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Long B, Field SM, Singh M, Koyfman A. High risk and low prevalence diseases: Cavernous sinus thrombosis. Am J Emerg Med 2024; 83:47-53. [PMID: 38959601 DOI: 10.1016/j.ajem.2024.06.024] [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: 05/16/2024] [Revised: 06/07/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Cavernous sinus thrombosis (CST) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of CST, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION CST is a potentially deadly thrombophlebitic disease involving the cavernous sinuses. The most common underlying etiology is sinusitis or other facial infection several days prior to development of CST, though other causes include maxillofacial trauma or surgery, thrombophilia, dehydration, or medications. Staphylococcus aureus, streptococcal species, oral anaerobic species, and gram-negative bacilli are the most frequent bacterial etiologies. The most prevalent presenting signs and symptoms are fever, headache, and ocular manifestations (chemosis, periorbital edema, ptosis, ophthalmoplegia, vision changes). Cranial nerve (CN) VI is the most commonly affected CN, resulting in lateral rectus palsy. Other CNs that may be affected include III, IV, and V. The disease may also affect the pulmonary and central nervous systems. Laboratory testing typically reveals elevated inflammatory markers, and blood cultures are positive in up to 70% of cases. Computed tomography of the head and orbits with intravenous contrast delayed phase imaging is recommended in the ED setting, though magnetic resonance venography demonstrates the highest sensitivity. Management includes resuscitation, antibiotics, and anticoagulation with specialist consultation. CONCLUSION An understanding of CST can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Steven M Field
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Manpreet Singh
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
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Zarimeidani F, Rahmati R, Mokary Y, Azizollahi S, Ebrahimi R, Raeisi Shahraki H, Bayati A, Jivad N. Sex differences in clinical profile and risk factors of cerebral venous sinus thrombosis at a high-altitude area: A 10-year retrospective cross-sectional study. Medicine (Baltimore) 2024; 103:e38711. [PMID: 39151491 PMCID: PMC11332771 DOI: 10.1097/md.0000000000038711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/04/2024] [Accepted: 06/06/2024] [Indexed: 08/19/2024] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon disorder with an increased mortality risk. Data on the sex-specific clinical profile and related factors can be practical in clinical diagnosis and management. Thus, we aimed to assess CVST characteristics in Shahrekord, the most elevated city among the centers of the provinces of Iran, referred to as the Roof of Iran. In this retrospective cross-sectional study, we reviewed the hospital records of 127 CVST patients between April 2013 and June 2023 to analyze the demographic characteristics, clinical profile, disease outcomes, and risk factors. STROBE guidelines were used to report this study. Females comprised 65.3% of the study. Females' age was almost equal to male patients (37.51 ± 13.95 years vs 38.09 ± 16.18 years, P = .832), and more than half of the patients (59.1%) were married. Clinical characteristics showed no significant difference between the sexes. In contrast to males, females had multifarious risk factors. However, the main risk factors for both sexes were CVST and hypertension. Most patients had 1 sinus affected (55.9%), and the location of thrombosis was mainly in the right transverse sinus in males (38.63%) and superior sagittal sinus in females (33.73%). However, those with more than 2 affected sinuses were mostly women. Regarding radiological findings, sinusitis was significantly seen in men (18.18% vs 3.61%). Among laboratory data, females significantly had higher erythrocyte sedimentation rate levels than males (21.66 ± 24.39 vs 9.60 ± 8.55). This study indicates that among CVST patients, men have significantly higher occurrences of sinusitis, and higher levels of erythrocyte sedimentation rate were observed in women. However, no other significant differences were found. More extensive studies are essential to fully comprehend the sex-specific aspects of CVST.
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Affiliation(s)
- Fatemeh Zarimeidani
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rahem Rahmati
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Yousef Mokary
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Setayesh Azizollahi
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rasool Ebrahimi
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hadi Raeisi Shahraki
- Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Asghar Bayati
- Department of Neurology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Nahid Jivad
- Department of Neurology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Shahalaei M, Azad AK, Sulaiman WMAW, Derakhshani A, Mofakham EB, Mallandrich M, Kumarasamy V, Subramaniyan V. A review of metallic nanoparticles: present issues and prospects focused on the preparation methods, characterization techniques, and their theranostic applications. Front Chem 2024; 12:1398979. [PMID: 39206442 PMCID: PMC11351095 DOI: 10.3389/fchem.2024.1398979] [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: 03/11/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024] Open
Abstract
Metallic nanoparticles (MNPs) have garnered significant attention due to their ability to improve the therapeutic index of medications by reducing multidrug resistance and effectively delivering therapeutic agents through active targeting. In addition to drug delivery, MNPs have several medical applications, including in vitro and in vivo diagnostics, and they improve the biocompatibility of materials and nutraceuticals. MNPs have several advantages in drug delivery systems and genetic manipulation, such as improved stability and half-life in circulation, passive or active targeting into the desired target selective tissue, and gene manipulation by delivering genetic materials. The main goal of this review is to provide current information on the present issues and prospects of MNPs in drug and gene delivery systems. The current study focused on MNP preparation methods and their characterization by different techniques, their applications to targeted delivery, non-viral vectors in genetic manipulation, and challenges in clinical trial translation.
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Affiliation(s)
- Mona Shahalaei
- Biomaterial Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center, Karaj, Iran
| | - Abul Kalam Azad
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University College of MAIWP International (UCMI), Kuala Lumpur, Malaysia
| | - Wan Mohd Azizi Wan Sulaiman
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University College of MAIWP International (UCMI), Kuala Lumpur, Malaysia
| | - Atefeh Derakhshani
- Department of Tissue Engineering and Applied Cell Sciences, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Banaee Mofakham
- Biomaterial Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center, Karaj, Iran
| | - Mireia Mallandrich
- Department of Pharmacy, Pharmaceutical Technology and Physical-Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Vetriselvan Subramaniyan
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Sunway, Malaysia
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Hirata H, Kaneshiro Y, Urano Y, Murata K. Isolated cortical vein thrombosis with hemorrhagic infarction during the application of a transdermal estradiol patch: A case report. Radiol Case Rep 2024; 19:3244-3249. [PMID: 38800082 PMCID: PMC11126879 DOI: 10.1016/j.radcr.2024.04.062] [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: 03/06/2024] [Accepted: 04/20/2024] [Indexed: 05/29/2024] Open
Abstract
Isolated cortical vein thrombosis (ICVT) is a rarer subtype of cerebral venous sinus thrombosis (CVST) that involves only the cortical veins without any thrombosis in the major cerebral veins or sinuses. Among the known causes of CVST are factors, such as being a young female or the use of hormonal preparations. This study presents a case of a 35-year-old female who underwent endometrial polyp removal 5 days before symptom onset and started using a transdermal estradiol patch. After 4 days of using the transdermal estradiol patch, the patient developed recurrent seizures and sustained sensory aphasia. The head computed tomography revealed hemorrhagic infarction. Given her young age and the use of hormonal therapy, CVST was suspected. However, the initial diagnosis with magnetic resonance imaging (MRI) was inconclusive, and no venous sinus thrombosis could be identified on additional cerebral angiography. Instead, stasis of venous flow in the temporal vein was noted. It was difficult to determine whether these findings were due to hemorrhage or ICVT. Upon re-evaluation with MRI, signal changes suggestive of thrombosis in a cortical vein in the parietal region, which is different from the stasis observed in cerebral angiography, led to the diagnosis of ICVT. This is the first study to link the use of transdermal estradiol patches to ICVT. In cases where ICVT leads to cerebral hemorrhage, cerebral angiography may not be useful. Instead, a comprehensive diagnosis should be made based on imaging findings from various MRI sequences and the patient's medical history.
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Affiliation(s)
- Haruki Hirata
- Department of Neurosurgery, Shimada General Medical Center, 1200-5 Noda, Shimada City, Shizuoka, Japan
| | - Yuta Kaneshiro
- Department of Neurosurgery, Shimada General Medical Center, 1200-5 Noda, Shimada City, Shizuoka, Japan
| | - Yumiko Urano
- Department of Neurosurgery, Shimada General Medical Center, 1200-5 Noda, Shimada City, Shizuoka, Japan
| | - Keiji Murata
- Department of Neurosurgery, Shimada General Medical Center, 1200-5 Noda, Shimada City, Shizuoka, Japan
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Wei W, Bai YT, Chang E, Liu JF. Post-marketing safety surveillance of fostamatinib: an observational, pharmacovigilance study leveraging FAERS database. Expert Opin Drug Saf 2024:1-9. [PMID: 39078338 DOI: 10.1080/14740338.2024.2387315] [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: 03/15/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Fostamatinib, an FDA-approved oral small-molecule spleen tyrosine kinase (SYK) inhibitor, is used to treat thrombocytopenia in adults with chronic immune thrombocytopenia (ITP) who have not responded to previous treatments. However, comprehensive safety data is lacking. This study uses the FDA Adverse Event Reporting System (FAERS) database to explore real-world adverse events (AEs) related to fostamatinib, aiming to inform its clinical use. METHODS The FAERS database was retrospectively queried to extract reports associated with fostamatinib from 2019 to 2023. To identify and evaluate potential AEs in patients receiving fostamatinib, various disproportionality analyses such as the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi-item gamma Poisson shrinker (MGPS) were employed. RESULTS A total of 23 AE signals were included in our analysis. Among them, hypertension, blood pressure increase, blood pressure abnormality, hepatic enzyme increase, and diarrhea were consistent with the common AEs described for fostamatinib in clinical trials. In addition, unexpected serious AEs were detected including cerebral thrombosis and necrotizing soft tissue infection. The median time to onset of fostamatinib-related AEs was 86 days. CONCLUSION Our investigation revealed several possibly emergent safety concerns associated with fostamatinib in real-world clinical practice, which might provide essential vigilance evidence for clinicians and pharmacists to manage the safety issues of fostamatinib.
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Affiliation(s)
- Wei Wei
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, China
| | - Ying-Tao Bai
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, China
| | - En Chang
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, China
| | - Jin-Feng Liu
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, Sichuan, China
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Rangappa R, Deshpande R, Teja ESP, Moola NS, Itagi S. Cerebral venous sinuses thrombosis post extracorporeal membrane oxygenation: a case report. Indian J Thorac Cardiovasc Surg 2024; 40:469-472. [PMID: 38919201 PMCID: PMC11194251 DOI: 10.1007/s12055-023-01672-8] [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: 10/06/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 06/27/2024] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) plays a crucial role in managing heart and respiratory failure. However, it is associated with complications such as bleeding, acute renal failure, neurological issues, and thrombosis. Cerebral venous sinuses thrombosis (CVST) is a rare condition that primarily affects young females, especially those of childbearing age. CVST can result from multiple factors, both congenital and acquired, such as pregnancy, dehydration, oral contraceptives, and the postpartum period. The most common and nonspecific symptom is headache. Notably, the occurrence of CVST during ECMO has not been documented in adult patients. In this case report, we present the case of a 29-year-old lactating mother who was admitted to our hospital with complaints and clinical features indicative of community-acquired pneumonia. Despite conventional treatment, her oxygen requirement increased; therefore, she was placed on veno-venous ECMO (VV ECMO). Her condition gradually improved, and she was extubated while still on ECMO support (Awake ECMO). However, a day later of successful weaning from ECMO, she reported blurred vision and proptosis. Magnetic resonance imaging (MRI) and MR venography (MRV) of the brain showed features suggestive of CVST. She was promptly treated with anticoagulation and later discharged with minimal residual complications. This paper emphasizes the importance of early clinical recognition and treatment with anticoagulants in cases of CVST during ECMO for improved outcomes.
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Affiliation(s)
| | | | | | | | - Soumya Itagi
- Manipal Hospitals Sarjapur Road, Bengaluru, 560102 India
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Coutinho JM, van de Munckhof A, Aguiar de Sousa D, Poli S, Aaron S, Arauz A, Conforto AB, Krzywicka K, Hiltunen S, Lindgren E, Sánchez van Kammen M, Shu L, Bakchoul T, Belder R, van den Berg R, Boumans E, Cannegieter S, Cano-Nigenda V, Field TS, Fragata I, Heldner MR, Hernández-Pérez M, Klok FA, Leker RR, Lucas-Neto L, Molad J, Nguyen TN, Saaltink DJ, Saposnik G, Sharma P, Stam J, Thijs V, van der Vaart M, Werring DJ, Wong Ramos D, Yaghi S, Yeşilot N, Tatlisumak T, Putaala J, Jood K, Arnold M, Ferro JM. Reducing the global burden of cerebral venous thrombosis: An international research agenda. Int J Stroke 2024; 19:599-610. [PMID: 38494462 PMCID: PMC11292977 DOI: 10.1177/17474930241242266] [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: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Due to the rarity of cerebral venous thrombosis (CVT), performing high-quality scientific research in this field is challenging. Providing answers to unresolved research questions will improve prevention, diagnosis, and treatment, and ultimately translate to a better outcome of patients with CVT. We present an international research agenda, in which the most important research questions in the field of CVT are prioritized. AIMS This research agenda has three distinct goals: (1) to provide inspiration and focus to research on CVT for the coming years, (2) to reinforce international collaboration, and (3) to facilitate the acquisition of research funding. SUMMARY OF REVIEW This international research agenda is the result of a research summit organized by the International Cerebral Venous Thrombosis Consortium in Amsterdam, the Netherlands, in June 2023. The summit brought together 45 participants from 15 countries including clinical researchers from various disciplines, patients who previously suffered from CVT, and delegates from industry and non-profit funding organizations. The research agenda is categorized into six pre-specified themes: (1) epidemiology and clinical features, (2) life after CVT, (3) neuroimaging and diagnosis, (4) pathophysiology, (5) medical treatment, and (6) endovascular treatment. For each theme, we present two to four research questions, followed by a brief substantiation per question. The research questions were prioritized by the participants of the summit through consensus discussion. CONCLUSIONS This international research agenda provides an overview of the most burning research questions on CVT. Answering these questions will advance our understanding and management of CVT, which will ultimately lead to improved outcomes for CVT patients worldwide.
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Affiliation(s)
- Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- Stroke Center, Centro Hospitalar Universitário Lisboa Central, Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, and L Lopes Lab, Instituto de Medicina Molecular JLA, Lisbon, Portugal
| | - Sven Poli
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | - Adriana B Conforto
- LIM-44, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Sini Hiltunen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Liqi Shu
- Brown University, Providence, RI, USA
| | - Tamam Bakchoul
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Rosalie Belder
- Netherlands Thrombosis Foundation, Voorschoten, The Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Suzanne Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vanessa Cano-Nigenda
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Isabel Fragata
- Stroke Center, Centro Hospitalar Universitário Lisboa Central, Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, and L Lopes Lab, Instituto de Medicina Molecular JLA, Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Mirjam R Heldner
- Inselspital Bern, University Hospital and University of Bern, Bern, Switzerland
| | | | - Frederikus A Klok
- Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronen R Leker
- Hadassah—Hebrew University Medical Center, Jerusalem, Israel
| | - Lia Lucas-Neto
- North Lisbon University Hospital Center and Lisbon Medical School, Lisbon, Portugal
| | | | | | | | - Gustavo Saposnik
- Stroke Outcomes & Decision Neuroscience Research Unit, University of Toronto, Toronto, ON, Canada
| | - Pankaj Sharma
- Royal Holloway University of London, London, United Kingdom
| | - Jan Stam
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | | | - David J Werring
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Diana Wong Ramos
- Portugal AVC-União de Sobreviventes, Familiares e Amigos, Portugal
| | | | - Nilüfer Yeşilot
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Marcel Arnold
- Inselspital Bern, University Hospital and University of Bern, Bern, Switzerland
| | - José M Ferro
- Hospital da Luz, University of Lisbon, Lisbon, Portugal
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Nguyen VN, Demetriou AN, Dallas J, Mack WJ. Cerebral Venous Sinus Thrombosis. Neurosurg Clin N Am 2024; 35:343-353. [PMID: 38782527 DOI: 10.1016/j.nec.2024.02.006] [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: 05/25/2024]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke indicated by the formation of blood clots within the dural venous sinuses. These are large venous conduits that are situated between the 2 layers of the dura mater which are responsible for draining blood from the brain and returning it to the systemic circulation. Cortical venous thrombosis refers to the blockage of veins on the brain's cortical surface. Cerebral venous thrombosis encompasses both dural and cortical vein occlusions.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Alexandra N Demetriou
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Jonathan Dallas
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - William J Mack
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA.
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Kellermair L, Höfer C, Zeller MWG, Kubasta C, Bandke D, Weis S, Kellermair J, Forstner T, Helbok R, Vosko MR. Endothelial receptor proteins in acute venous thrombosis and delayed thrombus resolution in cerebral sinus vein thrombosis. J Neurol 2024; 271:4095-4104. [PMID: 38578497 PMCID: PMC11233310 DOI: 10.1007/s00415-024-12225-3] [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: 12/14/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND PURPOSE Cerebral sinus venous thrombosis (CSVT) is a rare but life-threatening disease and its diagnosis remains challenging. Blood biomarkers, including D-Dimer are currently not recommended in guidelines. Soluble endothelial receptor proteins (sICAM-1, sPECAM-1 and sVCAM-1) have been shown to be promising diagnostic biomarkers in deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, we examined endothelial receptor proteins as potential biomarkers for detecting CSVT. METHODS In this bi-centre, prospective study, we quantified D-Dimer as well as sICAM-1, sPECAM-1 and sVCAM-1 in plasma of patients with clinically suspected CSVT managed in the neurological emergency department (ED) of a tertiary care hospital. All patients underwent cerebral magnetic resonance imaging (MRI) and were followed up after 3, 6 and 12 months to detect thrombus resolution. RESULTS Twenty-four out of 75 (32%) patients with clinically suspected CSVT presenting with headache to the ED were diagnosed with acute CSVT. These patients had a mean age of 45 ± 16 years and 78% were female. In patients with CSVT, mean baseline D-dimer (p < 0.001) and sPECAM-1 (p < 0.001) were significantly higher compared to patients without CSVT. The combination of D-Dimer and sPECAM-1 yielded the best ROC-AUC (0.994; < 0.001) with a negative predictive value of 95.7% and a positive predictive value of 95.5%. In addition, higher baseline sPECAM-1 levels (> 198 ng/ml) on admission were associated with delayed venous thrombus resolution at 3 months (AUC = 0.83). CONCLUSION sPECAM-1 in combination with D-Dimer should be used to improve the diagnostic accuracy of acute CSVT and sPECAM-1 may predict long-term outcome of CSVT. Confirmatory results are needed in other settings in order to show their value in the management concept of CSVT patients.
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Affiliation(s)
- Lukas Kellermair
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Christoph Höfer
- Department of Neurology, The Hospital of the Brothers of Saint John of God, Linz, Austria
| | - Matthias W G Zeller
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Christa Kubasta
- Department of Laboratory Medicine, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Dave Bandke
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Kepler University Hospital, Neuromed Campus, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Kepler University Hospital, Neuromed Campus, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Jörg Kellermair
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Department of Cardiology, Kepler University Hospital, Med Campus III, Linz, Austria
| | - Thomas Forstner
- Department of Applied Systems Research and Statistics, Johannes Kepler University Linz, Linz, Austria
| | - Raimund Helbok
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Milan R Vosko
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria.
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Bogale Z, Geleto G, Yosef D, Abdo AA. Hemiparesis Caused by Cerebral Venous Sinus Thrombosis during the Postpartum Period: A Case Report; Negelle Arsi General Hospital and Medical College, Ethiopia. Int Med Case Rep J 2024; 17:603-607. [PMID: 38911608 PMCID: PMC11192203 DOI: 10.2147/imcrj.s457170] [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: 03/08/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024] Open
Abstract
Background Although rare, cerebral venous sinus thrombosis (CVT) can result in significant neurological complications, particularly after childbirth. Early diagnosis poses a challenge due to symptom overlap with other conditions. Limited publications and underdiagnosis of CVT are prevalent in developing nations, notably in Ethiopia. Case A 29-year-old mother, having given birth four times, presented to the emergency department in her second month postpartum with complaints of persistent headaches and blurred vision over three weeks. Additionally, she reported sudden weakness on her right side for one day. Despite previous treatments for migraine headaches, she was diagnosed with CVT after magnetic resonance imaging/venography revealed blockage in the right anastomotic vein and the posterior segment of the superior sagittal sinus. Treatment commenced with the anticoagulant enoxaparin. During hospitalization, she experienced one episode of generalized seizures, leading to transfer to the intensive care unit where phenytoin was added. Subsequent diagnosis of papilledema occurred. After a 16-day hospital stay, she was discharged with warfarin, phenytoin, and acetazolamide. Oral anticoagulation and other medications ceased after six months of treatment, considering the postpartum period as a temporary risk factor for CVT. The patient currently maintains good health and has resumed normal activities. Conclusion Maintaining a high index of suspicion for CVT during the postpartum period and promptly conducting imaging scans are crucial for early diagnosis. This approach can halt neurological decline and facilitate immediate recovery through early therapeutic interventions.
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Affiliation(s)
- Zerihun Bogale
- Internal Medicine Department, Negelle Arsi General Hospital and Medical College, Negelle Arsi, Oromia, Ethiopia
| | - Gemechu Geleto
- Radiology Department, Negelle Arsi General Hospital and Medical College, Negelle Arsi, Oromia, Ethiopia
| | - Dawit Yosef
- Internal Medicine Department, Negelle Arsi General Hospital and Medical College, Negelle Arsi, Oromia, Ethiopia
| | - Abdella Amano Abdo
- Research and Community Service Office, Negelle Arsi General Hospital and Medical College, Negelle Arsi, Oromia, Ethiopia
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Klein P, Shu L, Lindgren E, de Winter MA, Siegler JE, Simpkins AN, Omran SS, Heldner MR, de Havenon A, Abdalkader M, Al Kasab S, Stretz C, Wu TY, Wilson D, Asad SD, Almallouhi E, Frontera J, Kuohn L, Rothstein A, Bakradze E, Henninger N, Zubair AS, Sharma R, Kerrigan D, Aziz Y, Mistry EA, van Kammen MS, Tatlisumak T, Krzywicka K, Aguiar de Sousa D, Jood K, Field TS, Yaghi S, Coutinho JM, Nguyen TN. External validation of the SI 2NCAL 2C score for outcomes following cerebral venous thrombosis. J Stroke Cerebrovasc Dis 2024; 33:107720. [PMID: 38614162 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107720] [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: 01/13/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES Prognostication for cerebral venous thrombosis (CVT) remains difficult. We sought to validate the SI2NCAL2C score in an international cohort. MATERIALS AND METHODS The SI2NCAL2C score was originally developed to predict poor outcome (modified Rankin Scale (mRS) 3-6) at 6 months, and mortality at 30 days and 1 year using data from the International CVT Consortium. The SI2NCAL2C score uses 9 variables: the absence of any female-sex-specific risk factors, intracerebral hemorrhage, central nervous system infection, focal neurological deficits, coma, age, lower level of hemoglobin, higher level of glucose, and cancer. The ACTION-CVT study was an international retrospective study that enrolled consecutive patients across 27 centers. The poor outcome score was validated using 90-day mRS due to lack of follow-up at the 6-month time-point in the ACTION-CVT cohort. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Missing data were imputed using the additive regression and predictive mean matching methods. Bootstrapping was performed with 1000 iterations. RESULTS Mortality data were available for 950 patients and poor outcome data were available for 587 of 1,025 patients enrolled in ACTION-CVT. Compared to the International CVT Consortium, the ACTION-CVT cohort was older, less often female, and with milder clinical presentation. Mortality was 2.5% by 30 days and 6.0% by one year. At 90-days, 16.7% had a poor outcome. The SI2NCAL2C score had an AUC of 0.74 [95% CI 0.69-0.79] for 90-day poor outcome, 0.72 [0.60-0.82] for mortality by 30 days, and 0.82 [0.76-0.88] for mortality by one year. CONCLUSIONS The SI2NCAL2C score had acceptable to good performance in an international external validation cohort. The SI2NCAL2C score warrants additional validation studies in diverse populations and clinical implementation studies.
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Affiliation(s)
- Piers Klein
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 725 Albany St. Suite 7B, Boston, MA 02118, United States
| | - Liqi Shu
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria A de Winter
- Department of Internal Medicine, UMC Utrecht, and Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - James E Siegler
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, United States; Department of Neurology, University of Chicago, United States
| | - Alexis N Simpkins
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Satareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Mirjam R Heldner
- Department of Neurology and Stroke Research Center Bern, University of Bern and University Hospital Bern, Bern, Switzerland
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, CT, United States
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, United States
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Christoph Stretz
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Duncan Wilson
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Syed Daniyal Asad
- Department of Neurology, Hartford Hospital, Hartford, CT, United States
| | - Eyad Almallouhi
- Department of Neuroscience, Sarasota Memorial Hospital, Sarasota, FL, United States
| | - Jennifer Frontera
- Department of Neurology, New York University, New York, NY, United States
| | - Lindsey Kuohn
- Department of Neurology, New York University, New York, NY, United States
| | - Aaron Rothstein
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Ekaterina Bakradze
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nils Henninger
- Departments of Neurology and Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Adeel S Zubair
- Department of Neurology, Yale University, New Haven, CT, United States
| | - Richa Sharma
- Department of Neurology, Yale University, New Haven, CT, United States
| | - Deborah Kerrigan
- Department of Neurology, Vanderbilt University, Nashville, TN, United States
| | - Yasmin Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Eva A Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Mayte Sanchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- Stroke Center, Centro Hospitalar Universitário Lisboa Central - ULS São José, and Instituto de Medicina Molecular and Instituto de Anatomia, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thalia S Field
- Division of Neurology and Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 725 Albany St. Suite 7B, Boston, MA 02118, United States; Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, United States.
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12
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Simaan N, Metanis I, Honig A, Hallevi H, Filioglo A, Mendel R, Barnea R, Naftali J, Auriel E, Aladdin S, Orion D, Dally N, Leker RR, Molad J. Efficacy and safety of Apixaban in the treatment of cerebral venous sinus thrombosis: a multi-center study. Front Neurol 2024; 15:1404099. [PMID: 38817547 PMCID: PMC11137185 DOI: 10.3389/fneur.2024.1404099] [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: 03/20/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
Background Information regarding the safety and efficacy of specific direct oral anticoagulants (DOAC) in the treatment of cerebral sinus and venous thrombosis (CSVT) is scarce. Apixaban is one of the most frequently prescribed DOACs. Therefore, we aimed to compare the safety and efficacy of Apixaban with those of vitamin k antagonists (VKA) in patients with CSVT. Methods Prospective CSVT databases from seven academic medical centers were retrospectively analyzed. Patients treated with Apixaban were compared to those treated with VKA. Data on demographics, clinical presentations, risk factors, radiological and outcome parameters were studied. Results Overall, 403 patients were included in the analysis. Of them, 48 (12%) were treated with Apixaban, and 355 (88%) were treated with VKA. Rates of coagulopathies were significantly higher in the VKA-treated patients but no other differences between the groups were found in baseline characteristics and underlying etiology. No significant differences were found between groups in efficacy or safety parameters including the rates of recanalization, favorable outcomes, one-year mortality, seizures, intracranial hemorrhage or CSVT recurrences. Conclusion Our data suggests that Apixaban may be safe and effective for patients with CSVT. These results should be tested in prospective randomized clinical studies.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed, Israel
- The Azrieli Faculty of Medicine, Safed Bar Ilan University, Safed, Israel
| | - Issa Metanis
- Hadassah Departments of Neurology, Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Honig
- Hadassah Departments of Neurology, Hebrew University Medical Center, Jerusalem, Israel
| | - Hen Hallevi
- Department of Neurology and Stroke, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Andrei Filioglo
- Hadassah Departments of Neurology, Hebrew University Medical Center, Jerusalem, Israel
| | - Rom Mendel
- Department of Neurology, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| | - Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| | - Shorooq Aladdin
- Departments of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - David Orion
- Departments of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Najib Dally
- The Azrieli Faculty of Medicine, Safed Bar Ilan University, Safed, Israel
- Department of Hematology, Ziv Medical Center, Safed, Israel
| | - Ronen R. Leker
- Hadassah Departments of Neurology, Hebrew University Medical Center, Jerusalem, Israel
| | - Jeremy Molad
- Department of Neurology and Stroke, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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13
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Mahadevan JJ, Psaltis PJ, Thrift AG, Kleinig TJ. Incidence of thrombocytopenia-associated cerebral venous sinus thrombosis: a population-based study. BMJ Neurol Open 2024; 6:e000605. [PMID: 38757112 PMCID: PMC11097850 DOI: 10.1136/bmjno-2023-000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives The identification of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia (VITT) followed the recognition of a hitherto uncommon clinical syndrome frequently associated with cerebral venous sinus thrombosis (CVST), termed 'thrombosis with thrombocytopenia' syndrome (TTS). While anecdotally recognised as rare, the background incidence of TTS is unknown. We therefore aimed to investigate the background incidence of CVST with TTS in a large, well-defined population-based CVST cohort. Methods We performed an analysis of our previously obtained retrospective population-based cohort of patients with CVST from Adelaide, Australia (2005-2011, comprising an adult population of 953 390) to identify the background incidence of CVST associated with TTS. Results Among 105 people with CVST, the background population-based incidence of TTS-associated CVST was 1.2 per million per year (95% CI 0.5 to 2.4). A single case of a severe CVST VITT-like syndrome with multiorgan thrombosis was identified, occurring 3 weeks postrotavirus infection. Conclusions In our population-based study, the background incidence of CVST with associated TTS was very low, and the sole clinically severe case with multiorgan thrombosis occurred following a rotaviral precipitant. Our study establishes a benchmark against which to measure future potential 'TTS' clusters and suggests that viruses other than adenovirus may trigger this syndrome.
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Affiliation(s)
- Joshua J Mahadevan
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter J Psaltis
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Timothy J Kleinig
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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14
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Balla Y, Hashi AS, Osman AA, Hassan MS, Mutlu E. Cerebral Venous Sinus Thrombosis as an Initial Presentation of Nephrotic Syndrome: A Case Report. Vasc Health Risk Manag 2024; 20:177-181. [PMID: 38623542 PMCID: PMC11018128 DOI: 10.2147/vhrm.s458539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Cerebral sinovenous thrombosis (CSVT) encompasses a spectrum of disorders involving thrombosis of the cerebral venous system. As shown by previous epidemiological studies, the prevalence of cerebral sinovenous thrombosis is 4-7 cases per million people. Nephrotic syndrome was very rarely associated with thrombosis cerebral veins or sinuses. Hypercoagulability and thrombotic complications in nephrotic syndrome are most commonly seen in deep veins of the lower extremities and renal veins. Our case highlights a unique scenario in which cerebral sinovenous thrombosis was the initial presentation of nephrotic syndrome in a patient that was not an important past medical or surgical problem. The patient was brought to the emergency department with severe headache, vomiting, altered mental status, and generalized body swelling. Laboratory results showed proteinuria, hypoalbuminemia and hyperlipidemia. Non-contrast brain CT demonstrated hemorrhagic venous infarct associated with vasogenic edema. A subsequent brain MR venogram demonstrated occlusion of superior sagittal and right transverse sinuses. She was managed with low molecular weight heparin and intervenous corticosteroids then shifted to rivaroxaban and oral steroids, respectively, which resulted in massive clinical improvement and resolution of thrombus.
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Affiliation(s)
- Yassir Balla
- Department of Internal Medicine, Somali-Sudanese Specialized hospital, Mogadishu, Somalia
| | - Abdullahi Said Hashi
- Department of Anesthesiology and Reanimation, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Adam Osman
- Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
- Faculty of Medicine and Surgery, University of Somalia, Mogadishu, Somalia
| | - Mohamed Sheikh Hassan
- Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Eren Mutlu
- Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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15
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Bian H, Wang X, Liu L, Yan F, Lu S, Hui W, Zhou C, Duan J, Li M, Chen J, Meng R, Cao L, Wang L, Ji X. Multicenter registry study of cerebral venous thrombosis in china (RETAIN-CH): Rationale and design. Brain Behav 2024; 14:e3353. [PMID: 38622893 PMCID: PMC11019244 DOI: 10.1002/brb3.3353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/30/2023] [Accepted: 11/26/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND AND RATIONALE Cerebral venous thrombosis (CVT) is a rare cerebrovascular disorder that mainly affects young and middle-aged adults. Epidemiological data on the incidence, risk factors, diagnosis, treatment, and prognosis of CVT are lacking in China. In addition, there is a lack of evidence from large, multicenter, real-world studies on the efficacy and safety of endovascular. AIM To understand the incidence, diagnosis and treatment status of CVT in China and to estimate the effectiveness and safety of endovascular treatment in the real-world. METHODS A multicenter, retrospective observational cohort study will be conducted on CVT patient records from 104 hospitals, between January 1, 2018 and June 30, 2022, identified using a 2-stage cluster sampling design based on per capita gross domestic product. Each enrolled participant is required to complete a further follow-up, which includes the current situation and the assessment at 3 and 12 months after discharge. STUDY OUTCOMES The outcomes of this study will include the current status of the incidence, pathogenesis, etiology, clinical symptoms, diagnosis, and treatment of CVT in China, as well as the effectiveness and safety of endovascular treatment in the real-world. DISCUSSION Results from this study will provide evidence on the incidence, specific risk factors, symptomatic and imaging features, and clinical outcomes of CVT in China as well as indicate whether endovascular treatment is superior to medical management alone for patients with acute CVT in the real-world. TRIAL REGISTRATION http://www. CLINICALTRIALS gov. IDENTIFIER NCT05448248.
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Affiliation(s)
- Hetao Bian
- Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
| | - Xia Wang
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Lan Liu
- School of StatisticsUniversity of Minnesota at Twin CitiesMinneapolisMinnesotaUSA
| | - Feng Yan
- Department of NeurosurgeryXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Shan Lu
- Department of Neurology and PsychiatryBeijing Shijitan HospitalCapital Medical UniversityBeijingChina
| | - Wen Hui
- Department of Science and TechnologyWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Chen Zhou
- Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
| | - Jiangang Duan
- Department of EmergencyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Min Li
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Jian Chen
- Department of NeurosurgeryXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Ran Meng
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Lei Cao
- The General Office of Stroke Prevention Project CommitteeNational Health Commission of the People's Republic of ChinaBeijingChina
| | - Longde Wang
- The General Office of Stroke Prevention Project CommitteeNational Health Commission of the People's Republic of ChinaBeijingChina
| | - Xunming Ji
- Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
- Department of NeurosurgeryXuanwu Hospital of Capital Medical UniversityBeijingChina
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16
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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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17
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Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente-Fernández L, de la Torre-Colmenero JD, Tejada Meza H, Vesperinas-Castro A, Sánchez-Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2024; 39:226-234. [PMID: 37442428 DOI: 10.1016/j.nrleng.2023.07.006] [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: 03/19/2021] [Accepted: 05/22/2021] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P = .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain.
| | | | | | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, Spain
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | | | | | - L Llul
- Hospital Clínic, Barcelona, Spain
| | - J Egido
- Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, Spain
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Zhou L, Wu H, Luo G, Zhou H. Deep learning-based 3D cerebrovascular segmentation workflow on bright and black blood sequences magnetic resonance angiography. Insights Imaging 2024; 15:81. [PMID: 38517610 PMCID: PMC10959883 DOI: 10.1186/s13244-024-01657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/18/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Cerebrovascular diseases have emerged as significant threats to human life and health. Effectively segmenting brain blood vessels has become a crucial scientific challenge. We aimed to develop a fully automated deep learning workflow that achieves accurate 3D segmentation of cerebral blood vessels by incorporating classic convolutional neural networks (CNNs) and transformer models. METHODS We used a public cerebrovascular segmentation dataset (CSD) containing 45 volumes of 1.5 T time-of-flight magnetic resonance angiography images. We collected data from another private middle cerebral artery (MCA) with lenticulostriate artery (LSA) segmentation dataset (MLD), which encompassed 3.0 T three-dimensional T1-weighted sequences of volumetric isotropic turbo spin echo acquisition MRI images of 107 patients aged 62 ± 11 years (42 females). The workflow includes data analysis, preprocessing, augmentation, model training with validation, and postprocessing techniques. Brain vessels were segmented using the U-Net, V-Net, UNETR, and SwinUNETR models. The model performances were evaluated using the dice similarity coefficient (DSC), average surface distance (ASD), precision (PRE), sensitivity (SEN), and specificity (SPE). RESULTS During 4-fold cross-validation, SwinUNETR obtained the highest DSC in each fold. On the CSD test set, SwinUNETR achieved the best DSC (0.853), PRE (0.848), SEN (0.860), and SPE (0.9996), while V-Net achieved the best ASD (0.99). On the MLD test set, SwinUNETR demonstrated good MCA segmentation performance and had the best DSC, ASD, PRE, and SPE for segmenting the LSA. CONCLUSIONS The workflow demonstrated excellent performance on different sequences of MRI images for vessels of varying sizes. This method allows doctors to visualize cerebrovascular structures. CRITICAL RELEVANCE STATEMENT A deep learning-based 3D cerebrovascular segmentation workflow is feasible and promising for visualizing cerebrovascular structures and monitoring cerebral small vessels, such as lenticulostriate arteries. KEY POINTS • The proposed deep learning-based workflow performs well in cerebrovascular segmentation tasks. • Among comparison models, SwinUNETR achieved the best DSC, ASD, PRE, and SPE values in lenticulostriate artery segmentation. • The proposed workflow can be used for different MR sequences, such as bright and black blood imaging.
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Affiliation(s)
- Langtao Zhou
- School of Cyberspace Security, Guangzhou University, Guangzhou, 510006, China
- Department of Radiology of the First Affiliated Hospital of the University of South China, Hengyang, 421001, China
| | - Huiting Wu
- Department of Radiology of the First Affiliated Hospital of the University of South China, Hengyang, 421001, China
| | - Guanghua Luo
- Department of Radiology of the First Affiliated Hospital of the University of South China, Hengyang, 421001, China.
| | - Hong Zhou
- Department of Radiology of the First Affiliated Hospital of the University of South China, Hengyang, 421001, China.
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19
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Li H, Wei S, Xu Q. Full sample analysis of cerebral venous sinus thrombosis in ophthalmology inpatients. J Fr Ophtalmol 2024; 47:104074. [PMID: 38377844 DOI: 10.1016/j.jfo.2024.104074] [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: 03/06/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE We hope that by analyzing the clinical features of cerebral venous sinus thrombosis (CVST), we can help ophthalmologists reduce misdiagnosis or delayed diagnosis. DESIGN We evaluated 47 patients with CVST in terms of clinical manifestations. METHODS All cases were analyzed in terms of risk factors, clinical symptoms, ophthalmic examination, imaging examination and lumbar puncture. RESULTS The body mass indices (BMIs) of 41 patients (87.2%; 95% CI, 77.7-96.8%) were≥24, which is overweight by Chinese standards. There were 22 patients (46.8%; 95% CI, 32.5-61.1%) with BMIs≥28, who were considered obese. Thirteen were hypertensive (27.7%; 95% CI, 14.9-40.5%). The initial symptoms included blurred vision (23, 48.9%; 95% CI, 34.6-63.2%), amaurosis fugax (13, 27.7%; 95% CI, 14.9-40.5%), headache (11 patients, 23.4%; 95% CI, 11.3-35.5%), dizziness (3, 6.4%; 95% CI, -0.6-13.4%), and bilateral diplopia (3, 6.4%; 95% CI, -0.6-13.4%). There were 9 patients (9, 19.2%; 95% CI, 7.9-30.4%) with blindness, 23 patients (48.9%; 95% CI, 34.6-63.2%) with pupillary abnormalities, and 40 patients (85.1%; 95% CI, 74.9-95.2%) with papilledema. Forty-three of the 45 patients who successfully underwent a routine lumbar puncture showed high intracranial pressure (91.7%; 95.6% CI, 89.6-101.6%). Finally, two cases are reported in greater detail for illustrative purposes. CONCLUSION The main reasons interfering with the diagnosis of CVST might be its nonspecific ocular symptoms and the physicians' clinical thought process being limited to the scope of common ophthalmological diseases.
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Affiliation(s)
- H Li
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian China.
| | - S Wei
- Department of Ophthalmology, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, PR China.
| | - Q Xu
- Department of Ophthalmology, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, PR China.
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20
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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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21
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Gabarin N, Hack M, Revilla R, Arnold DM, Nazy I. Hematology in the post-COVID era: spotlight on vaccine-induced immune thrombotic thrombocytopenia and a conceptual framework (the 4P's) for anti-PF4 diseases. Expert Rev Hematol 2024; 17:39-45. [PMID: 38149432 DOI: 10.1080/17474086.2023.2298333] [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: 10/26/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a life-threatening prothrombotic disorder first identified following the introduction of adenoviral vector vaccines for COVID-19. The condition is characterized by anti-PF4 antibodies and clinically presents with thrombocytopenia and thrombosis often in unusual anatomical sites. AREAS COVERED In this review, we discuss the clinical presentation, diagnostic testing, and treatment of VITT. We also review VITT-like syndromes that have been described in patients without previous vaccination. We propose a conceptual framework for the mechanism of anti-PF4 diseases that includes sufficiently high levels of PF4, the presence of a Polyanion that can form immune complexes with PF4, a Pro-inflammatory milieu, and an immunological Predisposition - the 4Ps. EXPERT OPINION Significant progress has been made in understanding the characteristics of the VITT antibody and in testing methods that can confirm that diagnosis. Future work should be directed at understanding long-term outcomes, mechanisms of thrombosis, and individual risk factors for this rare but dangerous immune-thrombotic disease.
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Affiliation(s)
- Nadia Gabarin
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Michael Hack
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Revilla
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
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22
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Algarni SA, ALGhasab NS, Alharbi MS, Albarrak A, Alanezi AA, Al Shehri HM. Sex Differences and Clinical Outcomes of Patients with Coronavirus Disease 2019 Infection and Cerebral Venous Sinus Thrombosis: A Systematic Review. Clin Appl Thromb Hemost 2024; 30:10760296241240748. [PMID: 38551022 PMCID: PMC10981232 DOI: 10.1177/10760296241240748] [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: 11/25/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare neurovascular condition that has been observed in individuals with coronavirus disease 2019 (COVID-19). This systematic review aimed to explore the sex differences and characteristics of concurrent COVID-19 and CVST cases. A total of 212 CVST patients were included in the study. Women with CVST had a slightly higher mean age compared to men (47.359 years vs 46.08 years). Women were more likely to report symptoms such as fever (56.1%) and decreased sense of smell or taste (71.4%), while men more frequently experienced nausea or vomiting (55.6%), headache (62.9%), and seizures (72%). Notably, current smokers, who were predominantly men, had a higher occurrence of CVST. On the other hand, women had a higher likelihood of CVST risk factors such as oral contraceptive pill (OCP) use and autoimmune diseases. Treatment approaches also showed sex-based differences. Unfractionated heparin was administered more often to women with CVST (63.2%). The in-hospital mortality rate for CVST patients was 21.3%, with men having a significantly higher mortality rate than women (65.2% vs 34.8%, P = .027). Survival analysis revealed that factors such as smoking history, diabetes mellitus, hypertension, OCP use, COVID-19 symptoms, CVST symptoms, and the need for intubation significantly influenced survival outcomes. Understanding these sex differences in COVID-19-related CVST is crucial for accurate diagnosis and effective management, ultimately leading to improved patient outcomes. Our findings highlight the importance of considering sex as a factor in the evaluation and treatment of individuals with COVID-19 and concurrent CVST.
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Affiliation(s)
- Saleh A. Algarni
- Department of Neuroscience, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Naif S. ALGhasab
- Department of Internal Medicine, Medical Collage, Ha’il University, Ha’il, Saudi Arabia
| | - Mohammed S. Alharbi
- Department of Internal Medicine, Medical Collage, Ha’il University, Ha’il, Saudi Arabia
| | - Anas Albarrak
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmad A. Alanezi
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
- Department of Pediatrics, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Hamdan M. Al Shehri
- Department of Internal Medicine, Medical Collage, Najran University, Najran, Saudi Arabia
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23
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Xiang W, Liang Y, Chen Z, Wang H, Guan Y, Xie D. Malnutrition and cerebral intraparenchymal damage in patients with thrombosis of dural sinuses and/or cerebral veins. BMC Neurol 2023; 23:449. [PMID: 38124042 PMCID: PMC10731804 DOI: 10.1186/s12883-023-03491-1] [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: 10/31/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUNDS Thrombosis of dural sinuses and/or cerebral veins (CVT) is an uncommon form of cerebrovascular disease. Malnutrition is common in patients with cerebrovascular disease, and early assessment of malnutrition and individualized nutritional treatment have been reported to improve functional outcomes of these patients. As for CVT patients, little is known about whether these patients would suffer from malnutrition. Also, the correlation between malnutrition and cerebral intraparenchymal damage (CID) in CVT patients was rarely studied. METHODS Patients with CVT were retrospectively included in this observational study. Multivariate logistic regressions were used to investigate the effects of nutritional indexes on the risk of CID. Subsequently, we used the independent risk factors to construct the nomogram model, and the consistency index (C-index), calibration curve and decision curve analysis (DCA) to assess the reliability and applicability of the model. RESULTS A total of 165 patients were included in the final analysis. Approximately 72.7% of CVT patients were regarded as malnourished by our malnutrition screening tools, and malnutrition is associated with an increased risk of CID. Prognostic Nutritional Index (PNI) (OR = 0.873; CI: 0.791, 0.963, p = 0.007) remained as an independent predictor for CID after adjustment for other risk factors. The nomogram model showed that PNI and gender have a great contribution to prediction. Besides, the nomogram model was consistent with the actual observations of CID risk (C-index = 0.65) and was of clinical significance. CONCLUSIONS We reported that malnutrition, as indicated by PNI, was associated with a higher incidence of CID in CVT patients. Also, we have constructed a nomogram for predicting the risk of CID in these patients.
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Affiliation(s)
- Weiwei Xiang
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160, Pujian Road, Shanghai, 200127, China
| | - Yangyang Liang
- The College of Renji, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhibo Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Hanmin Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yangtai Guan
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160, Pujian Road, Shanghai, 200127, China.
| | - Dewei Xie
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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24
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Liu L, Zhou C, Jiang H, Wei H, Zhou Y, Zhou C, Ji X. Epidemiology, pathogenesis, and management of Coronavirus disease 2019-associated stroke. Front Med 2023; 17:1047-1067. [PMID: 38165535 DOI: 10.1007/s11684-023-1041-7] [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: 05/05/2023] [Accepted: 10/15/2023] [Indexed: 01/03/2024]
Abstract
The Coronavirus disease 2019 (COVID-19) epidemic has triggered a huge impact on healthcare, socioeconomics, and other aspects of the world over the past three years. An increasing number of studies have identified a complex relationship between COVID-19 and stroke, although active measures are being implemented to prevent disease transmission. Severe COVID-19 may be associated with an increased risk of stroke and increase the rates of disability and mortality, posing a serious challenge to acute stroke diagnosis, treatment, and care. This review aims to provide an update on the influence of COVID-19 itself or vaccines on stroke, including arterial stroke (ischemic stroke and hemorrhagic stroke) and venous stroke (cerebral venous thrombosis). Additionally, the neurovascular mechanisms involved in SARS-CoV-2 infection and the clinical characteristics of stroke in the COVID-19 setting are presented. Evidence on vaccinations, potential therapeutic approaches, and effective strategies for stroke management has been highlighted.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
- Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
| | - Chenxia Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
- Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China
| | - Huimin Jiang
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Yifan Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
| | - Xunming Ji
- Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China.
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100032, China.
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25
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Ahmed N, Ibrahim M, Starostin D. A case of cerebral venous sinus thrombosis presented with SAH and isolated headache. Radiol Case Rep 2023; 18:4580-4584. [PMID: 37886727 PMCID: PMC10597787 DOI: 10.1016/j.radcr.2023.09.031] [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: 08/16/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 10/28/2023] Open
Abstract
Cerebral venous sinus thrombosis is a rare and challenging type of stroke. Coexistence of subarachnoid hemorrhage adds complexity to the diagnostic process leading to a missed or delayed diagnosis. Isolated headaches can be the only presentation and urgent neuroimaging using CT or MR venogram plays a pivotal role in the workup of these cases. We report a rare case of 64-years-old patient with subarachnoid hemorrhage and underlying cerebral venous sinus thrombosis who was presented with isolated headache where the management is different from arterial subarachnoid hemorrhage.
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Affiliation(s)
- Nali Ahmed
- Rotherham NHS Foundation Trust, Rotherham, UK
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26
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Şimşek F, Yevgi R. Assessment of fibrinogen albumin ratio in patients with pregnancy-related cerebral venous thrombosis. Acta Neurol Belg 2023; 123:2251-2258. [PMID: 37217742 DOI: 10.1007/s13760-023-02294-y] [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: 02/22/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION AND OBJECTIVE Cerebral venous thrombosis (CVT) is a cerebrovascular disease observed more commonly in women of childbearing age. There is currently no biomarker used to predict the risk of CVT during the follow-up of pregnant/postpartum patients. In this context, the objective of this study is to investigate the importance of fibrinogen and albumin levels and fibrinogen-to-albumin ratio (FAR) values, which predispose to thromboembolism, in pregnant/postpartum patients. MATERIAL AND METHOD The study sample consisted of 19 pregnant/postpartum patients with a diagnosis of CVT, 20 pregnant/postpartum patients without CVT. Albumin and fibrinogen levels and FAR values were compared between these two groups. RESULTS Fibrinogen level was significantly higher in pregnant/postpartum CVT patients compared to pregnant/postpartum patients without CVT (p = 0.010). On the other hand, albumin level was significantly lower in pregnant/postpartum CVT patients compared to the other group (p = 0.010). Lastly, FAR level was significantly higher in pregnant/postpartum CVT patients compared to the other group (p = 0.011). There was no correlation between FAR values and modified Rankin score. CONCLUSION The study findings indicated that high fibrinogen and low albumin levels and high FAR values are associated with an increased risk of CVT in pregnant/postpartum patients.
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Affiliation(s)
- Fatma Şimşek
- Faculty of Medicine, Department of Neurology, Ataturk University, Erzurum, Turkey.
| | - Recep Yevgi
- Faculty of Medicine, Department of Neurology, Ataturk University, Erzurum, Turkey
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27
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Rao AK, Whitaker I, Anthony T, Shaheen N, Lum Kong A. A Rare Case of Unprovoked Deep Cerebral Venous Sinus Thrombosis With Associated Petechial Hemorrhage. Cureus 2023; 15:e49442. [PMID: 38149132 PMCID: PMC10750879 DOI: 10.7759/cureus.49442] [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] [Accepted: 11/26/2023] [Indexed: 12/28/2023] Open
Abstract
A 73-year-old male with hyperlipidemia and prior squamous cell carcinoma presented with a new-onset generalized tonic-clonic seizure and left-sided weakness. He had a progressively worsening cervical and occipital headache for nine days and was initially evaluated with an unremarkable CT head. The patient arrived at the emergency department with a left gaze deviation, prompting a "Code Neuro." CT angiography (CTA) detected a large dural sinus thrombosis, which was confirmed with a CT venogram and brain MRI. The patient was closely monitored in the intensive care unit and managed with heparin, nicardipine, and hypertonic saline boluses. Neurosurgery opted against surgical intervention. EEG revealed right hemisphere focal dysfunction. Recanalization occurred on hospital day 6. The patient was transitioned to apixaban upon discharge and instructed to follow up with hematology for a hypercoagulable workup. This case highlights the diagnostic complexity of cerebral venous sinus thrombosis (CVST), urging consideration of a differential even in atypical patients. We hope reporting this case will prompt clinicians to consider CVST in patients with non-specific symptoms, leading to timely diagnosis and treatment.
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Affiliation(s)
- Abhinav K Rao
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - Ian Whitaker
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - Theshali Anthony
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - Nick Shaheen
- Radiology, Aultman Hospital, Canton, USA
- Interventional Radiology, Northeast Ohio Medical University, Rootstown, USA
| | - Aidan Lum Kong
- Internal Medicine, Trident Medical Center, North Charleston, USA
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28
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Holodinsky JK, Lindsay P, Yu AYX, Ganesh A, Joundi RA, Hill MD. Estimating the Number of Hospital or Emergency Department Presentations for Stroke in Canada. Can J Neurol Sci 2023; 50:820-825. [PMID: 36536997 DOI: 10.1017/cjn.2022.338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although age-standardized stroke occurrence has been decreasing, the absolute number of stroke events globally, and in Canada, is increasing. Stroke surveillance is necessary for health services planning, informing research design, and public health messaging. We used administrative data to estimate the number of stroke events resulting in hospital or emergency department presentation across Canada in the 2017-18 fiscal year. METHODS Hospitalization data were obtained from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database and the Ministry of Health and Social Services in Quebec. Emergency department data were obtained from the CIHI National Ambulatory Care Reporting System (Alberta and Ontario). Stroke events were identified using ICD-10 coding. Data were linked into episodes of care to account for readmissions and interfacility transfers. Projections for emergency department visits for provinces/territories outside of Alberta and Ontario were generated based upon age and sex-standardized estimates from Alberta and Ontario. RESULTS In the 2017-18 fiscal year, there were 108,707 stroke events resulting in hospital or emergency department presentation across the country. This was made up of 54,357 events resulting in hospital admission and 54,350 events resulting in only emergency department presentation. The events resulting in only emergency department presentation consisted of 25,941 events observed in Alberta and Ontario and a projection of 28,409 events across the rest of the country. CONCLUSIONS We estimate a stroke event resulting in hospital or emergency department presentation occurs every 5 minutes in Canada.
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Affiliation(s)
- Jessalyn K Holodinsky
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Lindsay
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada
| | - Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raed A Joundi
- Division of Neurology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Alberta, Canada
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29
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Huynh A, Arnold DM, Ivetic N, Clare R, Hadzi-Tosev M, Liu Y, Smith JW, Bissola AL, Daka M, Kelton JG, Nazy I. Antibodies against platelet factor 4 and the risk of cerebral venous sinus thrombosis in patients with vaccine-induced immune thrombotic thrombocytopenia. J Thromb Haemost 2023; 21:2833-2843. [PMID: 37394121 DOI: 10.1016/j.jtha.2023.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication of adenoviral vector-based vaccines against SARS-CoV-2. This syndrome is caused by antibodies against platelet factor 4 (PF4; CXCL4) that lead to platelet activation and is characterized by thrombocytopenia and thrombosis in unusual locations, including cerebral venous sinus thrombosis (CVST). VITT can be classified based on anti-PF4 antibodies properties in vitro: those that require PF4 to activate platelets (PF4-dependent) and those that can activate platelets without additional PF4 (PF4-independent) in the serotonin release assay. OBJECTIVES We aim to characterize the relationship of VITT platelet-activating profiles with CVST. METHODS We conducted a retrospective cohort study involving patients with confirmed VITT who were tested between March and June 2021. Data were collected with an anonymized form and cases were identified as VITT with high clinical suspicion according to platelet activation assays. Anti-PF4 antibody binding regions on PF4 were further characterized with alanine scanning mutagenesis. RESULTS Of the patients with confirmed VITT (n = 39), 17 (43.6%) had PF4-dependent antibodies and 22 (56.4%) had PF4-independent antibodies. CVST occurred almost exclusively in PF4-independent patients (11 of 22 vs 1 of 17; P < .05). Additionally, PF4-independent antibodies bound to 2 distinct epitopes on PF4, the heparin-binding region and a site typical for heparin-induced thrombocytopenia antibodies, whereas PF4-dependent antibodies bound to only the heparin-binding region. CONCLUSION These findings suggest that VITT antibodies that cause PF4-independent platelet activation represent a unique subset of patients more likely to be associated with CVST, possibly due to the 2 different types of anti-PF4 antibodies.
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Affiliation(s)
- Angela Huynh
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Nikola Ivetic
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rumi Clare
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Milena Hadzi-Tosev
- Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - James W Smith
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anna-Lise Bissola
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mercy Daka
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John G Kelton
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.
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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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31
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Simaan N, Molad J, Honig A, Filioglo A, Peretz S, Shbat F, Mansor T, Abu-Shaheen W, Leker RR. Factors influencing real-life use of direct oral anticoagulants in patients with cerebral sinus and venous thrombosis. J Stroke Cerebrovasc Dis 2023; 32:107223. [PMID: 37437504 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107223] [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: 04/11/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) are advocated as equally effective to vitamin K antagonists (VKA) for the treatment of patients with cerebral sinus and venous thrombosis (CSVT). However, data concerning the real-life management practices in CSVT patients are is lacking. METHODS Prospective CSVT databases from four large academic medical centers were retrospectively studied. Demographics, clinical presentations, risk factors, radiological and outcome parameters were compared between CSVT patients treated with DOAC and VKA. RESULTS Out of 504 CSVT patients, 43 (8.5%) were treated with DOAC, and the remaining 461 (91.5%) were treated with VKA. All patients with antiphospholipid syndrome (APLA) were treated with VKA (61 vs. 0, p=0.013). Patients with a history or presence of malignancy were also more often treated with VKA (16% vs. 5%, p=0.046). Other risk factors for thrombosis did not differ between the groups. There were no differences in clot extent or location and no differences in the percentage of favorable outcomes or mortality were observed. CONCLUSION Our data suggests that only malignancy and antiphospholipid antibodies significantly influenced physician's decisions towards choosing VKA rather than DOAC. DOAC appear to be as effective and safe as VKA in patients with CSVT.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed, Israel; The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jeremy Molad
- Department of Neurology Tel Aviv Sourasky Medical Center, Israel
| | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, 91120, Israel
| | - Andrei Filioglo
- Department of Neurology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, 91120, Israel
| | - Shlomi Peretz
- Department of Neurology Rabin Medical Center, Petach Tikva, Israel
| | - Fadi Shbat
- Department of Neurology, Ziv Medical Center, Safed, Israel; The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Tarek Mansor
- Department of Neurology, Ziv Medical Center, Safed, Israel; The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Waleed Abu-Shaheen
- Department of Neurology, Ziv Medical Center, Safed, Israel; The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, 91120, Israel.
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Wijeratne T, Wijeratne C, Korajkic N, Bird S, Sales C, Riederer F. Secondary headaches - red and green flags and their significance for diagnostics. eNeurologicalSci 2023; 32:100473. [PMID: 37456555 PMCID: PMC10339125 DOI: 10.1016/j.ensci.2023.100473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/22/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
A small percentage of patients suffer from a secondary headache syndrome. It is imperative that clinicians are able to differentiate primary headache syndromes from secondary headache syndromes, as failure to do so significantly worsens morbidity and mortality. Recent advances in our understanding of pathobiological mechanisms offer useful information on these enigmatic disorders. We now understand that the causes of secondary headache syndromes can vary significantly - these may be infectious, inflammatory, vascular, traumatic or structural in origin. A well-taken history and targeted physical examination coupled with appropriate investigations can enable these syndromes to be recognized consistently and thus allow their timely and appropriate treatment. Along with their epidemiology, some of their key characteristics shall thus be discussed in this review so as to aid the busy clinician at the bedside. Red flags including sudden onset, high pain intensity, pattern of change of a preexisting headache, focal neurological signs or seizure, systemic signs and precipitation by physical activity can guide the clinician to suspect a secondary headache. Importantly a preexisting headache is not an exclusion of a secondary headache - it might even be a predisposition in certain cases.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura, Sri Lanka
| | - Chanith Wijeratne
- Monash Medical School, Clayton, Victoria, Australia
- Migraine Foundation & Australian Institute of Migraine, 522, Bell Street, Pascoe Vale South, Victoria, Australia
| | - Nadja Korajkic
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
| | - Stefanie Bird
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
- Migraine Foundation & Australian Institute of Migraine, 522, Bell Street, Pascoe Vale South, Victoria, Australia
| | - Carmela Sales
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia
| | - Franz Riederer
- Department of Neurology, Clinic Hietzing and Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
- Faculty of Medicine, University of Zurich, Switzerland
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Liu L, Zhou C, Jiang H, Wei H, Zhou Y, Wu Y, Zhang K, Li C, Duan J, Meng R, Zhou C, Ji X. Cortical vein involvement and its influence in a cohort of adolescents with cerebral venous thrombosis. Thromb J 2023; 21:78. [PMID: 37488565 PMCID: PMC10367417 DOI: 10.1186/s12959-023-00521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND PURPOSE Cortical vein thrombosis (CVT) is a rare form of cerebral venous sinus thrombosis (CVST) in adolescent patients that has received little attention. We aimed to analyze the clinical and radiological features of adolescents with CVST and investigate the effects of CVT involvement. METHODS Patients aged ≥ 10 to ≤ 18 years and diagnosed with CVST were identified at Xuanwu Hospital, Capital Medical University between January 2015 and August 2022 and divided into two groups according to the presence or absence of cortical vein involvement. Additionally, the patients were also categorized based on their sex. Clinical features, radiological characteristics, and 12-month follow-up outcomes were compared between the two groups. RESULTS Fifty-three adolescents, including 21 with CVT, were included (mean age: 15.2 ± 1.8 years; females, 54.7%). The CVT group was more likely to experience seizures (P = 0.028) and deterioration (28.6% vs. 6.2%, P = 0.047) during hospitalization than the non-CVT group. Poor short-term outcomes, based on the modified Rankin Scale (mRS) score at discharge, were more common in adolescents with CVT (P = 0.007). The proportions of patients showing edema (42.9% vs. 6.2%, P = 0.004) and mass effect (P = 0.015) were significantly higher in the CVT group. Recanalization was observed in 61.9% and 82.1% of the patients in the CVT and non-CVT groups, respectively, during the first imaging review (median, 22 days). After a 12-month follow-up, female adolescents had more frequent resident secondary headaches than male adolescents (52.9% vs. 12.5%; P = 0.014). CONCLUSIONS Cortical vein involvement in adolescents with CVST was associated with a higher risk of epilepsy at presentation, deterioration during hospitalization, edema, and mass effect on acute imaging. Moreover, cortical vein involvement may lead to worse short-term outcomes. Sex differences require consideration in etiological analyses and prolonged follow-ups.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chenxia Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huimin Jiang
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Yifan Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Yan Wu
- Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kaiyuan Zhang
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Zahoor H, Hamza A, Aigbe E, Guzman N, Nabizadeh-Eraghi P. Cerebral Venous Thrombosis in Young Adults: Unknown Origins. Cureus 2023; 15:e41970. [PMID: 37588304 PMCID: PMC10427191 DOI: 10.7759/cureus.41970] [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] [Accepted: 07/16/2023] [Indexed: 08/18/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a relatively rare neurological disorder that may result in significant morbidity if not diagnosed and managed promptly. The clinical presentation of CVT is nonspecific and highly variable with acute, subacute, or chronic onset. It most often presents as a headache but may present with focal neurological symptoms, symptoms of intracranial hypertension, or encephalopathy. The predisposing factors for CVT are mainly acquired and genetic hypercoagulable conditions. However, the epidemiology, predisposing factors, and clinical presentation of CVT are not clearly established given the rare nature of the condition. We present a case series of three young patients who did not have any classic underlying etiology for CVT or any prior diagnosis of venous thrombosis. We want to report this case series to show that a high index of suspicion should be maintained regardless of the absence of risk factors.
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Affiliation(s)
- Hovra Zahoor
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Ameer Hamza
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Eboselumen Aigbe
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Nilmarie Guzman
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Payam Nabizadeh-Eraghi
- Pulmonary and Critical Care Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
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Yang Y, Cheng J, Peng Y, Luo Y, Zou D, Yang Y, Ma Y. Clinical features of patients with cerebral venous sinus thrombosis at plateau areas. Brain Behav 2023; 13:e2998. [PMID: 37095720 PMCID: PMC10275515 DOI: 10.1002/brb3.2998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Cerebral venous sinus thrombosis (CVST) is believed to be associated with high-altitude exposure and has worse clinical prognosis in plateau areas than in plain areas, although this needs to be further verified. This retrospective study aims to compare the clinical differences of patients with CVST in plateau and plain areas and further ascertain the role of high-altitude exposure in the etiology of aggravating predisposition toward CVST. METHODS Twenty-four symptomatic CVST patients occurring at plateau areas (altitude ≥ 4000 m), in corresponding with 24 CVST patients occurring at plain areas (altitude ≤ 1000 m), were recruited according to the inclusion and exclusion criteria from June 2020 to December 2021. The collected data and compared parameters include clinical features, neuroimaging findings, hematology profile, lipid profile, and coagulation profile within 24 h of hospital admission, as well as the treatment method and final outcome. RESULTS There were no obvious differences of demographic characteristics, including gender, age, height, and weight between patients with CVST in plateau and plain areas, as well as medical history, neuroimaging findings, treatment protocols, and clinical outcome (all p > .05). Compared to patients with CVST at plain areas, time before hospital admission was longer and heartbeat was slower in patients with CVST at plateau areas (all p < .05). More importantly, elevated red blood cells counts, hemoglobin level, and altered coagulation function were found in patients with CVST at plateau areas (all p < .05). CONCLUSION CVST patients in plateau areas presented with altered clinical characteristics, altered coagulation function, and aggravated predisposition toward venous thromboembolism compared with CVST patients in plain areas. Future prospective studies will be needed to further elucidate the influences of a high altitude on the pathogenesis of CVST.
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Affiliation(s)
- Yongxiang Yang
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Jingmin Cheng
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yuping Peng
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yan Luo
- Department of OncologyThe General Hospital of Western Theater CommandChengduChina
| | - Dongbo Zou
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yongjian Yang
- Department of CardiologyThe General Hospital of Western Theater CommandChengduChina
| | - Yuan Ma
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
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Chen C, Zhou K, Lu T, Ning H, Xiao R. Integration- and separation-aware adversarial model for cerebrovascular segmentation from TOF-MRA. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107475. [PMID: 36931018 DOI: 10.1016/j.cmpb.2023.107475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Cerebrovascular segmentation from time-of-flight magnetic resonance angiography (TOF-MRA) is important but challenging for the simulation and measurement of cerebrovascular diseases. Recently, deep learning has promoted the rapid development of cerebrovascular segmentation. However, model optimization relies on voxel or regional punishment and lacks global awareness and interpretation from the texture and edge. To overcome the limitations of the existing methods, we propose a new cerebrovascular segmentation method to obtain more refined structures. METHODS In this paper, we propose a new adversarial model that achieves segmentation using segmentation model and filters the results using discriminator. Considering the sample imbalance in cerebrovascular imaging, we separated the TOF-MRA images and utilized high- and low-frequency images to enhance the texture and edge representation. The encoder weight sharing from the segmentation model not only saves the model parameters, but also strengthens the integration and separation correlation. Diversified discrimination enhances the robustness and regularization of the model. RESULTS The adversarial model was tested using two cerebrovascular datasets. It scored 82.26% and 73.38%, respectively, ranking first on both datasets. The results show that our method not only outperforms the recent cerebrovascular segmentation model, but also surpasses the common adversarial models. CONCLUSION Our adversarial model focuses on improving the extraction ability of the model on texture and edge, thereby achieving awareness of the global cerebrovascular topology. Therefore, we obtained an accurate and robust cerebrovascular segmentation. This framework has potential applications in many imaging fields, particularly in the application of sample imbalance. Our code is available at the website https://github.com/MontaEllis/ISA-model.
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Affiliation(s)
- Cheng Chen
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Kangneng Zhou
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Tong Lu
- Visual 3D Medical Science and Technology Development, Co. Ltd, Beijing 100082, China
| | - Huansheng Ning
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Ruoxiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China; Shunde Innovation School, University of Science and Technology Beijing, Foshan 100024, China.
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Carletti F, Vilela P, Jäger HR. Imaging Approach to Venous Sinus Thrombosis. Radiol Clin North Am 2023; 61:501-519. [PMID: 36931766 DOI: 10.1016/j.rcl.2023.01.011] [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: 02/22/2023]
Abstract
Cerebral venous thrombosis (CVT) is a rare cerebrovascular disease caused by an occlusion of the cerebral venous sinuses or cortical veins. It has a favorable prognosis if diagnosed and treated early. CVT can be difficult to diagnose on clinical grounds, and imaging plays a key role. We discuss clinical features and provide an overview of current neuroimaging methods and findings in CTV.
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Affiliation(s)
- Francesco Carletti
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | - Pedro Vilela
- Neuroradiology Department. Lisbon Western University Center (Centro Hospitalar Lisboa Ocidental -CHLO), Lisbon Portugal; Imaging Department, Hospital da Luz Lisbon, Portugal
| | - Hans Rolf Jäger
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
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Ciarambino T, Crispino P, Minervini G, Giordano M. Cerebral Sinus Vein Thrombosis and Gender: A Not Entirely Casual Relationship. Biomedicines 2023; 11:biomedicines11051280. [PMID: 37238951 DOI: 10.3390/biomedicines11051280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
Cerebral sinus venous thrombosis (CSVT) is a relatively rare acute disorder of cerebral circulation, but it can potentially be associated with serious sequelae and a poor prognosis. The neurological manifestations associated with it are often not adequately taken into consideration given the extreme variability and nuances of its clinical presentation and given the need for radiological methods suitable for this type of diagnosis. CSVT is usually more common in women, but so far there are little data available in the literature on sex-specific characteristics regarding this pathology. CSVT is the result of multiple conditions and is therefore to be considered a multifactorial disease where at least one risk factor is present in over 80% of cases. From the literature, we learn that congenital or acquired prothrombotic states are to be considered extremely associated with the occurrence of an acute episode of CSVT and its recurrences. It is, therefore, necessary to fully know the origins and natural history of CSVT, in order to implement the diagnostic and therapeutic pathways of these neurological manifestations. In this report, we summarize the main causes of CSVT considering the possible influence of gender, bearing in mind that most of the causes listed above are pathological conditions closely linked to the female sex.
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Affiliation(s)
- Tiziana Ciarambino
- Internal Medicine Department, Hospital of Marcianise, ASL Caserta, 81024 Caserta, Italy
| | - Pietro Crispino
- Internal Medicine Department, Hospital of Latina, ASL Latina, 04100 Latina, Italy
| | - Giovanni Minervini
- Emergency Department, Hospital of Lagonegro, AOR San Carlo, 85042 Lagonegro, Italy
| | - Mauro Giordano
- Advanced Medical and Surgical Sciences Department, University of Campania, L. Vanvitelli, 81100 Naples, Italy
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Jianu DC, Jianu SN, Iacob N, Dan TF, Munteanu G, Gogu AE, Sadik R, Motoc AGM, Axelerad A, Sirbu CA, Petrica L, Ionita I. Diagnosis and Management of Cerebral Venous Thrombosis Due to Polycythemia Vera and Genetic Thrombophilia: Case Report and Literature Review. Life (Basel) 2023; 13:life13051074. [PMID: 37240720 DOI: 10.3390/life13051074] [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: 02/24/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Cerebral venous and dural sinus thrombosis (CVT) rarely appears in the adult population. It is difficult to diagnosis because of its variable clinical presentation and the overlapping signal intensities of thrombosis and venous flow on conventional MR images and MR venograms. (2) Case presentation: A 41-year-old male patient presented with an acute isolated intracranial hypertension syndrome. The diagnosis of acute thrombosis of the left lateral sinus (both transverse and sigmoid portions), the torcular Herophili, and the bulb of the left internal jugular vein was established by neuroimaging data from head-computed tomography, magnetic resonance imaging (including Contrast-enhanced 3D T1-MPRAGE sequence), and magnetic resonance venography (2D-TOF MR venography). We detected different risk factors (polycythemia vera-PV with JAK2 V617F mutation and inherited low-risk thrombophilia). He was successfully treated with low-molecular-weight heparin, followed by oral anticoagulation. (3) Conclusions: In the case of our patient, polycythemia vera represented a predisposing risk factor for CVT, and the identification of JAK2 V617F mutation was mandatory for the etiology of the disease. Contrast-enhanced 3D T1-MPRAGE sequence proved superior to 2D-TOF MR venography and to conventional SE MR imaging in the diagnosis of acute intracranial dural sinus thrombosis.
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Affiliation(s)
- Dragos Catalin Jianu
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Silviana Nina Jianu
- Department of Ophthalmology, "Dr. Victor Popescu" Military Emergency Hospital, 7 G. Lazar Ave., 300080 Timisoara, Romania
| | - Nicoleta Iacob
- Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Neuromed Diagnostic Imaging Centre, 300218 Timisoara, Romania
| | - Traian Flavius Dan
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Georgiana Munteanu
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Anca Elena Gogu
- First Division of Neurology, Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- First Department of Neurology, "Pius Brînzeu" Emergency County Hospital, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
| | - Raphael Sadik
- Department of Geriatrics-Rehabilitation, Riviera-Chablis Hospital, 3 Prairie Ave., 1800 Vevey, Switzerland
| | - Andrei Gheorghe Marius Motoc
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Department of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
| | - Any Axelerad
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania
| | - Carmen Adella Sirbu
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Department of Neurology, Central Military Emergency University Hospital, Clinical Neuroscience Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ligia Petrica
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
- Division of Nephrology, Department of Internal Medicine II, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
| | - Ioana Ionita
- Division of Hematology, Department V, "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Multidisciplinary Research Center for Malignant Hemopathies (CMCHM), "Victor Babes" University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
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Pillsbury A, Phillips A, Deng L, Quinn H, Macartney K, Gidding H. Background incidence rates of selected adverse events of special interest (AESI) to monitor the safety of COVID-19 vaccines. Vaccine 2023; 41:3422-3428. [PMID: 37088604 PMCID: PMC10110935 DOI: 10.1016/j.vaccine.2023.04.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Determining background rates of medical conditions identified as adverse events of special interest (AESI) that may occur following COVID-19 vaccination is important for contextualising and investigating potential vaccine safety signals. METHODS We conducted a retrospective population-based cohort study using linked emergency department, hospitalisation and death data for 2017 and 2018 from Australia's most populous state, New South Wales. Incident cases of select neurological conditions, arterial or venous thromboembolic conditions, secondary thrombocytopenia, myocarditis/pericarditis, and unique events of anaphylaxis and generalised convulsions were identified using internationally agreed upon diagnostic (ICD-10) codes. State-specific rates per 100,000 person-years were calculated, with further stratification by age group and sex where clinically relevant to the condition, and the number of expected cases nationally in one and 6 weeks was estimated. RESULTS Background rates of selected neurological conditions were low with the exception of generalised convulsions for which 1,599-1,872 cases were estimated nationally in a 1-week period in the absence of vaccination. Using a narrow case definition, rates of Guillain-Barré Syndrome (3.9 per 100,000 person-years) were higher than international rates reported elsewhere. Thromboembolic and cerebral venous sinus thrombosis event rates increased with age. Myocarditis occurred more commonly in males, and was highest in males aged 18-24 years, with an estimated 1-4 cases expected nationally in a 1-week period. CONCLUSIONS Using routinely collected linked healthcare data provides localised estimates of background rates of new onset or periodic AESI which enables rapid estimation of observed-versus-expected rates of events reported following COVID-19 vaccination. This Australian-specific analysis contributes AESI background rates which can be compared with those from other countries to enhance understanding of geographic variability in the frequency of specific AESI in the absence of vaccination, and can be utilised for signal detection during program implementation.
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Affiliation(s)
- Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Anastasia Phillips
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia.
| | - Lucy Deng
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Helen Quinn
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, Australia.
| | - Heather Gidding
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Northern Clinical School, St Leonards, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia; School of Population Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia.
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41
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Chen C, Zhou K, Wang Z, Zhang Q, Xiao R. All answers are in the images: A review of deep learning for cerebrovascular segmentation. Comput Med Imaging Graph 2023; 107:102229. [PMID: 37043879 DOI: 10.1016/j.compmedimag.2023.102229] [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: 10/24/2022] [Revised: 03/03/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
Cerebrovascular imaging is a common examination. Its accurate cerebrovascular segmentation become an important auxiliary method for the diagnosis and treatment of cerebrovascular diseases, which has received extensive attention from researchers. Deep learning is a heuristic method that encourages researchers to derive answers from the images by driving datasets. With the continuous development of datasets and deep learning theory, it has achieved important success for cerebrovascular segmentation. Detailed survey is an important reference for researchers. To comprehensively analyze the newest cerebrovascular segmentation, we have organized and discussed researches centered on deep learning. This survey comprehensively reviews deep learning for cerebrovascular segmentation since 2015, it mainly includes sliding window based models, U-Net based models, other CNNs based models, small-sample based models, semi-supervised or unsupervised models, fusion based models, Transformer based models, and graphics based models. We organize the structures, improvement, and important parameters of these models, as well as analyze development trends and quantitative assessment. Finally, we have discussed the challenges and opportunities of possible research directions, hoping that our survey can provide researchers with convenient reference.
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Affiliation(s)
- Cheng Chen
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Kangneng Zhou
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Zhiliang Wang
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Ruoxiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China; Shunde Innovation School, University of Science and Technology Beijing, Foshan 100024, China.
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Liu L, Jiang H, Wei H, Zhou Y, Wu Y, Zhang K, Duan J, Meng R, Zhou C, Ji X. Risk factors of impaired employability after cerebral venous thrombosis. CNS Neurosci Ther 2023; 29:1086-1093. [PMID: 36601664 PMCID: PMC10018074 DOI: 10.1111/cns.14083] [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: 09/11/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
AIMS Cerebral venous thrombosis (CVT) is a major cause of stroke in young and middle-aged adults. This study aimed to evaluate the prevalence of post-CVT employability decline and identify factors associated with unemployment. METHODS We identified patients first diagnosed with acute/subacute CVT at Xuanwu Hospital, Capital Medical University (January 2018 to June 2021) and invited all survivors to a clinical 6-months follow-up visit after onset. Baseline data were collected from all patients at admission. A modified Rankin Scale (mRS) and employment status were used to assess functional outcomes. Multivariate logistic regression was used to identify independent factors associated with unemployment. RESULTS A total of 303 CVT patients were eligible for this study, 131 (42.23%) patients could not return to work 6-month after discharge. After adjusting for age and sex in multivariate analysis, motor deficits, aphasia, mental disorders, CVT recurrence, National Institutes of Health Stroke Scale (NIHSS) score at admission, and mRS 0-2 at 6-month follow-up were independently associated with employment after CVT. Among 263 patients whose mRS showed a favorable outcome, 102 patients were unable to return to their previous work and the risk factors for impaired ability to return to work were aphasia and CVT recurrence. CONCLUSIONS Impaired employability after CVT was associated with motor deficits, aphasia, mental status disorders, and NIHSS score at admission. Even if they recover from CVT without physical disability, patients with a good functional prognosis have a higher risk of employment failure due to their higher rates of aphasia and CVT recurrence.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital, 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 Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing, 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
| | - Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing, Capital Medical 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
| | - Kaiyuan Zhang
- Department of Radiology & Nuclear Medicine, 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
- Department of Neurology, Xuanwu Hospital, 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
| | - Chen Zhou
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China.,Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing, Capital Medical University, Beijing, China
| | - Xunming Ji
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China.,Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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43
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Liberman AL. Diagnosis and Treatment of Cerebral Venous Thrombosis. Continuum (Minneap Minn) 2023; 29:519-539. [PMID: 37039408 DOI: 10.1212/con.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cerebral venous thrombosis (CVT), thrombosis of the dural sinus, cerebral veins, or both, is a rare cerebrovascular disease. Although mortality rates after CVT have declined over time, this condition can result in devastating neurologic outcomes. This article reviews the latest literature regarding CVT epidemiology, details new factors associated with the development of CVT, and describes advances in CVT treatment. It also contains a discussion of future directions in the field, including novel diagnostic imaging modalities, and potential strategies to reduce the risks associated with CVT. LATEST DEVELOPMENTS The incidence of CVT may be as high as 2 per 100,000 adults per year. It remains a difficult condition to diagnose given its variable clinical manifestations and the necessity of neuroimaging for confirmation. The COVID-19 pandemic has revealed a novel CVT trigger, vaccine-induced immune thrombotic thrombocytopenia (VITT), as well as an association between COVID-19 infection and CVT. Although VITT is a very rare event, timely diagnosis and treatment of CVT due to VITT likely improves patient outcomes. Direct oral anticoagulants are currently being used to treat CVT and emerging data suggest that these agents are as safe and effective as vitamin K antagonists. The role of endovascular therapy to treat CVT, despite a recent clinical trial, remains unproven. ESSENTIAL POINTS The incidence of CVT has increased, outcomes have improved, and the use of direct oral anticoagulants to treat CVT represents an important advance in the clinical care of these patients. Rates of CVT as a complication of COVID-19 vaccines using adenoviral vectors are very low (<5 per million vaccine doses administered), with the benefits of COVID-19 vaccination far outweighing the risks.
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Chen C, Zhou K, Qi S, Lu T, Xiao R. A learnable Gabor Convolution kernel for vessel segmentation. Comput Biol Med 2023; 158:106892. [PMID: 37028143 DOI: 10.1016/j.compbiomed.2023.106892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/26/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023]
Abstract
Vessel segmentation is significant for characterizing vascular diseases, receiving wide attention of researchers. The common vessel segmentation methods are mainly based on convolutional neural networks (CNNs), which have excellent feature learning capabilities. Owing to inability to predict learning direction, CNNs generate large channels or sufficient depth to obtain sufficient features. It may engender redundant parameters. Drawing on performance ability of Gabor filters in vessel enhancement, we built Gabor convolution kernel and designed its optimization. Unlike traditional filter using and common modulation, its parameters are automatically updated using gradients in the back propagation. Since the structural shape of Gabor convolution kernels is the same as that of regular convolution kernels, it can be integrated into any CNNs architecture. We built Gabor ConvNet using Gabor convolution kernels and tested it using three vessel datasets. It scored 85.06%, 70.52% and 67.11%, respectively, ranking first on three datasets. Results shows that our method outperforms advanced models in vessel segmentation. Ablations also proved that Gabor kernel has better vessel extraction ability than the regular convolution kernel.
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45
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Ranjan R, Ken-Dror G, Martinelli I, Grandone E, Hiltunen S, Lindgren E, Margaglione M, Le Cam Duchez V, Bagan Triquenot A, Zedde M, Mancuso M, Ruigrok YM, Worrall B, Majersik JJ, Putaala J, Haapaniemi E, Zuurbier SM, Brouwer MC, Passamonti SM, Abbattista M, Bucciarelli P, Lemmens R, Pappalardo E, Costa P, Colombi M, Aguiar de Sousa D, Rodrigues S, Canhao P, Tkach A, Santacroce R, Favuzzi G, Arauz A, Colaizzo D, Spengos K, Hodge A, Ditta R, Han TS, Pezzini A, Coutinho JM, Thijs V, Jood K, Tatlisumak T, Ferro JM, Sharma P. Age of onset of cerebral venous thrombosis: the BEAST study. Eur Stroke J 2023; 8:344-350. [PMID: 37021156 PMCID: PMC10069208 DOI: 10.1177/23969873221148267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Background Cerebral venous thrombosis (CVT) is an uncommon cause of stroke in young adults. We aimed to determine the impact of age, gender and risk factors (including sex-specific) on CVT onset. Methods We used data from the BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis), a multicentre multinational prospective observational study on CVT. Composite factors analysis (CFA) was performed to determine the impact on the age of CVT onset in males and females. Results A total of 1309 CVT patients (75.3% females) aged ⩾18 years were recruited. The overall median (IQR-interquartile range) age for males and females was 46 (35-58) years and 37 (28-47) years (p < 0.001), respectively. However, the presence of antibiotic-requiring sepsis (p = 0.03, 95% CI 27-47 years) among males and gender-specific risk factors like pregnancy (p < 0.001, 95% CI 29-34 years), puerperium (p < 0.001, 95% CI 26-34 years) and oral contraceptive use (p < 0.001, 95% CI 33-36 years) were significantly associated with earlier onset of CVT among females. CFA demonstrated a significantly earlier onset of CVT in females, ~12 years younger, in those with multiple (⩾1) compared to '0' risk factors (p < 0.001, 95% CI 32-35 years). Conclusions Women suffer CVT 9 years earlier in comparison to men. Female patients with multiple (⩾1) risk factors suffer CVT ~12 years earlier compared to those with no identifiable risk factors.
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Affiliation(s)
- Redoy Ranjan
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Ida Martinelli
- Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Home for the Relief of Suffering, S. Giovanni Rotondo, Foggia, Italy
- Medical and Surgical Department, University of Foggia, Foggia, Italy
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Veronique Le Cam Duchez
- Normandy University, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular Hemostasis Unit and INSERM CIC-CRB 1404, Rouen, France
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Local Health Unit – Authority IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brad Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | | | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elena Haapaniemi
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna M Zuurbier
- Department of Neurology, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Serena M Passamonti
- Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Maria Abbattista
- Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Paolo Bucciarelli
- Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven–University of Leuven, Leuven, Belgium
- VIB Center for Brain & Disease Research, Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Emanuela Pappalardo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Costa
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Marina Colombi
- Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy
| | - Diana Aguiar de Sousa
- Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal
- CEEM and Institute of Anatomy, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Rodrigues
- Department of Neurosciences, Hospital of Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Patrícia Canhao
- Department of Neurosciences, Hospital of Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Aleksander Tkach
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Rosa Santacroce
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giovanni Favuzzi
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Home for the Relief of Suffering, S. Giovanni Rotondo, Foggia, Italy
| | - Antonio Arauz
- Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Donatella Colaizzo
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Home for the Relief of Suffering, S. Giovanni Rotondo, Foggia, Italy
| | - Kostas Spengos
- Department of Neurology, University of Athens School of Medicine, Eginition Hospital, Athens, Greece
| | - Amanda Hodge
- McMaster University, Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Reina Ditta
- McMaster University, Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Thang S Han
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
- Department of Diabetes and Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, UK
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Location AMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisboa, Portugal
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
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46
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Sandhu M, Hurley S, Ruiz L, Imbert-Mummery J, Nitta S, Stout CS, Lozano JD. Cerebral venous sinus thrombosis manifesting as a spontaneous left tentorial subdural hematoma: A case report. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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47
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Noto R, Creditt A. Looking Beyond the Bleed: A Case Report. Cureus 2023; 15:e36897. [PMID: 37139270 PMCID: PMC10151001 DOI: 10.7759/cureus.36897] [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] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Cerebral venous thrombosis (CVT) can be one of the most challenging diagnoses to make in a patient with an undifferentiated headache. A missed diagnosis of the condition can lead to catastrophic consequences, as seen in the case described here. There needs to be a high index of clinical suspicion for CVT as the diagnosis involves imaging modalities that are not frequently used in the emergency setting. This case report demonstrates how the classic avenues of headache workup can miss this diagnosis. It also illustrates how delayed diagnosis can present in the extremis and have unsalvageable outcomes.
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Affiliation(s)
- Rachel Noto
- Emergency Medicine, Virginia Commonwealth University, Richmond, USA
| | - Angela Creditt
- Emergency Medicine, Virginia Commonwealth University, Richmond, USA
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48
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Venier LM, Clerici B, Bissola AL, Modi D, Jevtic SD, Radford M, Mahamad S, Nazy I, Arnold DM. Unique features of vaccine-induced immune thrombotic thrombocytopenia; a new anti-platelet factor 4 antibody-mediated disorder. Int J Hematol 2023; 117:341-348. [PMID: 36574172 PMCID: PMC9793819 DOI: 10.1007/s12185-022-03516-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a highly prothrombotic disorder caused by anti-PF4 antibodies that activate platelets and neutrophils, leading to thrombosis. Heparin-induced thrombocytopenia (HIT) is a related anti-PF4 mediated disorder, with similar pathophysiology and clinical manifestations but different triggers (i.e., heparin vs adenoviral vector vaccine). Clinically, both HIT and VITT typically present with thrombocytopenia and thrombosis, although the risk of thrombosis is significantly higher in VITT, and the thromboses occur in unusual anatomical sites (e.g., cerebral venous sinus thrombosis and hepatic vein thrombosis). The diagnostic accuracy of available laboratory testing differs between HIT and VITT; for VITT, ELISAs have better specificity compared to HIT and platelet activation assays require the addition of PF4. Treatment of VITT and HIT is anticoagulation non-heparin anticoagulants; however, heparin may be considered for VITT if no other option is available.
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Affiliation(s)
- Laura M Venier
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Bianca Clerici
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
- McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON, L8S 4K1, Canada
| | - Anna-Lise Bissola
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Dimpy Modi
- McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON, L8S 4K1, Canada
| | - Stefan D Jevtic
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Michael Radford
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Syed Mahamad
- McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON, L8S 4K1, Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
- McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON, L8S 4K1, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada.
- McMaster Centre for Transfusion Research, McMaster University, 1280 Main Street West, Room HSC 3H50, Hamilton, ON, L8S 4K1, Canada.
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49
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Ding J, Pan L, Lan D, Chen Z, Wang Z, Zou M, Meng R. Inflammatory Markers Differentiate Cerebral Venous Sinus Thrombosis from Mimics. Thromb Haemost 2023; 123:326-335. [PMID: 36167332 DOI: 10.1055/a-1951-3402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Imaging tests always misdiagnose anatomical variants of cerebral sinuses as cerebral venous sinus thrombosis (CVST). Anatomical variants of cerebral sinuses are called CVST mimics. This study aimed to identify the role of inflammatory markers in differentiating CVST from mimics. A total of 146 patients diagnosed as CVST and 93 patients with mimics were recruited in this study. Receiver operating characteristic (ROC) analysis was performed to demonstrate the sensitivity and specificity of inflammatory markers for diagnosing CVST. Rank logistic regression analysis was performed to identify the association of markers to CVST severity and prognosis. CVST presented higher inflammatory reactions compared with mimics, demonstrated by the neutrophil count (5.11 [3.97-6.80] vs. 3.06 [2.34-3.86]), interleukin (IL)-6 (7.42 [3.85-14.22] vs. 2.47 [1.50-4.00]), and neutrophil-to-lymphocyte ratio (NLR; 3.19 [2.18-4.62] vs. 1.66 [1.16-2.22]). ROC analysis showed markers with area under the curve (AUC) >0.8, including IL-6 (optimal cutoff: 3.790; kappa value: 0.499), neutrophil count (3.975; 0.522), and NLR (2.070; 0.476). After propensity score matching, only IL-6 had an AUC >0.8, with an optimal cutoff of 3.060 and a kappa value of 0.636. Ranked logistic regression showed that IL-6 (odds ratio, 95% confidence interval: 1.063, 1.026-1.101; 1.029, 1.009-1.050), cerebrospinal fluid (CSF) immunoglobulin (Ig) A (0.279, 0.110-0.706; 0.398, 0.162-0.974), CSF IgM (22.399, 3.004-167.001; 9.545, 1.382-65.928), and CSF IgG (1.287, 1.124-1.473; 1.232, 1.091-1.392) were independently correlated with the baseline and follow-up mRS. In conclusion, inflammatory markers in CVST were different from those in mimics. These markers, especially IL-6, could not only differentiate CVST from its mimics, but also evaluate CVST severity and prognosis.
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Affiliation(s)
- Jiayue Ding
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Duo Lan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhiying Chen
- Department of Neurology, Jiujiang University Affiliated Hospital, Jiujiang, Jiangxi, People's Republic of China
| | - Zhongao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming Zou
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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50
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Hovi P, Palmu AA, Nieminen TA, Artama M, Jokinen J, Ruokokoski E, Lassila R, Nohynek H, Kilpi T. Incidence of sinus thrombosis with thrombocytopenia-A nation-wide register study. PLoS One 2023; 18:e0282226. [PMID: 36827275 PMCID: PMC9956025 DOI: 10.1371/journal.pone.0282226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Safe vaccination is essential for mitigation of the COVID-19 pandemic. Two adenoviral vector vaccines, ChAdOx1 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson&Johnson/Janssen) have shown to be effective and they are distributed globally, but reports on serious cerebral venous sinus thrombosis (CVST) associated with thrombocytopenia, have emerged. Our objective was to evaluate the background incidence of CVST with thrombocytopenia and to compare it to incidences following COVID-19 vaccines. We conducted a register-based nation-wide cohort study in Finland, including all 5.5 million individuals alive in Finland, 1 Jan 2020. COVID-19 vaccinations registered in the National Vaccination Register served as the exposure. We detected CVST admissions or hospital visits recorded in the hospital discharge register from Jan 1, 2020 through April 2, 2021. We confirmed the diagnosis of CVST and thrombocytopenia (platelet count <150,000 per cubic millimeter) using radiology reports and laboratory data. By Poisson regression, we compared the baseline incidences to the risks within four weeks after COVID-19 vaccinations. Out of the 167 CVST episodes identified in the registers, 117 were confirmed as CVST, 18 of which coincided with thrombocytopenia (baseline incidence 0.18 per 28 days per million persons). We found 2 episodes of CVST with thrombocytopenia within 28 days of the first ChAdOx1 nCov-19 vaccination (among 200,397 vaccinated, aged 16 or above). No cases were found following the first mRNA vaccine dose among 782,604 vaccinated. The background incidence of CVST combined with thrombocytopenia was minuscule compared to the incidence during the weeks following the ChAdOx1 nCov-19 vaccination. Accurate estimation of the baseline incidence is essential in the critical appraisal of the benefit-risk of any vaccination program.
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Affiliation(s)
- Petteri Hovi
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Pediatrics, Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Arto A. Palmu
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuomo A. Nieminen
- Knowledge brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Miia Artama
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Health security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Jokinen
- Knowledge brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Esa Ruokokoski
- Knowledge brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Lassila
- Health security, Finnish Institute for Health and Welfare, Helsinki, Finland
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
- Research Program Unit in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna Nohynek
- Health security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Terhi Kilpi
- Management, Finnish Institute for Health and Welfare, Helsinki, Finland
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