST at Dr Hasan Sadikin Hospital Bandung. Results Sixty-five CVST patients met the study criteria with mean age of 47 years and mostly female (76.9%). Patients with single sinus involvement had a median initial NRS of 4 (range 2-6) and multiple sinus involvement was higher at 8 (range 5-9). Statistical test results showed a significant difference between D-dimer level, NRS and amount of sinus involvement (P<0.001). Conclusion D-dimer level, NRS, and amount of sinus involvement are associated with amount of sinus involvement in CVST patients. Involvement of multiple sinus will cause higher NRS with higher D-dimer level.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ryan Tantri Ardo
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
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Hachenberger M, Braun T, Gerner ST, Suenner L, Schänzer A, Juenemann M, Mueller C, Wietelmann A, Stolz E, Schoenburg M, Tschernatsch M, Gerriets T, Huttner HB, Yeniguen M. Aluminium Chloride instead of Ferric chloride for inducing superior sagittal sinus thrombosis to reduce ferromagnetic artifacts on MRI-imaging in experimental models. Sci Rep 2024; 14:10998. [PMID: 38745068 PMCID: PMC11094183 DOI: 10.1038/s41598-024-61885-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
Using ferric chloride (FeCl3) to induce experimental superior sagittal sinus (SSS) thrombosis might interfere with magnetic resonance imaging (MRI)-assisted visualization and evaluation of the thrombus, the brain parenchyma, and the quality of the occlusion. The aim of this study was to investigate whether aluminum chloride (AlCl3)-induced thrombosis of the SSS has comparable properties to those of FeCl3 without causing artifacts in MRI. SSS thrombosis was induced in 14 male Wistar rats by exposure of the SSS and subsequent topical application of a filter paper strip soaked in AlCl3 (n = 7) or FeCl3 (n = 7) over a period of 15 min. The animals with AlCl3-induced SSS thrombosis showed a constant and complete occlusion with in histological analysis large thrombi. Blood flow measurements indicated a significant reduction on the first and seventh postoperative day compared to preoperative measurements. MRI enabled visualization and subsequent evaluation of the thrombus and the surrounding parenchyma. In comparison, FeCl3-induced SSS thrombosis could not be evaluated by MRI due to artifacts caused by the paramagnetic properties and increased susceptibility of FeCl3. The occluded sinus and the surrounding area appeared hypointense. The quality of SSS occlusion by AlCl3 was comparable to that of FeCl3. AlCl3 therefore represents a significant alternative substance in experimental SSS thrombosis ideally suited for studies using MRI.
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Affiliation(s)
- Maaike Hachenberger
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - Tobias Braun
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany.
- Heart and Brain Research Group, 35385, Giessen, Germany.
- Department of Neurology, Lahn-Dill-Kliniken Wetzlar, 35578, Wetzlar, Germany.
| | - Stefan T Gerner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
| | - Laura Suenner
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - Anne Schänzer
- Institute of Neuropathology, Justus-Liebig University Giessen, 35385, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - Clemens Mueller
- Department of Radiology, Kerckhoff-Klinik Bad Nauheim, 61231, Bad Nauheim, Germany
| | - Astrid Wietelmann
- Scientific Service Group Magnetic Resonance Imaging, Max Planck Institute for Heart and Lung Research, 61231, Bad Nauheim, Germany
| | - Erwin Stolz
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - Markus Schoenburg
- Heart and Brain Research Group, 35385, Giessen, Germany
- Department of Cardiac Surgery, Kerckhoff-Klinik Bad Nauheim, 61231, Bad Nauheim, Germany
| | - Marlene Tschernatsch
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- Die Neurologen, Private Practice, Frankfurter Strasse 34, 61231, Bad Nauheim, Germany
| | - Tibo Gerriets
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- Die Neurologen, Private Practice, Frankfurter Strasse 34, 61231, Bad Nauheim, Germany
| | - Hagen B Huttner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
| | - Mesut Yeniguen
- Department of Neurology, Justus-Liebig University Giessen, Klinikstrasse 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- NeuroCentrum Wetzlar, Sportparkstrasse 2, 35578, Wetzlar, Germany
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Kui L, Jiao Y, Jiang H, Wang G, Li Z, Ji X, Zhou C. Expression and metabolism profiles of CVT associated with inflammatory responses and oxygen carrier ability in the brain. CNS Neurosci Ther 2024; 30:e14494. [PMID: 37902195 PMCID: PMC11017414 DOI: 10.1111/cns.14494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/21/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
AIM As the main type of stroke, the incidence of cerebral venous thrombosis (CVT) has been rising. However, the comprehensive mechanisms behind it remain unclear. Thus, the multi-omics study is required to investigate the mechanism after CVT and elucidate the characteristic pathology of venous stroke and arterial stroke. METHODS Adult rats were subjected to CVT and MCAO models. Whole-transcriptome sequencing (RNA-seq) and untargeted metabolomics analysis were performed to construct the transcriptome and metabolism profiles of rat brains after CVT and also MCAO. The difference analysis, functional annotation, and enrichment analysis were also performed. RESULTS Through RNA-seq analysis, differentially expressed genes (DEGs) were screened. 174 CVT specific genes including Il1a, Ccl9, Cxxl6, Tnfrsf14, etc., were detected. The hemoglobin genes, including both Hba and Hbb, were significantly downregulated after CVT, compared both to the MCAO and Sham groups. Metabolism analysis showed that CVT had higher heterogeneity of metabolism compared to MCAO. Metabolites including N-stearoyltyrosine, 5-methoxy-3-indoleaceate, Afegostat, pipecolic acid, etc. were specially regulated in CVT. Through the immune infiltration analysis, it was found that CVT had a higher immune response, with the abundance of certain types of immune cells increased, especially T helper cells. It was important to find the prevalence of the activation of inflammatory chemokine, cytokine, NOD-like pathway, and neutrophil extracellular trap. CONCLUSION We explored and analyzed the gene expression and metabolomic characteristics of CVT, revealed the specific inflammatory reaction mechanism of CVT and found the markers in transcriptome and metabolism levels. It points out the direction for CVT early diagnosis and treatment.
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Affiliation(s)
- Ling Kui
- Shenzhen Qianhai Shekou Free Trade Zone HospitalShenzhenChina
| | - Yinming Jiao
- Shenzhen Qianhai Shekou Free Trade Zone HospitalShenzhenChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Guoyun Wang
- Shenzhen Qianhai Shekou Free Trade Zone HospitalShenzhenChina
| | - Zongyu Li
- Dehong People's HospitalMangshiChina
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
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Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD. Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association. Stroke 2024; 55:e77-e90. [PMID: 38284265 DOI: 10.1161/str.0000000000000456] [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] [Indexed: 01/30/2024]
Abstract
Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
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Hao W, Gu Y, Hu S, Ji X, Wang Y, Duan J. An Exploration of Anti-Inflammatory Therapy in Acute/Subacute Severe Cerebral Venous Thrombosis with Hereditary Protein C/S Deficiency: Case Series. J Inflamm Res 2023; 16:5403-5415. [PMID: 38026243 PMCID: PMC10676091 DOI: 10.2147/jir.s428589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Inflammation was associated with the severity of severe cerebral venous thrombosis (CVT) on admission and poor prognosis at discharge. Hereditary protein C/S deficiency (hereditary PCD/PSD) not only promotes thrombosis but also activates the inflammatory response, further inducing venous thrombosis. However, conventional treatments such as standard anticoagulant/endovascular therapy (EVT) do not seem to improve prognosis. Anti-inflammatory therapy may be a new way to treat the disease. Methods We enrolled five patients with acute/subacute severe CVT with hereditary PCD/PSD from January 2020 to July 2022. In addition to standard anticoagulant therapy, all of them were given short-term methylprednisolone pulse therapy. Neurological deficit, increased intracranial pressure, venous recanalization, serum and cerebrospinal fluid (CSF) inflammatory markers and adverse events were retrospectively described before and after treatment and at 6 months after discharge. Results Inflammatory indexes of all patients were significantly elevated on admission. After methylprednisolone pulse therapy, serum inflammatory indexes including neutrophil-to-lymphocyte ratio (P=0.043); platelet-to-lymphocyte ratio (P=0.043); systemic immune inflammatory index (P=0.043); interleukin-6 (P=0.043) and hypersensitive C-reactive protein (P=0.022) reduced dramatically compared with baseline. CSF inflammatory indexes had a decreasing trend compared with baseline (P>0.05). In terms of venous recanalization, one patient achieved complete recanalization, four patients obtained partial recanalization. Compared with baseline on admission, the NIH Stroke Scale (NIHSS), modified Rankin Scale (mRS) and intracranial pressure were all considerably lower at discharge (P=0.029, P=0.041 and P=0.017). At 6-month follow-up, NIHSS and mRS further declined. During hospitalization and 6-month follow-up, none of the five patients experienced severe steroid-related adverse effects such as recurrence of venous thrombosis, spontaneous fracture or osteonecrosis, and gastroduodenal ulcer. Conclusion Acute/subacute severe CVT with hereditary PCD/PSD has high levels of inflammation. In addition to conventional anticoagulant therapy, early anti-inflammatory therapy using steroids may be necessary. Nevertheless, substantial randomized controlled trials with larger sample sizes are required for further investigation.
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Affiliation(s)
- Wensi Hao
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yaqin Gu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuyuan Hu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xunming Ji
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
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9
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Chang YZ, Zhu HY, Song YQ, Tong X, Li XQ, Wang YL, Dong KH, Jiang CH, Zhang YP, Mo DP. High-resolution magnetic resonance imaging-based radiomic features aid in selecting endovascular candidates among patients with cerebral venous sinus thrombosis. Thromb J 2023; 21:116. [PMID: 37950211 PMCID: PMC10636961 DOI: 10.1186/s12959-023-00558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Cerebral venous sinus thrombosis (CVST) can cause sinus obstruction and stenosis, with potentially fatal consequences. High-resolution magnetic resonance imaging (HRMRI) can diagnose CVST qualitatively, although quantitative screening methods are lacking for patients refractory to anticoagulation therapy and who may benefit from endovascular treatment (EVT). Thus, in this study, we used radiomic features (RFs) extracted from HRMRI to build machine learning models to predict response to drug therapy and determine the appropriateness of EVT. MATERIALS AND METHODS RFs were extracted from three-dimensional T1-weighted motion-sensitized driven equilibrium (MSDE), T2-weighted MSDE, T1-contrast, and T1-contrast MSDE sequences to build radiomic signatures and support vector machine (SVM) models for predicting the efficacy of standard drug therapy and the necessity of EVT. RESULTS We retrospectively included 53 patients with CVST in a prospective cohort study, among whom 14 underwent EVT after standard drug therapy failed. Thirteen RFs were selected to construct the RF signature and CVST-SVM models. In the validation dataset, the sensitivity, specificity, and area under the curve performance for the RF signature model were 0.833, 0.937, and 0.977, respectively. The radiomic score was correlated with days from symptom onset, history of dyslipidemia, smoking, fibrin degradation product, and D-dimer levels. The sensitivity, specificity, and area under the curve for the CVST-SVM model in the validation set were 0.917, 0.969, and 0.992, respectively. CONCLUSIONS The CVST-SVM model trained with RFs extracted from HRMRI outperformed the RF signature model and could aid physicians in predicting patient responses to drug treatment and identifying those who may require EVT.
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Affiliation(s)
- Yu-Zhou Chang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao-Yu Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Qi Song
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Qing Li
- Interventional Neuroradiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke-Hui Dong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chu-Han Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Yu-Peng Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Da-Peng Mo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China.
- Interventional Neuroradiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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10
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Zhou Y, Jiang H, Wei H, Xiao X, Liu L, Ji X, Zhou C. Cerebral venous thrombosis in patients with autoimmune disease, hematonosis or coronavirus disease 2019: Many familiar faces and some strangers. CNS Neurosci Ther 2023; 29:2760-2774. [PMID: 37365966 PMCID: PMC10493677 DOI: 10.1111/cns.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Cerebral venous thrombosis, a rare stroke, is characterized by neurological dysfunction caused by bleeding and/or infarction resulting from venous sinus thrombosis, the so-called venous stroke. Current guidelines recommend anticoagulants as first-line therapy in the treatment of venous stroke. With complicated causes of cerebral venous thrombosis, treatment is difficult, especially when combined with autoimmune diseases, blood diseases, and even COVID-19. AIMS This review summarizes the pathophysiological mechanisms, epidemiology, diagnosis, treatment, and clinical prognosis of cerebral venous thrombosis combined with autoimmune diseases, blood diseases, or infectious diseases such as COVID-19. CONCLUSION A systematic understanding of particular risk factors that should not be neglected when unconventional cerebral venous thrombosis occurs and for a scientific understanding of pathophysiological mechanisms, clinical diagnosis, and treatment, thus contributing to knowledge on special types of venous stroke.
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Affiliation(s)
- Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Xuechun Xiao
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Lu Liu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
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11
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Sun J, Nan G, Zhang L, Gao Y, Cui M. Endovascular treatment for severe cerebral venous sinus thrombosis in a patient with polycythemia vera and nephrotic syndrome: a case report. Am J Transl Res 2023; 15:5900-5907. [PMID: 37854205 PMCID: PMC10579010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease that can occur at any age and generally has a good prognosis. Polycythemia vera and nephrotic syndrome are uncommon risk factors for cerebral venous sinus thrombosis. A dilemma exists in the treatment of cerebral venous sinus thrombosis with polycythemia vera and nephrotic syndrome, as some cases are refractory to first-line therapy. Here, we report a patient with CVST who presented with a generalized seizure and was found to have bilateral frontal lobe hemorrhage and subarachnoid hemorrhage. Brain magnetic resonance venography showed extensive cerebral venous sinus thrombosis extending from the superior sagittal sinus to the left internal jugular vein. Further testing revealed that the patient had polycythemia vera and nephrotic syndrome. Anticoagulation therapy had limited effects. He underwent endovascular intervention, including stent thrombectomy, intermediate catheter aspiration, balloon dilatation, and local intravenous thrombolysis, to achieve revascularization. After 9 months of follow-up, the patient had recovered well without any sequelae. This case shows that in patients with critical cerebral venous sinus thrombosis who fail to respond to anticoagulant therapy, stent thrombectomy combined with intermediate catheter aspiration, balloon dilation, and local thrombolysis may be a viable option. This strategy can quickly resolve venous sinus obstruction and improve the prognosis of patients with critical cerebral venous sinus thrombosis.
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Affiliation(s)
- Jing Sun
- Department of Neurology, China-Japan Union Hospital of Jilin UniversityNo. 126 Xiantai Street, Changchun 130031, Jilin, China
| | - Guangxian Nan
- Department of Neurology, China-Japan Union Hospital of Jilin UniversityNo. 126 Xiantai Street, Changchun 130031, Jilin, China
| | - Li Zhang
- Department of Neurology, China-Japan Union Hospital of Jilin UniversityNo. 126 Xiantai Street, Changchun 130031, Jilin, China
| | - Yu Gao
- Department of Neurology, China-Japan Union Hospital of Jilin UniversityNo. 126 Xiantai Street, Changchun 130031, Jilin, China
| | - Mingji Cui
- Department of Nephrology, The First Affiliated Hospital of Jilin UniversityNo. 3302 Jilin Road, Changchun 130031, Jilin, China
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12
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Jiang H, Zhou C, Wei H, Wu Y, Zhou Y, Xiao X, Liu L, Li M, Duan J, Meng R, Ji X. Potential role of plasma branched-chain amino acids in the differential diagnosis of acute cerebral venous thrombosis. J Cereb Blood Flow Metab 2023; 43:1532-1543. [PMID: 37066688 PMCID: PMC10414010 DOI: 10.1177/0271678x231170037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023]
Abstract
Cerebral venous thrombosis (CVT) is a special and easily misdiagnosed or undiagnosed subtype of stroke. To identify specific biomarkers with a high predictive ability for the diagnosis of acute CVT, we performed metabolomic analysis in plasma samples from acute CVT patients and healthy controls and confirmed the results in validation cohorts. In the discovery stage, there were 343 differential metabolites, and the caffeine metabolism pathway and the biosynthesis pathway for the branched chain amino acids (BCAAs) valine, leucine, and isoleucine were two significant pathways between the CVT and healthy cohorts. The area under the curve (AUC) for metabolites associated with valine, leucine, and isoleucine biosynthesis was 0.934. In the validation stage, the BCAA concentrations demonstrated an AUC of 0.935 to differentiate patients with acute CVT from the control cohort. In addition, BCAAs combined with D-dimer levels were used to establish a diagnostic model for CVT, and the AUC was 0.951, showing good diagnostic efficacy of separating CVT patients from the control cohort. BCAAs as plasma biomarkers deserve to be further studied and even developed in clinical CVT management.
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Affiliation(s)
- Huimin Jiang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yan Wu
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yifan Zhou
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Xuechun Xiao
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Lu Liu
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Emergency, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ran Meng
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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13
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Mead GE, Sposato LA, Sampaio Silva G, Yperzeele L, Wu S, Kutlubaev M, Cheyne J, Wahab K, Urrutia VC, Sharma VK, Sylaja PN, Hill K, Steiner T, Liebeskind DS, Rabinstein AA. A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization. Int J Stroke 2023; 18:499-531. [PMID: 36725717 DOI: 10.1177/17474930231156753] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines. AIMS To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced). SUMMARY OF REVIEW Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited. CONCLUSION The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation.
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Affiliation(s)
- Gillian E Mead
- Usher Institute, University of Edinburgh and Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.,Heart & Brain Lab, Western University, London, ON, Canada.,Robarts Research Institute, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Laetitia Yperzeele
- Antwerp NeuroVascular Center and Stroke Unit, Antwerp University Hospital, Antwerp, Belgium.,Research Group on Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Mansur Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa, Russia
| | - Joshua Cheyne
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Neurology, University Medicine Cluster, National University Health System, Singapore
| | - P N Sylaja
- Neurology and Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Kelvin Hill
- Stroke Treatment, Stroke Foundation, Melbourne, VIC, Australia
| | - Thorsten Steiner
- Departments of Neurology, Klinikum Frankfurt Höchst and Heidelberg University Hospital, Frankfurt, Germany
| | - David S Liebeskind
- UCLA Department of Neurology, Neurovascular Imaging Research Core, UCLA Comprehensive Stroke Center, Los Angeles, CA, USA
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14
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Wang Y, Shen X, Wang P, Fang Q. Clinical characteristics of cerebral venous sinus thrombosis patients with new-onset of headache. BMC Neurol 2023; 23:56. [PMID: 36732686 PMCID: PMC9893575 DOI: 10.1186/s12883-023-03098-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study aimed to assess the clinical characteristics of cerebral venous sinus thrombosis (CVT) patients with new-onset headache and to identify the risk factors for headache in this population. METHODS We retrospectively reviewed the demographic and clinical data of 69 CVT patients recruited between September 2017 and September 2019. Patients were classified into two groups, the headache group and the non-headache group, according to the presence or absence of new-onset headache symptoms at admission. The following characteristics and parameters were measured and analyzed, including gender, age, amount of thromboembolic cerebral venous sinus(ATCVS), and other relevant indicators. RESULTS The incidence of headache was 75% in this cohort. The proportion of female patients in the headache group was higher than that in the non-headache group. Patients in the headache group were younger than those without headache. CVT patients of headache group showed higher lymphocyte ratio (LR), blood urea nitrogen (BUN), and intracranial pressure (ICP) compared to the non-headache group, whereas mean corpuscular volume (MCV) and levels of protein (cerebrospinal fluid, CSF) and lactic dehydrogenase (LDH) in CSF were lower in headache patients. The data also revealed younger age and the increased level of chloride ion CI-(CSF) were the risk factors for the occurrence of headache in CVT patients. CONCLUSION Age, LR, MCV, BUN levels, ICP, protein (CSF), and LDH (CSF) in patients with headache were significantly different from those in the non-headache group at admission. Younger age and a level of CI- (CSF) were risk factors for headache in CVT patients. These findings may provide guidance for clinical diagnosis and treatment of CVT.
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Affiliation(s)
- Yugang Wang
- grid.429222.d0000 0004 1798 0228Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu China ,Department of Neurology, The First People’s Hospital of XianYang, XianYang, Sha’anxi China
| | - Xiaozhu Shen
- grid.440299.2Department of Neurology, The Second People’s Hospital of Lian Yun Gang, Lian Yun Gang, Jiangsu, China
| | - Ping Wang
- grid.412478.c0000 0004 1760 4628Department of Neurology, The First People’s Hospital of He Fei, He Fei, An’Hui China
| | - Qi Fang
- grid.429222.d0000 0004 1798 0228Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu China
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15
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Zhou Y, Jiang H, Wei H, Liu L, Zhou C, Ji X. Venous stroke–a stroke subtype that should not be ignored. Front Neurol 2022; 13:1019671. [PMID: 36277910 PMCID: PMC9582250 DOI: 10.3389/fneur.2022.1019671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Based on the etiology, stroke can be classified into ischemic or hemorrhagic subtypes, which ranks second among the leading causes of death. Stroke is caused not only by arterial thrombosis but also by cerebral venous thrombosis. Arterial stroke is currently the main subtype of stroke, and research on this type has gradually improved. Venous thrombosis, the particular type, accounts for 0.5–1% of all strokes. Due to the lack of a full understanding of venous thrombosis, as well as its diverse clinical manifestations and neuroimaging features, there are often delays in admission for it, and it is easy to misdiagnose. The purpose of this study was to review the pathophysiology mechanisms and clinical features of arterial and venous thrombosis and to provide guidance for further research on the pathophysiological mechanism, clinical diagnosis, and treatment of venous thrombosis. This review summarizes the pathophysiological mechanisms, etiology, epidemiology, symptomatology, diagnosis, and treatment heterogeneity of venous thrombosis and compares it with arterial stroke. The aim is to provide a reference for a comprehensive understanding of venous thrombosis and a scientific understanding of various pathophysiological mechanisms and clinical features related to venous thrombosis, which will contribute to understanding the pathogenesis of intravenous stroke and provide insight into diagnosis, treatment, and prevention.
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Affiliation(s)
- Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Wei
- School of Engineering Medicine, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Lu Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Chen Zhou
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xunming Ji
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16
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Shen J, Tao Z, Chen W, Sun J, Li Y, Fu F. Malignant Isolated Cortical Vein Thrombosis as the Initial Manifestation of Primary Antiphospholipid Syndrome: Lessons on Diagnosis and Management From a Case Report. Front Immunol 2022; 13:882032. [PMID: 35547735 PMCID: PMC9082262 DOI: 10.3389/fimmu.2022.882032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Antiphospholipid syndrome (APS) with isolated cortical vein thrombosis (ICoVT) is an extremely rare but potentially malignant entity. It is particularly challenging to diagnose APS-related ICoVT because of the non-specific clinical manifestations and the frequent absence of typical neuroimaging. Moreover, there is currently limited knowledge on the clinical features and management strategies for the condition. Delays in diagnosis and treatment may lead to life-threatening consequences. Case Presentation We present a rare case of a 74-year-old Chinese woman who presented with sudden onset of headache and right arm weakness that mimicked acute ischemic stroke. Her initial computed tomography was unremarkable, and intravenous thrombolysis was performed. Serial neuroimages confirmed ICoVT 4 days after symptom onset, and low-molecular-weight heparin (LMWH) was started at a dose of 0.4 ml twice per day, according to the 2019 Chinese guidelines. The workup for the predisposing causes of ICoVT revealed triple positivity APS. LMWH dose was adjusted according to the anti-Xa chromogenic assay. However, the patient’s condition deteriorated rapidly, and there was a progressive enlargement of the venous infarction despite treatment with anticoagulants. Transtentorial herniation developed on day 12, and decompressive craniectomy was immediately performed. The patient’s symptoms did not improve significantly after surgery, and she remained aphasic and hemiplegic at the 3-month follow-up, with a modified Rankin Scale score of 5. Conclusion ICoVT is a rare yet potentially fatal manifestation of APS, and its diagnosis and treatment are extremely challenging. Timely diagnosis, prompt treatment, and close monitoring are essential to improve the clinical prognosis of patients with APS-related ICoVT.
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Affiliation(s)
- Jie Shen
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zi Tao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Sun
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Li
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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17
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Yang X, Wu F, Liu Y, Duan J, Fisher M, Ji X, Meng R, Zhang H, Fan Z, Yang Q. Diagnostic performance of MR black-blood thrombus imaging for cerebral venous thrombosis in real-world clinical practice. Eur Radiol 2022; 32:2041-2049. [PMID: 34542696 DOI: 10.1007/s00330-021-08286-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/24/2021] [Accepted: 08/19/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES MR black-blood thrombus imaging (BTI) has been developed for the detection of cerebral venous thrombosis (CVT). Yet, there is a lack of real-world data to verifying its clinical performance. This study aims to evaluate the performance of BTI in diagnosing and staging CVT in a 5-year period. METHODS Patients suspected of CVT were enrolled between 2014 and 2019. Patients with or without BTI scans were classified into group A and group B, respectively. The prevalence of correct diagnosis of CVT and patients with evaluable clot age were compared. The diagnostic performance of BTI including sensitivity, specificity, and specific staging information was further analyzed. RESULTS Two hundred and twenty-one of the 308 patients suspected of CVT were eligible in the current study (114 in group A and 97 in group B), with 125 diagnosed by multidisciplinary teams to have CVTs (56 in group A, 69 in group B). The rate of correct diagnosis of CVT was higher in group A than that in group B (94.7% vs 60.8%, p < 0.001, x2 = 36.517) after adding BTI images. The percent of patients with evaluable staged segments between the two groups were 96.4% and 33.9%, respectively (x2 = 48.191, p < 0.001). BTI showed a sensitivity of 96.4% and 87.9% in the detection of CVT on per-patient and per-segment level, respectively. Up to 98.1% of all thrombosed segments could be staged by BTI and 59.6% of them were matched with clinical staging. CONCLUSIONS In the actual clinical practice, BTI improves diagnostic confidence and has an excellent performance in confirming and staging CVT. KEY POINTS • Black-blood thrombus imaging has good diagnostic performance in detecting cerebral venous thrombosis compared to traditional imaging methods with strong evidence in the actual clinical setting. • BTI helps clinicians to diagnose CVT with more accuracy and confidence, which can be served as a promising imaging examination. • BTI can also provide additional information of different thrombus ages objectively, the valuable reference for clinical strategy.
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Affiliation(s)
- Xiaoxu Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Fang Wu
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Yuehong Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Beijing, China
| | - Marc Fisher
- Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Beijing, China
| | - Huibo Zhang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Zhaoyang Fan
- Radiology and Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China.
- Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China.
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China.
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18
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Dong W, Wan DY, Yang X, Fu M, Liu X, Li H, Xie XQ. Delayed onset of fat embolus in the cerebral venous system after breast and hip augmentation: a case report. BMC Neurol 2021; 21:411. [PMID: 34702212 PMCID: PMC8549338 DOI: 10.1186/s12883-021-02419-x] [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: 04/09/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background Cerebral fat embolism (CFE) is a subtype of fat embolism syndrome which tends to cause ischemic cerebral infarction. Fat embolism in the cerebral venous system have not been reported. We hereby present a rare case of fat embolus formed in the cerebral venous system 10 days after cosmetic surgery, and describe our management of this patient. Case presentation A 26-year-old woman with the disturbance of consciousness and recurrent convulsions of the right upper extremity over a 21-h period was admitted to our hospital. The patient was initially diagnosed with haemorrhagic infarction, and cerebral venous thrombosis (CVT) was suspected based on computed tomography (CT). A diagnosis of CFE was confirmed based on surgical findings. Breast and hip augmentation performed 10 days ago was considered the underlying cause. Drug-induced hypothermia, low molecular weight heparin, atorvastatin, dexamethasone, piperacillin/tazobactam, valproic acid, and mannitol were applied. On hospital day 30, she was discharged with a Montreal Cognitive Assessment score of 25. Conclusions Fat embolism can occur in the cerebral venous system, and may mimic CVT symptoms rather than CFE symptoms. Early identification of the nature of the embolus is essential. The use of heparin may prevent secondary thrombus formation, and accelerate fat embolus decomposition.
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Affiliation(s)
- Wei Dong
- Department of Neuro-intensive Care Unit, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ding-Yuan Wan
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Min Fu
- Department of Neuro-intensive Care Unit, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xing Liu
- Department of Intensive Care Unit, Mianyang 404 Hospital, Mianyang, 621000, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiao-Qi Xie
- Department of Neuro-intensive Care Unit, West China Hospital, Sichuan University, Chengdu, 610041, China.
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19
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Chen J, Cai Y, Chen Y, Williams AP, Gao Y, Zeng J. Nervous and Muscular Adverse Events after COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Clinical Trials. Vaccines (Basel) 2021; 9:vaccines9080939. [PMID: 34452064 PMCID: PMC8402736 DOI: 10.3390/vaccines9080939] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Nervous and muscular adverse events (NMAEs) have garnered considerable attention after the vaccination against coronavirus disease (COVID-19). However, the incidences of NMAEs remain unclear. We aimed to calculate the pooled event rate of NMAEs after COVID-19 vaccination. Methods: A systematic review and meta-analysis of clinical trials on the incidences of NMAEs after COVID-19 vaccination was conducted. The PubMed, Medline, Embase, Cochrane Library, and Chinese National Knowledge Infrastructure databases were searched from inception to 2 June 2021. Two independent reviewers selected the study and extracted the data. Categorical variables were analyzed using Pearson’s chi-square test. The pooled odds ratio (OR) with the corresponding 95% confidence intervals (CIs) were estimated and generated with random or fixed effects models. The protocol of the present study was registered on PROSPERO (CRD42021240450). Results: In 15 phase 1/2 trials, NMAEs occurred in 29.2% vs. 21.6% (p < 0.001) vaccinated participants and controls. Headache and myalgia accounted for 98.2% and 97.7%, and their incidences were 16.4% vs. 13.9% (OR = 1.97, 95% CI = 1.28–3.06, p = 0.002) and 16.0% vs. 7.9% (OR = 3.31, 95% CI = 2.05–5.35, p < 0.001) in the vaccine and control groups, respectively. Headache and myalgia were more frequent in the newly licensed vaccines (OR = 1.97, 95% CI = 1.28–3.06, p = 0.02 and OR = 3.31, 95% CI = 2.05–5.35, p < 0.001) and younger adults (OR = 1.40, 95% CI = 1.12–1.75, p = 0.003 and OR = 1.54, 95% CI = 1.20–1.96, p < 0.001). In four open-label trials, the incidences of headache, myalgia, and unsolicited NMAEs were 38.7%, 27.4%, and 1.5%. Following vaccination in phase 3 trials, headache and myalgia were still common with a rate of 29.5% and 19.2%, although the unsolicited NMAEs with incidence rates of ≤ 0.7% were not different from the control group in each study. Conclusions: Following the vaccination, NMAEs are common of which headache and myalgia comprised a considerable measure, although life-threatening unsolicited events are rare. NMAEs should be continuously monitored during the ongoing global COVID-19 vaccination program.
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Affiliation(s)
- Jiaxin Chen
- Department of Neurology, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Sun Yat-sen University, Guangzhou 510080, China; (J.C.); (Y.C.); (Y.C.)
| | - Yuangui Cai
- Department of Neurology, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Sun Yat-sen University, Guangzhou 510080, China; (J.C.); (Y.C.); (Y.C.)
| | - Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Sun Yat-sen University, Guangzhou 510080, China; (J.C.); (Y.C.); (Y.C.)
| | - Anthony P. Williams
- Department of Immunology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK;
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton and Southampton NIHR Experimental Cancer Medicine Centre, Southampton SO16 6YD, UK
| | - Yifang Gao
- Organ Transplantation Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Correspondence: (Y.G.); (J.Z.); Tel.: +86-020-87755766 (ext. 8667) (Y.G.); +86-020-87755766 (ext. 8286) (J.Z.)
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Sun Yat-sen University, Guangzhou 510080, China; (J.C.); (Y.C.); (Y.C.)
- Correspondence: (Y.G.); (J.Z.); Tel.: +86-020-87755766 (ext. 8667) (Y.G.); +86-020-87755766 (ext. 8286) (J.Z.)
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20
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Meng SH, Li JH, Zuo LJ, Feng LM. The outcomes of pregnant and postpartum patients with cerebral venous sinus thrombosis after anticoagulant therapy. Medicine (Baltimore) 2021; 100:e26360. [PMID: 34190153 PMCID: PMC8257884 DOI: 10.1097/md.0000000000026360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To describe the outcome of the patients with cerebral venous sinus thrombosis (CVST) during pregnancy and postpartum treated with anticoagulant therapy. METHODS This is a retrospective cohort study and patients with CVST were collected from October 2009 to March 2018. Patients were divided into pregnancy-related (occurred during pregnancy and postpartum) group and non-pregnancy-related. Recovery rate at 12 months after anticoagulant therapy, adverse events, characteristics of patients with poor outcomes were statistically analyzed. RESULTS Fifty-eight pregnancy-related CVST patients (17 pregnancy and 41 postpartum) as study group and 76 non-pregnancy-related CVST women as control group were enrolled. Study group was statistically different to control group in several baseline variables. More pregnancy-related patients had modified rankin scale (mRS) = 5 (15.5% vs 11.8%, P = 8.1×10-3) before anticoagulant therapy. At 12 months heparinization, difference in recovery rate was not statistically significant (80% vs 87.5%, P = .29) between 2 groups. No differences were found of adverse events between 2 groups. Patients with poor outcomes had less sigmoid sinus thrombosis (16.7% vs 61.5%, P = .14), more coma (41.2% vs 17.2%, P = 5.2×10-7), more mRS = 4 (33.3% vs 19.2%, P = 1.63 × 10-4), more mRS = 5 (66.7% vs 9.6%, P = 1.63 × 10-4) before treatment. CONCLUSION Pregnancy-related CVST patients had severer condition before treatment, but can achieve comparable recovery rate at 12 months after anticoagulant therapy with non-pregnancy-related women. Pregnancy-related patients with poor prognosis had less sinus sigmoid occlusion, more coma, high mRS at admission.
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Affiliation(s)
- Shi-Hui Meng
- Department of Obstetrics and Gynecology, Peking University People's Hospital
| | | | - Li-Jun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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