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Omara C, Mammi M, Kvilhaug M, Soni S, Arora H, Yoo H, Smith TR, Mekary RA. Dural Venous Sinus Thrombosis After Vestibular Schwannoma Surgery: Should We Anticoagulate? World Neurosurg 2024:S1878-8750(24)00933-1. [PMID: 38838938 DOI: 10.1016/j.wneu.2024.05.170] [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: 01/22/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of dural venous sinus thrombosis (DVST) following vestibular schwannoma (VS) surgery remains understudied. The diverse clinical presentation complicates forming anticoagulation treatment guidelines. This meta-analysis aimed to investigate the incidence of DVST post-VS surgery and to evaluate the role of anticoagulation. METHODS A systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, was conducted. Studies reporting DVST incidence after VS surgery were included. DVST incidence stratified by detection method was the primary outcome. Adverse events per treatment strategy (anticoagulation or no anticoagulation) were the secondary outcome. Pooled incidence with respective 95% confidence intervals were calculated using the random-effects model via the DerSimonian and Laird method. RESULTS The overall DVST incidence post-VS resection was 15.5% (95% confidence interval: 10.3%, 22.5%; 10 studies). Stratification by detection method revealed 29.4% (19.2%, 42.3%) for magnetic resonance imaging, 8.2% (3.2%, 19.5%) for computed tomography, and 0.7% (0.2%, 2.8%) upon clinical suspicion. The pooled incidence of adverse events was 16.1% (6.4%, 35.0%) for the anticoagulation treatment and 4.4% (1.4%, 12.9%) for no anticoagulation treatment, with one mortality case being among the adverse events in this latter group. CONCLUSIONS DVST after VS surgery is more common than initially perceived, predominantly presenting asymptomatically. Variability in anticoagulation protocols hinders the establishment of definitive therapeutic stances; nevertheless, there is no supporting evidence to promote anticoagulation administration for DVST. This begs the need for further institutional comparative studies with a proper adjustment for confounding and well-defined anticoagulation regimens.
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Affiliation(s)
- Chady Omara
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Marco Mammi
- Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy
| | - Magnar Kvilhaug
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Sahjesh Soni
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Harshit Arora
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Heejeung Yoo
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA.
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2
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Amalia L, Ardo RT. Clinical Significance of D-dimer Level and Numeric Rating Scale with Amount of Sinus Involvement in Cerebral Sinus Thrombosis Patients. Int J Gen Med 2024; 17:2143-2149. [PMID: 38766601 PMCID: PMC11102121 DOI: 10.2147/ijgm.s460407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Cerebral venous sinus thrombosis (CVST) is a cerebral vascular disorder that currently occurs quite often and has very varied clinical symptoms. Headache is the main symptom most commonly found in patients with CVST and multiple sinus involvement often have a more severe prognosis and poor clinical outcome. This study aimed to learn the relationship between D-dimer level, numeric rating scale (NRS), and amount of sinus involvement in CVST patients. Methods This study was a retrospective observational analytic study with a cross-sectional approach using medical records and supporting data (D-dimer level and imaging finding) on patients diagnosed with CVST at Dr Hasan Sadikin Hospital Bandung. Results Sixty-five CVST patients met the study criteria with mean age of 47 years and mostly female (76.9%). Patients with single sinus involvement had a median initial NRS of 4 (range 2-6) and multiple sinus involvement was higher at 8 (range 5-9). Statistical test results showed a significant difference between D-dimer level, NRS and amount of sinus involvement (P<0.001). Conclusion D-dimer level, NRS, and amount of sinus involvement are associated with amount of sinus involvement in CVST patients. Involvement of multiple sinus will cause higher NRS with higher D-dimer level.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ryan Tantri Ardo
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
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3
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Rothrock JF. Headache due to Vascular Disorders. Neurol Clin 2024; 42:375-388. [PMID: 38575257 DOI: 10.1016/j.ncl.2023.12.002] [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: 04/06/2024]
Abstract
Headache and cerebrovascular disease (CVD) are inextricably linked. Although in some cases headache complicating CVD may be little more than a symptomatic afterthought, in other cases, early recognition of headache's role in the CVD process is critical to effective management. In other words, headaches secondary to CVD span a spectrum, and in this article, we will review that spectrum.
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Affiliation(s)
- John F Rothrock
- Inova Health/University of Virginia School of Medicine, Migraineur.
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4
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Wan S, Han G, Huang X, Guo Y, Chen J, Zhou D, Wu C, Ji X, Ding Y, Meng R. Dural Arteriovenous Fistulas With or Without Cerebral Venous Thrombosis: A Cross-Sectional Analysis of 511 Patients. Neurosurgery 2024; 94:771-779. [PMID: 37930149 PMCID: PMC10914226 DOI: 10.1227/neu.0000000000002748] [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: 07/27/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies suggest a bidirectional relationship of dural arteriovenous fistula (DAVF) with cerebral venous thrombosis (CVT). We aimed to compare the characteristics of patients with DAVF with or without CVT and to analyze the risk factors for the coexistence of CVT in a DAVF population. METHODS A total of 511 adult patients with DAVF were enrolled consecutively in our hospital from February 2019 through November 2022. Demographic data, clinical manifestations, and imaging characteristics were reviewed in detail. The patients with DAVF were divided into two groups: DAVF with CVT (DAVF-CVT) group and without CVT (DAVF alone) group. Univariate logistic regression and multivariate logistic regression were used to analyze the risk factors for the coexistence of CVT and DAVF. RESULTS CVT was found in 19.8% of patients with DAVF. In univariate analysis, compared with the DAVF-alone group, the DAVF-CVT group was more likely to have tinnitus ( P = .001), blurred vision ( P < .001), visual field loss ( P = .001), focal neurological deficits ( P = .002), seizures ( P = .008), and cognitive impairment ( P = .046) and less likely to have spinal cord/brain stem dysfunction ( P = .004). In addition, there were significant differences in age ( P = .009), sex ( P = .019), the occurrence of venous cerebral infarction ( P = .001), and DAVF location ( P < .001) between the two groups. Furthermore, multivariate analysis showed that blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF were risk factors for the coexistence of CVT in patients with DAVF, with the odds ratio of 2.416 (95% CI 1.267-4.606, P = .007), 6.018 (95% CI 1.289-28.100, P = .022), 5.801 (95% CI 2.494-13.496, P < .001), and 5.640 (95% CI 2.122-14.989, P = .001), respectively. CONCLUSION CVT occurred in approximately one fifth of patients with DAVF. Blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF may be the risk factors for predicting the coexistence of CVT in patients with DAVF.
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Affiliation(s)
- Shuling Wan
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Guangyu Han
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiangqian Huang
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yibing Guo
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Da Zhou
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xunming Ji
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ran Meng
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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Rangarajan SA, Ramachandran D, Mishra T, Gunaseelan V, Dash GK, Philip VJ, Manohar R, Shetty K, Thomas P, Huded V. Endovascular Treatment for Cerebral Venous Sinus Thrombosis: Comparison among Different Endovascular Procedures. Ann Indian Acad Neurol 2024; 27:140-145. [PMID: 38751919 PMCID: PMC11093168 DOI: 10.4103/aian.aian_965_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 05/18/2024] Open
Abstract
Background Cerebral venous sinus thrombosis (CVST) is a rare, treatable cause of stroke. Even though CVST has an established medical treatment, 15% of patients remain refractory to treatment. These patients may be candidates for endovascular treatment (EVT), yet the selection of patients remains a challenge. The study aims to understand the profile and outcome of patients treated with EVT and the type of procedure associated with good outcomes. Methods This is a single-center, retrospective analysis of CVST patients who underwent EVT from 2009 till 2022. Patients who received only medical management were excluded. Modified Rankin Scale (mRS) ≤2 at 3 months was taken as the primary outcome. Secondary outcomes assessed were hospital stay, death, recurrence, mRS ≤ 2 at discharge, and angiographic recanalization. Results Fifty-two patients were included. Twenty-eight (53.8%) were males; the mean age was 33.3 ± 12.3 years. Headache (n = 44, 84.6%) predominated among the symptoms. The common risk factors were anemia (n = 13, 25.5%) and hyperhomocysteinemia (n = 13, 25.5%). Worsening of sensorium (n = 21, 40.3%) and non-improvement of symptoms (n = 15, 28.8%) were the common indications for the procedure. Twenty-five (48.1%) people underwent in situ thrombolysis (IST). Death occurred in eight (15.3%) patients. Thirty-six (73.5%; 36/49) patients had a good outcome at 3 months. IST had a significantly better outcome (mRS ≤ 2, n = 20, 80%) compared to other procedures (P = 0.04). Hospital stay was lesser in the IST subgroup, but without statistical significance. Midline shift >5 mm (odds ratio [OR] 6.8 [1.5-30.9], P = 0.01) and Glasgow Coma Scale <9 before the procedure (OR 27.2 [3.1-236.4], P = 0.002) predicted bad outcomes at 3 months. Female gender (OR 4.5 [1.07-8.8], P = 0.03), presence of altered sensorium (OR 10.2 [1.2-87.5], P = 0.01), encephalopathic syndrome (P = 0.02), presence of parenchymal bleed (OR 3.7 [0.9-4.5], P = 0.04), and midline shift (OR 4.8 [1.1-20.2], P = 0.03) were associated with poor outcome at discharge. Conclusion EVT yielded good outcomes in carefully selected, medically refractory patients of CVST. IST performed well compared to other procedures.
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Affiliation(s)
- S Anush Rangarajan
- Department of Interventional Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Dileep Ramachandran
- Department of Interventional Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Tanaya Mishra
- Department of Interventional Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | | | - Gopal K. Dash
- Department of Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Vivek J. Philip
- Department of Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Radhika Manohar
- Department of Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Kuldeep Shetty
- Department of Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Pavin Thomas
- Department of Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Vikram Huded
- Department of Interventional Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
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6
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Ding R, Cheng J, Wei S, Qin X, Liu Y, Li H, Xie T, Chai H, Chen Z. Sequential transcriptomic alterations in the cerebral cortex of mice after cerebral venous sinus thrombosis. J Proteomics 2024; 291:105035. [PMID: 37918797 DOI: 10.1016/j.jprot.2023.105035] [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: 07/25/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
To investigate the expression alterations of specific genes that occur after venous stroke, we identified differentially expressed genes (DEGs) between sham and damaged cortical tissues at 2 and 7 days after induction of cerebral venous sinus thrombosis (CVST) model. The profiles of DEGs were analyzed using GO, KEGG, GSEA, and PPI, and the crucial gene was further verified by western blot and immunofluorescence. We found 969 and 883 DEGs at 2 and 7 days after CVST, respectively. A marked increase in biological-process categories, such as immune system process and inflammatory response, and a decrease in neuropeptide signaling pathway were observed both at 2 and 7 days post-CVST. The KEGG pathway was enriched to varying degrees on complement and coagulation cascades, cytokine-cytokine receptor interaction, and multiple immune-inflammatory signaling pathways at 2 and 7 days post-CVST, separately. Furthermore, GSEA highlights the potential roles of the NOD-like receptor signaling pathway and cytokine-cytokine receptor interaction in CVST. Importantly, numerous genes related to KEGG pathways above featured prominently in the PPI network analysis, with IL1b being one of the most conspicuous. These time-dependent alterations in gene profiles and enrichment pathways reveal the unique pathophysiological characteristics of CVST and indicate novel therapeutic targets for venous stroke. SIGNIFICANCE: Cerebral venous sinus thrombosis (CVST) is an underrated and potentially fatal cause of stroke with a reported mortality of 5-10% worldwide. Currently, in addition to anticoagulant and thrombolytic therapy, effective treatments targeting the injured brain parenchyma after CVST remain limited. Besides, accurate diagnostic markers are still sorely lacking. In the present study, we will detect the transcriptomic alterations of the cerebral cortex of mice post-CVST by RNA-sequencing, screen differentially expressed genes and abnormal pathways through bioinformatics methods, analyze the correlation of these signals and CVST pathology, and finally validate the key molecules through western blot and immunofluorescence assays. Collectively, the study aimed to offer a reference for the discovery of specific genes/pathway alterations in the damaged cortical tissues of CVST mice and further reveal the underlying pathogenesis, thereby providing evidence for the diagnosis and treatment of CVST.
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Affiliation(s)
- Rui Ding
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jing Cheng
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Shanshan Wei
- Department of Oncology, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430063, China
| | - Xiaohong Qin
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yaqi Liu
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Haiyan Li
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Teng Xie
- Department of Neurosurgery, Hanchuan Renmin Hospital, Hanchuan, Hubei 431600, China
| | - Huihui Chai
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China; Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Laboratory for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Laboratory of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai 200040, China.
| | - Zhibiao Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China.
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7
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Katwal S, Suwal S, Lamichhane S, Bhusal A, Yogi TN. Cerebral venous sinus thrombosis with hemorrhagic infarct: A rare presentation in a risk-defying male patient. Radiol Case Rep 2024; 19:153-157. [PMID: 37954677 PMCID: PMC10632245 DOI: 10.1016/j.radcr.2023.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 11/14/2023] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare but critical cerebrovascular condition characterized by clot formation in cerebral veins or sinuses. We present a case of a 30-year-old male with CVST, an atypical presentation of right-sided weakness and sudden loss of consciousness. While CVST typically manifests as severe headaches and neurological deficits, our patient's unique symptoms pose diagnostic challenges. Advanced imaging techniques, including MRI with venography, played a pivotal role in confirming the diagnosis. Treatment involved anticoagulation therapy and resulted in a favorable outcome. This case highlights the importance of considering CVST in patients with unusual neurological symptoms and the crucial role of early diagnosis and intervention. Advances in diagnostic modalities and treatment options have significantly improved outcomes in CVST patients, emphasizing the need for timely recognition and management.
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Affiliation(s)
- Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Sudurpaschim, Nepal
| | - Sundar Suwal
- Department of Radiology, Maharajgunj Medical College, Kathmandu, Nepal
| | - Suman Lamichhane
- Department of Radiology, Nepal A.P.F. Hospital, Kathmandu, Nepal
| | - Amrit Bhusal
- Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Tek Nath Yogi
- Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Samridhi, Setia A, Mehata AK, Priya V, Pradhan A, Prasanna P, Mohan S, Muthu MS. Nanoparticles for Thrombus Diagnosis and Therapy: Emerging Trends in Thrombus-theranostics. Nanotheranostics 2024; 8:127-149. [PMID: 38328614 PMCID: PMC10845253 DOI: 10.7150/ntno.92184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/09/2023] [Indexed: 02/09/2024] Open
Abstract
Cardiovascular disease is one of the chief factors that cause ischemic stroke, myocardial infarction, and venous thromboembolism. The elements that speed up thrombosis include nutritional consumption, physical activity, and oxidative stress. Even though the precise etiology and pathophysiology remain difficult topics that primarily rely on traditional medicine. The diagnosis and management of thrombosis are being developed using discrete non-invasive and non-surgical approaches. One of the emerging promising approach is ultrasound and photoacoustic imaging. The advancement of nanomedicines offers concentrated therapy and diagnosis, imparting efficacy and fewer side effects which is more significant than conventional medicine. This study addresses the potential of nanomedicines as theranostic agents for the treatment of thrombosis. In this article, we describe the factors that lead to thrombosis and its consequences, as well as summarize the findings of studies on thrombus formation in preclinical and clinical models and also provide insights on nanoparticles for thrombus imaging and therapy.
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Affiliation(s)
- Samridhi
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi-221005, India
| | - Aseem Setia
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi-221005, India
| | - Abhishesh Kumar Mehata
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi-221005, India
| | - Vishnu Priya
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi-221005, India
| | - Aditi Pradhan
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi-221005, India
| | - Pragya Prasanna
- National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Syam Mohan
- Substance Abuse and Toxicology Research Centre, Jazan University, Jazan 45142, Saudi Arabia
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun 248007, India
| | - Madaswamy S Muthu
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi-221005, India
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9
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Atallah O, Badary A, Almealawy YF, Sanker V, Andrew Awuah W, Abdul-Rahman T, Alrubaye SN, Chaurasia B. Non-colloid-cyst primary brain tumors: A systematic review of unexpected fatality. J Clin Neurosci 2024; 119:129-140. [PMID: 38029695 DOI: 10.1016/j.jocn.2023.11.022] [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: 10/10/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Primary brain tumors have the potential to present a substantial health hazard, ultimately resulting in unforeseen fatalities. Despite the enhanced comprehension of many diseases, the precise prediction of disease progression continues to pose a significant challenge. The objective of this study is to investigate cases of unexpected mortality resulting from primary brain tumors and analyze the variables that contribute to such occurrences. METHODS This systematic review explores research on individuals diagnosed with primary brain tumors who experienced unexpected deaths. It uses PRISMA standards and searches PubMed, Google Scholar, and Scopus. Variables considered include age, gender, symptoms, tumor type, WHO grade, postmortem findings, time of death - time taken from first medical presentation or hospital admission to death, comorbidity, and risk factors. RESULTS This study examined 46 studies to analyze patient-level data from 76 individuals with unexpected deaths attributed to intracranial lesions, deliberately excluding colloid cysts. The cohort's age distribution showed an average age of 37 years, with no significant gender preference. Headache was the most common initial symptom. Astrocytomas, meningiomas, and glioblastoma were the most common lesions, while the frontal lobe, temporal lobe, and cerebellum were common locations. Meningiomas and astrocytomas showed faster deaths within the first hour of hospital admission. CONCLUSION The etiology of unforeseen fatalities resulting from cerebral tumors elucidates an intricate and varied phenomenon. Although unexpected deaths account for a very tiny proportion of total fatalities, it is probable that their actual occurrence is underestimated as a result of underreporting and misdiagnosis.
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Affiliation(s)
- Oday Atallah
- Departemnt of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | | | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Kerala, India
| | | | | | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj ,Nepal.
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10
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Wang C, Xian L, Zheng S, Li J, Chen X, Wang S. Cranial venous-outflow obstruction promotes neuroinflammation via ADAM17/solTNF-α/NF-κB pathway following experimental TBI. Brain Res Bull 2023; 204:110804. [PMID: 37918697 DOI: 10.1016/j.brainresbull.2023.110804] [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: 03/30/2022] [Revised: 09/13/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
Traumatic brain injury (TBI) is a global public health problem. As an important cause of secondary injury, cerebrovascular reaction can cause secondary bleeding, venous sinus thrombosis, and malignant brain swelling. Recent clinical studies have confirmed that intracranial venous return disorder is closely related to the prognosis of patients, yet the specific molecular mechanism involved in this process is still unclear. This study used an acute subdural hematoma (ASDH) model with cranial venous outflow obstruction (CVO) to explore how CVO aggravates the pathological process after TBI, especially for inflammation and tissue damage. The results suggest that intracranial venous return disorder exacerbates neurological deficits and brain edema in rats with ASDH by aggravating the destruction of endothelial cell tight junctions (TJs) proteins and promoting the expression of inflammatory factors, the activation of microglia and expression of recombinant A disintegrin and metalloprotease 17 (ADAM17) as well as the secretion of solTNF-α, a soluble form of tumor necrosis factor-alpha (TNFα), which in turn increase IκB-α ((inhibitor of the transcription factor nuclear factor-κB) and NF-κB p65. Our study revealed a molecular basis of how CVO aggravates inflammation and tissue damage.
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Affiliation(s)
- Cheng Wang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, PR China; Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Liang Xian
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Shaorui Zheng
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, PR China
| | - Jun Li
- Department of Neurosurgery, 900th Hospital, Fuzhou, PR China
| | - Xiangrong Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, PR China.
| | - Shousen Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, PR China; Department of Neurosurgery, 900th Hospital, Fuzhou, PR China.
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11
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Reddy TAV, Seshagiri DV, Reddy HK, Patwardhan AA, Joshi TH, Shukla D, Kulkarni GB, Mustare VK, Ramakrishnan S. Surgical Management of Vision Loss in Cerebral Venous Thrombosis: Case Series from a Tertiary Care Stroke Center. Ann Indian Acad Neurol 2023; 26:733-741. [PMID: 38022466 PMCID: PMC10666845 DOI: 10.4103/aian.aian_121_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Purpose Cerebral venous thrombosis (CVT) presenting as vision loss is uncommon. Raised intracranial tension in CVT is proposed as one of the mechanisms (13.2%). There are still unknown underlying mechanisms to explain vision loss in CVT. The safety and outcome of the surgery (optic nerve sheath fenestration [ONSF] or theco-peritoneal shunt [TPS]) to reduce intracranial hypertension and prevent vision loss has not been studied. Methods A retrospective case record review of CVT patients with impending vision loss who underwent ONSF/TPS from 2007 to 2019 was performed from the stroke registry. All patients had formal neuro-ophthalmological evaluation and documentation of visual acuity, supplemented by visual field assessments by perimetry in a subset of patients. Safety and outcomes were assessed based on vision improvement and adverse effects after the surgery. Results Among approximately 1400 patients with CVT admitted in the stroke ward over 12 years, surgery for rescuing vision was done in 18. Among these, the males were 6, and the females were 12. The mean age of presentation was 24 (range 18-52 years). All of them had headaches and progressive blurring of vision with papilledema. The number of patients who underwent TPS was 13, ONSF was 1, and both were 4. In the TPS group (26 eyes), vision improved in 15 eyes (57.7%), remained status-quo in 8 eyes (30.7%), and worsened in 3 eyes (11.5%). Four patients underwent both surgeries; three eyes improved, two remained status quo, and three worsened. One patient underwent ONSF, and his vision remained status quo (no perception of light). Three patients (17.6%) of the TPS group had minor complications (low-pressure headache, subdural hygroma), and five (29.4%) had major complications like subdural hemorrhage, abdominal wound infection, and meningitis. Conclusion and Implications In patients with CVT, adequate vision monitoring is mandatory. Shunt surgeries (especially TPS) may help in stabilizing/improving vision in CVT patients with impending vision loss, despite adequate anti-edema measures (53.8% improved). Early diagnosis and precise decisions in referring for surgery are crucial.
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Affiliation(s)
- Taallapalli Ashok Vardhan Reddy
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Doniparthi V. Seshagiri
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Haripriya Krishna Reddy
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Ameya A. Patwardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Tarachand H. Joshi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Girish B. Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Veerendra Kumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
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Casanova Rivera MF, Ligua Duque NB, Moreno Veloz EA, Casanova Rivera PS. Cerebral Venous Thrombosis in a 17-Year-Old Female Patient: A Case Report. Cureus 2023; 15:e42384. [PMID: 37621825 PMCID: PMC10446105 DOI: 10.7759/cureus.42384] [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: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare disorder predominantly affecting young women. Clinical presentation is not specific and varies depending on the location of the thrombus. The diagnosis requires clinical suspicion with confirmation by images. Guidelines for treatment recommend heparin during the acute phase even in patients with intraparenchymal hemorrhage. It is associated with a good prognosis when diagnosed and treated promptly. We present a case of CVT and intraparenchymal hemorrhage in a 17-year-old female with severe headache, nausea, vomiting, and altered mental status. The patient was diagnosed with CVT secondary to systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). She showed improvement after anticoagulation and corticosteroids.
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13
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Dinç Y, Ozpar R, Hakyemez B, Bakar M. Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:426-432. [PMID: 37257462 DOI: 10.1055/s-0043-1767822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important. OBJECTIVE This study aims to determine the risk factors for intracranial herniation in patients with CVST. METHODS A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study. RESULTS Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 ± 13.23 and 44.13 ± 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages. CONCLUSION This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy.
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Affiliation(s)
- Yasemin Dinç
- Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye
| | - Rıfat Ozpar
- Uludağ University, Faculty of Medicine, Department of Radiology, Bursa, Türkiye
| | - Bahattin Hakyemez
- Uludağ University, Faculty of Medicine, Department of Radiology, Bursa, Türkiye
| | - Mustafa Bakar
- Uludağ University, Faculty of Medicine, Department of Neurology, Bursa, Türkiye
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14
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Wang Y, Zhang G, Ding J. An obvious antinomy, superior sagittal sinus thrombosis in a patient with immune thrombocytopenia: Case report and a review of literatures. Medicine (Baltimore) 2023; 102:e33412. [PMID: 37000101 PMCID: PMC10063276 DOI: 10.1097/md.0000000000033412] [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: 01/07/2023] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
RATIONALE Immune thrombocytopenia (ITP) is an autoimmune disease with an increased risk of bleeding. However, in recent years, it has been reported that patients with this hemorrhagic disease have the risk of thrombosis and embolism. PATIENT CONCERNS AND DIAGNOSIS The patient, in this case, was a young female who was diagnosed with ITP. When the platelet count was low, she had skin, mucosa, internal organs, and intracranial hemorrhage. In the process of ITP and hemostatic treatment, superior sagittal sinus thrombosis occurred when she was still bleeding. INTERVENTIONS She was given treatments for reducing intracranial pressure and controlling epilepsy. OUTCOMES And then the embolectomy operation failed. It was suggested in this case that ITP patients with severe thrombocytopenia and bleeding tendency also have a risk of having thrombotic disease. We reviewed literatures regarding the mechanism of the simultaneous occurrence of 2 antinomy diseases and cerebral venous thrombosis. LESSONS There are many factors for ITP patients to have thrombosis involving ITP itself, its treatment and the patients' constitution, medical history, and former medication. ITP is not only a hemorrhagic disease but also a thrombotic disease. Clinicians should be alert to the risk of thrombotic diseases in ITP treatment. Therefore thrombus monitoring and screening should be carried out, and early prevention or appropriate anticoagulant treatment should be selected, especially for patients with high risk.
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Affiliation(s)
- Yuhui Wang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ge Zhang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinggang Ding
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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15
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Elfil M, Aladawi M, Balian D, Fahad I, Zhou DJ, Villafuerte-Trisolini B, Diesing TS. Cerebral venous sinus thrombosis after COVID-19 vaccination: a case report and literature review. Oxf Med Case Reports 2023; 2023:omac154. [PMID: 36694608 PMCID: PMC9853928 DOI: 10.1093/omcr/omac154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023] Open
Abstract
As COVID-19 vaccines became widely available, there have been reports of neurovascular complications. In this article, we aim to report a case of cerebral venous sinus thrombosis (CVST) induced by COVID-19 vaccination, with a literature review on similar cases as well as the potential pathophysiological mechanisms. Our case is a healthy male who developed headache, vomiting, photophobia and diplopia after receiving the Ad26.COV2.S vaccine. Fundus examination showed papilledema, and magnetic resonance imaging of the brain and cerebral veins showed CVST involving the superior sagittal sinus and right transverse sinus extending into the right jugular vein. Hypercoagulability workup was unremarkable, and the patient received immunotherapy and anticoagulation. Following this treatment, symptoms resolved, and he had no residual neurologic deficits. Developing neurologic manifestations, especially severe headaches with papilledema, after COVID-19 vaccination should warrant neuroimaging. Early recognition and management of CVST are essential for good clinical outcomes.
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Affiliation(s)
- Mohamed Elfil
- Correspondence address. Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, USA. Tel: 402-559-4496; E-mails: ;
| | | | - Dmitry Balian
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ismail Fahad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Thomas Scott Diesing
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
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16
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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] [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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17
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Gollamudi J, Sartain SE, Navaei AH, Aneja S, Kaur Dhawan P, Tran D, Joshi J, Gidudu J, Gollamudi J, Chiappini E, Varricchio F, Law B, Munoz FM. Thrombosis and thromboembolism: Brighton collaboration case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:6431-6444. [PMID: 36150973 DOI: 10.1016/j.vaccine.2022.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.
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Affiliation(s)
- Jahnavi Gollamudi
- Department of Medicine, Section of Hematology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Amir Hassan Navaei
- Pediatric Critical Care, Transfusion Medicine & Coagulation, Pediatrics and Pathology & Immunology Departments, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite WB110, Houston 77021, TX, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | | | - Dat Tran
- Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention Section, Portland, OR, USA
| | - Jyoti Joshi
- International Centre for Antimicrobial Resistance Solutions (ICARS), Orestads Boulevard 5, 2300 Copenhagen, Denmark
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | | | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Vancouver, BC, Canada
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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18
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Zhou Y, Jiang H, Wei H, Liu L, Zhou C, Ji X. Venous stroke–a stroke subtype that should not be ignored. Front Neurol 2022; 13:1019671. [PMID: 36277910 PMCID: PMC9582250 DOI: 10.3389/fneur.2022.1019671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Based on the etiology, stroke can be classified into ischemic or hemorrhagic subtypes, which ranks second among the leading causes of death. Stroke is caused not only by arterial thrombosis but also by cerebral venous thrombosis. Arterial stroke is currently the main subtype of stroke, and research on this type has gradually improved. Venous thrombosis, the particular type, accounts for 0.5–1% of all strokes. Due to the lack of a full understanding of venous thrombosis, as well as its diverse clinical manifestations and neuroimaging features, there are often delays in admission for it, and it is easy to misdiagnose. The purpose of this study was to review the pathophysiology mechanisms and clinical features of arterial and venous thrombosis and to provide guidance for further research on the pathophysiological mechanism, clinical diagnosis, and treatment of venous thrombosis. This review summarizes the pathophysiological mechanisms, etiology, epidemiology, symptomatology, diagnosis, and treatment heterogeneity of venous thrombosis and compares it with arterial stroke. The aim is to provide a reference for a comprehensive understanding of venous thrombosis and a scientific understanding of various pathophysiological mechanisms and clinical features related to venous thrombosis, which will contribute to understanding the pathogenesis of intravenous stroke and provide insight into diagnosis, treatment, and prevention.
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Affiliation(s)
- Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Wei
- School of Engineering Medicine, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Lu Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Chen Zhou
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xunming Ji
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19
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Xiao L, Ji X, Zhao H, Luo Y, Hu S, Zhao T, Hu Z, Duan J. A novel severe cerebral venous thrombosis rat model based on semi-ligation combined with ferric chloride and thrombin. CNS Neurosci Ther 2022; 28:2129-2140. [PMID: 36000206 PMCID: PMC9627376 DOI: 10.1111/cns.13950] [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: 06/02/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
AIMS An applicable cerebral venous sinus thrombosis (CVST) model is imperative for exploring its pathophysiology. We established a novel severe CVST model using semi-ligation, ferric chloride, and thrombin. METHODS A total of 138 male Sprague-Dawley rats were randomly divided into semi-ligation (n = 75) and non-semi-ligation (n = 63) groups. A sham group (n = 46) was also included. We compared short-term and long-term neurological and cognitive dysfunction, mortality rates, thrombus load, venous infarction volume, the blood-brain barrier permeability, brain water content, and microglia activation among the three groups. RESULTS Thrombi involving multiple venous sinuses appeared in all semi-ligation rats within 2 days postoperatively. Compared with the non-semi-ligation group, short-term and long-term neurological dysfunction were more severe (p < 0.05), and thrombus weight, venous infarction volumes, and microglia activation were more significant (p < 0.05) in the semi-ligation group. Further, the cognitive function of the semi-ligation group significantly decreased (p < 0.05) on postoperative day 21. Cumulative mortality rates between the semi-ligation and non-semi-ligation groups did not differ significantly. CONCLUSION Semi-ligation combined with ferric chloride and thrombin can produce a severe CVST model with multiple venous sinus involvement, which is suitable for short- and long-term neurological and cognitive dysfunction assessment.
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Affiliation(s)
- Lipo Xiao
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina,Department of NeurologyThe People's Hospital of QingxianCangzhouChina
| | - Xunming Ji
- Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Haiping Zhao
- Cerebrovascular Diseases Research Institute and Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yumin Luo
- Cerebrovascular Diseases Research Institute and Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Shuyuan Hu
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Tingyu Zhao
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Zeliang Hu
- Department of Pathology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jiangang Duan
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
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20
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Zhang S, Li J, Ren J, Xue Z, Qi X, Si Q. Cyclic RGD functionalized PLGA nanoparticles loaded with noncovalent complex of indocyanine green with urokinase for synergistic thrombolysis. Front Bioeng Biotechnol 2022; 10:945531. [PMID: 36032719 PMCID: PMC9399888 DOI: 10.3389/fbioe.2022.945531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Thrombotic diseases have the characteristics of long latency period, rapid onset, and high mortality rate, which seriously threaten people’s life and health. The aim of this research is to fabricate a novel indocyanine green complex of urokinase (ICG@uPA) and employ the amphiphilic PEG-PLGA polymer to deliver the complex as an enzyme-phototherapeutic synergistic thrombolysis platform. The noncovalent indocyanine green (ICG) complex of urokinase (ICG@uPA) was prepared via supramolecular self-assembly and then encapsulated into cRGD decorated polymeric nanoparticles (cRGD-ICG-uPA NPs) by double-emulsion solvent evaporation method. Then the nanoparticles (NPs) were characterized in terms of particle size, optical properties, in vitro release, etc. The targeting and thrombolytic effect of the nanoparticles were studied both in vitro and in vivo. ICG@uPA and cRGD-ICG-uPA NPs displayed significantly higher photostability and laser energy conversion efficiency than free ICG. Concomitantly, the NPs exhibited selective binding affinity to the activated platelets and specific accumulation in the mouse mesenteric vessel thrombus. Significant thrombolysis was achieved in vivo by photo-assisted synergistic therapy with reduced dose and systemic bleeding risk of uPA. Our results prove that the functional PLGA nanoparticle loaded with the ICG@uPA offers a novel option for effective and safe thrombolytic treatment.
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Affiliation(s)
- Sha Zhang
- Department of Geriatric Cardiology, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jinjie Li
- Centre of Sport Nutrition and Health, Zhengzhou University, Zhengzhou, China
| | - Jiefeng Ren
- Department of Geriatric Cardiology, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Zaiyao Xue
- Department of Geriatric Cardiology, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xinlian Qi
- Department of Geriatric Cardiology, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Quanjin Si
- Department of the Third Health Care, Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
- *Correspondence: Quanjin Si,
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21
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Jesuyajolu D, Olukoya O, Moti T. Simultaneous occurrence of subarachnoid hemorrhage and cerebral venous sinus thrombosis: A systematic review of cases. Clin Case Rep 2022; 10:e6200. [PMID: 35937018 PMCID: PMC9347694 DOI: 10.1002/ccr3.6200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/06/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022] Open
Abstract
Although the leading causes of subarachnoid hemorrhage (SAH) are aneurysm rupture and arteriovenous malformations, cerebral venous sinus thrombosis (CVST) can, in rare cases, be associated with SAH. This phenomenon is an uncommon presentation, with less than a hundred cases reported based on our review of the literature. The purpose of this review is to highlight what is known regarding these cases, how they are managed and to highlight the need for further studies that will serve as a basis for the development of a standard management guideline across board. The following databases were searched: PubMed and Ovid Embase. A complementary search of Google Scholar and AJOL was done. Gray literature search was also conducted on the Google search engine for any additional relevant papers. We were able to extract data regarding 33 cases from 29 identified studies. The mean age was 46.6 ± 14.08. 17 (51.5%) of the cases were female, and the female‐to‐male ratio is 1.1:1. Headache was by far the commonest symptom, occurring in 82% of cases followed by seizures in 42% of cases. Four patients (12%) had loss of consciousness while 5 patients (15%) had some form of focal neurologic deficit. Twenty patients had cerebral venous sinus thrombosis in at least two different sinuses. The superior sagittal sinus was the most common location for CVSTs (79%), followed by the transverse sinus (57.5%). Twenty‐nine cases (89%) were managed with anticoagulation alone and one case had a mechanical thrombectomy. We have performed a comprehensive review of cases that had the simultaneous occurrence of SAH and CVST and have identified their peculiarities and the challenges to management. Further research is needed in order to identify a causal relationship and to serve as a basis for the development of a standard management guideline across the board.
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Affiliation(s)
- Damilola Jesuyajolu
- Department of Neurosurgery Association of Future African Neurosurgeons Yaounde Cameroon
| | - Olatomiwa Olukoya
- Department of Neurosurgery Surgery Interest Group of Africa Lagos Nigeria
| | - Terngu Moti
- Department of Neurosurgery Surgery Interest Group of Africa Lagos Nigeria
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22
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Donato UM, Donato S, Galligan A. Case Report of a 13-Year-Old Female With Trauma Secondary to a Fall From a Golf Cart, Found to Have Intraparenchymal & Subarachnoid Hemorrhages With Transverse Sinus Thrombosis. Cureus 2022; 14:e27251. [PMID: 36039220 PMCID: PMC9400923 DOI: 10.7759/cureus.27251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is the occlusion of cerebral veins of the brain secondary to blood clot formation. These can result in increased intracranial pressure, cerebral edema, and may even have fatal consequences such as a stroke. Despite CVSTs being considered a rare pathology, these are said to have an increased incidence in the pediatric population. These individuals with CVST are often asymptomatic causing physicians to often overlook and delay possibly life-saving interventions. The current literature is lacking on CVST examples in the “older” range of the pediatric population, specifically teenagers. Here we present the case of a 13-year-old female with trauma secondary to a fall from a golf cart, who was found to have intraparenchymal and subarachnoid hemorrhages with transverse sinus thrombosis.
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23
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Domingo RA, Ramos-Fresnedo A, Perez-Vega C, Tripathi S, Pullen MW, Martinez JL, Erben YM, Meschia J, Tawk RG. Cerebral venous thrombosis during the COVID-19 Pandemic: A multi-center experience. Clin Neurol Neurosurg 2022; 217:107256. [PMID: 35462303 PMCID: PMC9017058 DOI: 10.1016/j.clineuro.2022.107256] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
Objective To describe the clinical characteristics and outcomes of CVT in patients with history of recent COVID-19 infection or vaccination. Methods We reviewed demographic, clinical, and radiographic characteristics of non-pyrogenic, non-traumatic CVT cases at our multi-center institution between March 2020 and December 2021. Patients were grouped according to their history of recent COVID-19 infection or vaccination into group-I (+COVID-19 association) and group-II (-COVID-19 association). Results Fifty-one patients with CVT were included, of which 14 (27.4%) had a positive COVID-19 association: 10 with infection and 4 with mRNA-COVID-vaccine. Nine patients in group-I had COVID-19 infection or vaccine within 30 days of CVT diagnosis, including 3 patients with active infection at the time of CVT diagnosis. Half of the patients in group-I (n = 7,50.0%) and 32.4% (n = 12) of group-II were male, and mean age was 52.6 years in group-I and 51.4 years in group-II. Fever at presentation was noted in one patient who had active COVID infection (I=1 (7.1%), II= 0 (0%)). Higher rates of comorbidities were observed in group-II: hypertension (I= 2 (14.3%), II= 13 (35.1%)), deep venous thrombosis(I=1(7.1%), II= 10 (27.0%)), pulmonary emboli (I=1(7.1%), II= 8(21.6%)), or stroke(I=0(0%), II= 6(16.4%)). Three patients had thrombocytopenia at the time of CVT diagnosis (5.4%) and most patients (n = 37, 72.5%) were treated medically with anticoagulation. Complication rate during hospitalization was 17.6% (n = 6), and no mortality was noted. Conclusion Twenty-seven percent of CVT patients were associated with COVID-19 infection or vaccination, and the majority presented within 30 days of infection/vaccination.
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Affiliation(s)
- Ricardo A Domingo
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Carlos Perez-Vega
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Shashwat Tripathi
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael W Pullen
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Jaime L Martinez
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Young M Erben
- Neurology Department, Mayo Clinic, Jacksonville, Florida, USA
| | - James Meschia
- Neurology Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Rabih G Tawk
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA.
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24
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Amalia L. The Role of Platelet-Selectin as a Marker of Thrombocyte Aggregation on Cerebral Sinus Venous Thrombosis. J Blood Med 2022; 13:267-274. [PMID: 35642190 PMCID: PMC9148572 DOI: 10.2147/jbm.s356028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
Cerebral sinus venous thrombosis (CVST) is a disease caused by occlusion of intracranial venous structures, including the cerebral sinuses, cortical veins, and the proximal jugular vein. Delay in diagnosis and therapy can lead to complications such as bleeding infarction and even death. Thrombosis that causes CVST is the process of forming a blood clot in a blood vessel. Thrombosis occurs when the balance between thrombogenic factors and the protective mechanisms of thrombogenesis is disturbed. Platelet function abnormalities in CVST cases can be in the form of impaired adhesion function, impaired release or secretion reactions, and impaired aggregation function. Dysfunction and disruption of endothelial structure due to inflammation causes platelet adhesion so that platelets stick together with collagen in endothelial cells. Platelet-selectin is a type 1 transmembrane protein in platelet granules and megakaryocytes and plays a role in mediating interactions between leukocytes and ligands that help the adhesion process of leukocytes and platelets so that they can be used as predictors of thrombosis in patients with CVST.
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Affiliation(s)
- Lisda Amalia
- Department of Neurology, Medical Faculty, Universitas Padjadjaran/RSUP Dr. Hasan Sadikin Bandung, West Java, Indonesia
- Correspondence: Lisda Amalia, Email
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25
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Assessment of Neurological Status in Patients with Cerebrovascular Diseases through the Nursing Outcome Classification: A Methodological Study. NURSING REPORTS 2022; 12:152-163. [PMID: 35324562 PMCID: PMC8948868 DOI: 10.3390/nursrep12010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Nurses play an important role in healthcare, and the Nursing Outcomes Classification is a key tool for the standardization of care. This study aims to validate the nursing outcome “Neurological Status” for patients with cerebrovascular diseases. A methodological study was performed in four phases. In Phase 1, the relevance of the indicators was evaluated by seven specialists and the modified kappa coefficient and content validity index were calculated. In Phase 2, conceptual and operational definitions were formulated. In addition, their content was validated with a focus group in Phase 3. In Phase 4, the results were applied in clinical practice and convergence with the National Institute of Health Stroke Scale was verified. The reliability was measured by Cronbach’s alpha. Of the 22 initial indicators, 6 were excluded. The focus group suggested changes in the definitions and the exclusion of two indicators. In Phase 4, only 13 indicators were validated due to the impossibility of measuring intracranial pressure. A strong correlation between the two scales and agreement among all the indicators were observed. Following the specialists’ review, the nursing outcome was reliable and clinically validated with 13 indicators: consciousness, orientation, language, central motor control, cranial sensory and motor function, spinal sensory and motor function, body temperature, blood pressure, heart rate, eye movement pattern, pupil size, pupil reactivity, and breathing pattern.
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26
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Ayele BA, Abdella RI, Wachamo LZ. Reversible anomia and cerebral venous thrombosis: a case report and review of the literature. J Med Case Rep 2022; 16:56. [PMID: 35148783 PMCID: PMC8840775 DOI: 10.1186/s13256-022-03264-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cerebral venous thrombosis is a rare form of venous stroke with diverse clinical manifestations. Word-finding difficulty (anomia) is rarely reported in patients with cerebral venous thrombosis. Case presentation We report a 30-year-old right-handed Ethiopian female patient, who presented with global headache associated with a new onset word-finding difficulty of 2 weeks duration. The headache was not responsive to over-the-counter medications. She reported blurring of vision and nausea. Two months previously, she gave birth to a dead fetus. On neurological assessment, the patient was fully conscious and oriented, with a Glasgow coma score of 15/15, and cranial nerves, motor, and sensory examinations were unremarkable. Examination of fundus showed grade 2 papilledema bilaterally. Language assessment showed normal fluency, compression, naming, reading, and repetition. Naming was assessed using a 60 second word generating test, which indicated anomia. Brain magnetic resonance imaging showed left temporoparietal ischemia, magnetic resonance venography showed thrombosis of the left transverse, sigmoid sinus, and corresponding cortical veins. She was started on warfarin 5 mg daily for 6 months and showed significant resolution of symptoms, including the anomia. Conclusion The present case describes a young female patient with reversible anomia as a complication of cerebral venous thrombosis. The case also highlights the importance of timely diagnosis and treatment of cerebral venous thrombosis for a benign prognosis.
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Affiliation(s)
- Biniyam A Ayele
- Department of Neurology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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27
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Harrington AM, Brown TA, Simpson JR. Metastatic Cerebral Tumor Thrombus From Renal Cell Carcinoma. Neurohospitalist 2022; 12:426. [PMID: 35419130 PMCID: PMC8995614 DOI: 10.1177/19418744211067973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anthony M. Harrington
- Department of Neurology, University of Colorado Denver School of Medicine, Centennial, CO, USA
| | - Tiffany A. Brown
- Department of Neurology, University of Colorado Denver School of Medicine, Centennial, CO, USA
| | - Jennifer R. Simpson
- Department of Neurology, University of Colorado Denver School of Medicine, Centennial, CO, USA
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28
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Clinical Efficacy of Conventional Heparin Anticoagulation Combined with Apixaban in the Treatment of Patients with Cerebral Venous Thrombosis and Its Effect on Serum D-Dimer and FIB Expression. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2021:4979210. [PMID: 35003321 PMCID: PMC8741378 DOI: 10.1155/2021/4979210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022]
Abstract
Objective The aim of this study was to explore the clinical efficacy of conventional heparin anticoagulation in combination with apixaban in the treatment of patients with cerebral venous thrombosis (CVT) and its influence on serum D-dimer (D-D) and fibrinogen (FIB). Methods One hundred and fifty-seven consecutive CVT patients admitted to our hospital from January 1, 2006, to December 31, 2013, were allocated into two groups according to the different treatment methods, of which 95 cases received standard anticoagulation therapy (standard group (SG)) and the remaining 62 cases were given apixaban therapy (research group (RG)). The curative effects and the changes of coagulation function during the treatment, as well as the incidence of adverse reactions, were analyzed in the two groups. The changes of D-D and FIB levels before treatment and at days 1, 4, and 7 posttreatment were detected. Results In treatment efficacy, RG was superior to SG. No evident difference was observed in the incidence of adverse events or coagulation function between the two groups. At day 1 posttreatment, D-D level was increased largely in both SG and RG, but the increase was much more significant in RG. However, D-D level was decreased gradually with time in both groups, and the reduction was more notable in RG. The FIB level in SG declined gradually with time after treatment and was higher than that in RG at the same time point. In RG, FIB was decreased gradually at day 1 and day 4 posttreatment, and its level at day 7 posttreatment showed no difference compared with that at day 4 posttreatment. Spearman's analysis identified that the higher the D-D level or the lower the FIB level at day 1 posttreatment was, the better the treatment efficacy was. After seven-day treatment, the lower the level of D-D and FIB was, the better the therapeutic effect was. Logistic analysis indicated that age, time of diagnosis, deep vein thrombosis (DVT), Glasgow Coma Scale (GCS) score, infection, Apixaban, D-D, and FIB all independently affect the treatment effect of patients. Conclusions The combined use of Apixaban with heparin is high-performing and safe in the treatment of CVT. The changes of D-D and FIB levels during the treatment are strongly linked to the therapeutic effect, which can be used as plausible evaluation indexes for the efficacy of CVT.
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29
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Fallah Arzpeyma S, Kazemnezhad-Leili E, Rashidi H, Ghorbani-Shirkouhi S, Saberi A. Factors Contributing to Attenuation of Cerebral Venous Sinus in Brain Noncontrast Computed Tomography Scan. Indian J Radiol Imaging 2022; 31:882-887. [PMID: 35136500 PMCID: PMC8817799 DOI: 10.1055/s-0041-1741048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/Aim
In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT.
Material and Methods
Total 1,680 patients were included in this study, and their demographic and laboratory data and brain NCCT were reviewed. In their brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. Data analysis was conducted using the Statistical Package for the Social Sciences version 21.0 software by Kolmogorov-Smirnov, Spearman's correlation coefficient, and multiple linear regression tests. The significance level was considered less than 0.05.
Results
Hematocrit (B = 0.251,
p
< 0.001), hemoglobin (B = 0.533,
p
< 0.001), and creatinine (B = − 0.270,
p
= 0.048) were determined as predictors of attenuation of superior sagittal sinus. For both sigmoid sinuses, hematocrit (
p
< 0.001) and hemoglobin (
p
< 0.001) were determined as positive predictors, and creatinine (
p
< 0.001) and BUN (
p
< 0.002) were determined as negative and positive predictors, respectively.
Conclusion
Hemoglobin, hematocrit, creatinine, and BUN are the main factors that should be considered in the assessment of CVS density on brain NCCT. As with increasing hematocrit and hemoglobin of the subject, the CVS density in NCCT increases, and with increasing creatinine and in some instance decreasing BUN of the subject, the CVS density in NCCT decreases.
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Affiliation(s)
- Sima Fallah Arzpeyma
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad-Leili
- Clinical Statistics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hosna Rashidi
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghorbani-Shirkouhi
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alia Saberi
- Neuroscience Research Center, Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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30
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Picard JM, Schmidt C, Sheth KN, Bösel J. Critical Care of the Patient With Acute Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Yang J, Wang H, Chen Y, Qiu M, Zhang B, Chen Z. Balloon-Assisted Thrombectomy and Intrasinus Urokinase Thrombolysis for Severe Cerebral Venous Sinus Thrombosis. Front Neurol 2021; 12:735540. [PMID: 34867719 PMCID: PMC8636312 DOI: 10.3389/fneur.2021.735540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Current clinical guidelines recommend systemic anticoagulation as the initial treatment for severe cerebral venous sinus thrombosis (CVST). However, anticoagulation alone does not always dissolve large and extensive CVSTs in some patients. Here, we investigated the effectiveness and safety of balloon-assisted thrombectomy and intrasinus urokinase thrombolysis in our retrospective study of a series of 23 patients with CVST. Methods: We reviewed the clinical, radiological, and outcome data of all patients. Complete recanalization was defined as all the occluded sinuses were recanalized on digital subtraction angiography or Contrast-enhanced magnetic resonance venography. Partial recanalization was defined as the complete recanalization of one sinus but persistent occlusion of other sinuses, or partial recanalization of one or more sinuses. The modified Rankin Scale (mRS) was used to represent the clinical outcome. Results: From May 2017 to November 2019, a total of 23 patients were treated with balloon-assisted thrombectomy and intrasinus urokinase thrombolysis. A total of 84 venous sinuses were involved, ≥3 sinuses were involved in 20 (87%) patients. Among them, 21 (91%) patients achieved technical success. Complete and partial recanalization were obtained in 17 (81%) and 4 (19%) patients at 6 months follow-up, respectively. All 21 patients had mRS scores of 0 (18) or 1 (3). Conclusions: Our case series shows that balloon-assisted thrombectomy combined with intrasinus urokinase thrombolysis and activated partial thromboplastin time-regulated systemic anticoagulation is safe and effective in treating severe CVST.
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Affiliation(s)
- Jiansheng Yang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Hongyang Wang
- Department of Ultrasonography, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Minjian Qiu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhicai Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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32
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Lavadi RS, Sandeep BV, Banga MS, Halhalli S, Kishan A. Cerebral venous thrombosis with a catch. Surg Neurol Int 2021; 12:590. [PMID: 34992907 PMCID: PMC8720431 DOI: 10.25259/sni_1021_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Cerebral venous thrombosis (CVT) is a rare entity typically occurring in patients in hypercoagulable states. They can also occur in cases of trauma. The symptoms are nonspecific. Case Description: A 28-year-old male presented to the emergency department with a head injury. During the necessary imaging, it was found that he had a depressed skull fracture and other signs of traumatic brain injury. Unbeknownst to the patient and the patient party, it was also revealed that the patient only had one kidney. Wound debridement and excision of the depressed fracture were performed. A postoperative MRI revealed that the patient had CVT. Conclusion: There should be a high index of suspicion for CVT in case of traumatic head injuries. The surgeon should plan management according to the patient’s comorbidities.
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Affiliation(s)
- Raj Swaroop Lavadi
- Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - B. V. Sandeep
- Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Manpreet Singh Banga
- Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Sangamesh Halhalli
- Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Anantha Kishan
- Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
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33
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Kannarkat GT, Moghekar A. Before and after: lumbar puncture complicated by cerebral venous sinus thrombosis. Neurol Sci 2021; 43:1469-1470. [PMID: 34817730 DOI: 10.1007/s10072-021-05773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- George T Kannarkat
- Department of Neurology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA.
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
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34
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Lee KJ, Kim ST, Lee WH, Lee KS, Paeng SH, Pyo SY. Cerebral Venous Thrombosis Caused by Spontaneous Intracranial Hypotension: A Case Report. Korean J Neurotrauma 2021; 17:174-179. [PMID: 34760830 PMCID: PMC8558020 DOI: 10.13004/kjnt.2021.17.e21] [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: 06/28/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/15/2022] Open
Abstract
This case report presents a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH). The cause and prognosis of CVT can vary; CVT caused by SIH is uncommon and difficult to diagnose and treat. In this case, magnetic resonance imaging myelography showed definite cerebrospinal fluid leakage, and the patient's symptoms did not improve after conventional treatment. Furthermore, subdural hematoma occurred, causing mental deterioration; however, it improved dramatically after the blood patch procedure and burr hole drainage, which was performed after early cessation of anticoagulant therapy.
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Affiliation(s)
- Kyung-Jae Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Sung-Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Won-Hee Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Keun Soo Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Se-young Pyo
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
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35
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van der Bruggen MM, Kremers B, van Oerle R, van Oostenbrugge RJ, Ten Cate H. Potential value of the calibrated automated thrombogram in patients after a cerebral venous sinus thrombosis; an exploratory study. Thromb J 2021; 19:81. [PMID: 34736478 PMCID: PMC8567338 DOI: 10.1186/s12959-021-00335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Cerebral venous sinus thrombosis (CVST) is a relatively rare, but potentially lethal condition. In approximately 15% of the patients, the cause of CVST remains unclear. Conventional clotting tests such as prothrombin time and activated partial thromboplastin time are not sensitive enough to detect prothrombotic conditions nor mild haemostatic abnormalities. The calibrated automated thrombogram (CAT) is a physiological function test that might be able to detect minor aberrations in haemostasis. Therefore, we aimed to detect the presence of a prothrombotic state in patients who endured idiopathic CVST with the CAT assay. Methods Five adult patients with an idiopathic, radiologically proven CVST that had been admitted during the past 3 years were included in this study. The control group consisted of five age/gender matched healthy volunteers. Exclusion criteria were known haematological disorders, malignancy (current/past) or hormonal and anticoagulant therapy recipients. We obtained venous blood samples from all participants following cessation of anticoagulation. Using the CAT assay, we determined lag time, normalized endogenous thrombin potential (ETP), ETP reduction and normalized peak height. In addition, prothrombin concentrations were determined. Results We found no significant differences in lag time (4.7 min [4.5–4.9] vs 5.3 min [3.7–5.7], p = 0.691), normalized ETP (142% [124–148] vs 124% [88–138], p = 0.222), ETP reduction (29% [26–35] vs 28% [24–58], p > 0.999), and normalized peak height (155% [153–175] vs 137 [94–154], p = 0.056) between patients and their age/gender matched controls. In addition, prothrombin concentrations did not significantly differ between patients and controls (120% [105–132] vs 127% [87–139], p > 0.999). Conclusion Reasons for absent overt hypercoagulability within this study population may be the small patient sample, long time since the event (e.g. 3 years) and avoidance of acquired risk factors like oral contraception. Given the fact that CVST is a serious condition with a more than negligible risk of venous thrombosis event recurrence, exclusion of clinically relevant hypercoagulability remains a challenging topic to further study at the acute and later time points, particularly in patients with idiopathic CVST.
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Affiliation(s)
- Myrthe M van der Bruggen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bram Kremers
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Rene van Oerle
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.,Clinical Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Hugo Ten Cate
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands. .,Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
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Ken-Dror G, Cotlarciuc I, Martinelli I, Grandone E, Hiltunen S, Lindgren E, Margaglione M, Duchez VLC, Triquenot AB, Zedde M, Mancuso M, Ruigrok YM, Marjot T, Worrall B, Majersik JJ, Metso TM, Putaala J, Haapaniemi E, Zuurbier SM, Brouwer MC, Passamonti SM, Abbattista M, Bucciarelli P, Mitchell BD, Kittner SJ, Lemmens R, Jern C, Pappalardo E, Costa P, Colombi M, Aguiar de Sousa D, Rodrigues S, Canhão P, Tkach A, Santacroce R, Favuzzi G, Arauz A, Colaizzo D, Spengos K, Hodge A, Ditta R, Pezzini A, Debette S, Coutinho JM, Thijs V, Jood K, Pare G, Tatlisumak T, Ferro JM, Sharma P. Genome-Wide Association Study Identifies First Locus Associated with Susceptibility to Cerebral Venous Thrombosis. Ann Neurol 2021; 90:777-788. [PMID: 34459509 PMCID: PMC8666091 DOI: 10.1002/ana.26205] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cerebral venous thrombosis (CVT) is an uncommon form of stroke affecting mostly young individuals. Although genetic factors are thought to play a role in this cerebrovascular condition, its genetic etiology is not well understood. METHODS A genome-wide association study was performed to identify genetic variants influencing susceptibility to CVT. A 2-stage genome-wide study was undertaken in 882 Europeans diagnosed with CVT and 1,205 ethnicity-matched control subjects divided into discovery and independent replication datasets. RESULTS In the overall case-control cohort, we identified highly significant associations with 37 single nucleotide polymorphisms (SNPs) within the 9q34.2 region. The strongest association was with rs8176645 (combined p = 9.15 × 10-24 ; odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.76-2.31). The discovery set findings were validated across an independent European cohort. Genetic risk score for this 9q34.2 region increases CVT risk by a pooled estimate OR = 2.65 (95% CI = 2.21-3.20, p = 2.00 × 10-16 ). SNPs within this region were in strong linkage disequilibrium (LD) with coding regions of the ABO gene. The ABO blood group was determined using allele combination of SNPs rs8176746 and rs8176645. Blood groups A, B, or AB, were at 2.85 times (95% CI = 2.32-3.52, p = 2.00 × 10-16 ) increased risk of CVT compared with individuals with blood group O. INTERPRETATION We present the first chromosomal region to robustly associate with a genetic susceptibility to CVT. This region more than doubles the likelihood of CVT, a risk greater than any previously identified thrombophilia genetic risk marker. That the identified variant is in strong LD with the coding region of the ABO gene with differences in blood group prevalence provides important new insights into the pathophysiology of CVT. ANN NEUROL 2021;90:777-788.
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Affiliation(s)
- Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Ioana Cotlarciuc
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
- Ob/Gyn Dept. The First I.M. Sechenov Moscow State Medical University
| | - Sini Hiltunen
- 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, Dept. of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Veronique Le Cam Duchez
- Normandie University, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular Hemostasis Unit and Inserm CIC-CRB 1404, F 76000 Rouen, France
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Michelangelo Mancuso
- Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Italy
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
| | - Thomas Marjot
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Brad Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | | | - Tiina M. Metso
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Elena Haapaniemi
- 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, the Netherlands
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam Neuroscience, University of Amsterdam, the Netherlands
| | - Serena M. Passamonti
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Abbattista
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Bucciarelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Braxton D. Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Steven J. Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Neurology, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Robin Lemmens
- KU Leuven – University of Leuven, Department of Neurosciences, Experimental Neurology; VIB Center for Brain & Disease Research; University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emanuela Pappalardo
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Costa
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
| | - Marina Colombi
- Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Italy
| | - Diana Aguiar de Sousa
- Department of Neurosciences, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Sofia Rodrigues
- Department of Neurosciences, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Patrícia Canhão
- Department of Neurosciences, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Aleksander Tkach
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Rosa Santacroce
- Medical Genetics, Dept. of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Giovanni Favuzzi
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, 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. Casa Sollievo della Sofferenza, 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, Ontario, Canada
| | - Reina Ditta
- McMaster University, Pathology and Molecular Medicine. Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, Ontario, Canada
| | - Alessandro Pezzini
- Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Italy
| | - Stephanie Debette
- Department of Neurology, Bordeaux University Hospital, Bordeaux University, France
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam Neuroscience, University of Amsterdam, the Netherlands
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, 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
| | - Guillaume Pare
- McMaster University, Pathology and Molecular Medicine. Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences, Ontario, Canada
| | - Turgut Tatlisumak
- 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
- Department of Neurosciences, Hospital de Santa Maria, University of Lisbon, Lisbon, 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
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Li AY, Tong E, Yedavalli VS. A Case-Based Review of Cerebral Venous Infarcts With Perfusion Imaging and Comparison to Arterial Ischemic Stroke. FRONTIERS IN RADIOLOGY 2021; 1:687045. [PMID: 37492169 PMCID: PMC10365275 DOI: 10.3389/fradi.2021.687045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/13/2021] [Indexed: 07/27/2023]
Abstract
Cerebral venous thrombosis (CVT) and cerebral venous infarcts (CVI) are diagnostic dilemmas secondary to their rarity, non-specific symptomatology at presentation, and variable imaging features. Despite its relatively infrequence, CVT is particularly prevalent in the younger adult population and is a potentially life-threatening disease with devastating neurological complications if not addressed in a timely manner. However, when treated promptly, CVT has the potential for a more reversible course and favorable prognosis than arterial ischemic strokes (AIS). The pathophysiology of CVI is distinct from that of AIS and is closely related to its potentially reversible nature. Familiarity with the conventional and variant venous anatomy, as well as the temporal evolution of imaging findings, is crucial in establishing diagnostic confidence. The use of MR perfusion imaging (MRP) and arterial spin-labeling (ASL) can potentially aid in the diagnosis of CVT/CVI via characterization of cerebral blood flow. The presence and extent of a cerebral perfusion deficit on either CT or MRI may play a role in clinical outcomes for patients with CVT, although future larger studies must be performed. This review presents a case-based overview focusing on the classic imaging characteristics of CVT and CVI in conjunction with bolus MRP and ASL findings in the adult population.
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Affiliation(s)
- Anna Y. Li
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Elizabeth Tong
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Vivek S. Yedavalli
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Abstract
PURPOSE OF REVIEW Nontraumatic intracerebral hemorrhage (ICH) is the second most common type of stroke. This article summarizes the basic pathophysiology, classification, and management of ICH and discusses the available evidence on therapy for hematoma, hematoma expansion, and perihematomal edema. RECENT FINDINGS Current available data on potential therapeutic options for ICH are promising, although none of the trials have shown improvement in mortality rate. The literature available on reversal of anticoagulation and antiplatelet agents after an ICH and resumption of these medications is also increasing. SUMMARY ICH continues to have high morbidity and mortality. Advances in therapeutic options to target secondary brain injury from the hematoma, hematoma expansion, and perihematomal edema are increasing. Data on reversal therapy for anticoagulant-associated or antiplatelet-associated ICH and resumption of these medications are evolving.
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Li M, Pan L, Gao X, Hou J, Meng R, Ji X. Low Diastolic Blood Pressure Predicts Good Clinical Outcome in Patients With Cerebral Venous Thrombosis. Front Neurol 2021; 12:649573. [PMID: 34566828 PMCID: PMC8458896 DOI: 10.3389/fneur.2021.649573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Cerebral venous thrombosis (CVT) refers to a stroke subtype characterized by the disturbance of cerebral venous outflow caused by venous thrombosis. Previous studies have reported a range of factors that predict the prognosis of CVT. This study is aimed to find out whether systolic blood pressure (SBP) and diastolic blood pressure (DBP) are suitable as potential indicators of the severity and clinical outcome in CVT patients. Methods: The CVT patients admitted to Xuanwu Hospital from January 2014 to December 2019 were enrolled. The severity of CVT was assessed by the National Institute of Health Stroke Scale (NIHSS) and intracranial pressure (ICP) at the time of admission. The modified Rankin score (mRS) was assessed at 6 months of follow-up. Results: One hundred fifty-six CVT patients were enrolled with a mean age of 35.8 ± 12.8 years. A percentage of 55.8% of the CVT patients recruited were female, and 17.3% were either pregnant or in perinatal period. Headache was the most common symptom. SBP and DBP were not correlated with NIHSS at admission. Furthermore, SBP and DBP had no impact on the disturbance of consciousness, epilepsy, intracranial hemorrhage, and mental disorders. However, SBP and DBP were positively correlated with ICP at admission. SBP > 129.5 mmHg and/or DBP > 77.5 mmHg suggested the presence of intracranial hypertension (IH). Based on current results, SBP was not correlated with mRS at 6 months of follow-up. However, DBP was found to be positively correlated with mRS at 6 months of follow-up. DBP in CVT patients with good prognosis was significantly lower than in those with poor prognosis. DBP > 79.5 mmHg was identified as a cutoff value to predict a poor clinical outcome. A higher mRS and a higher rate of poor clinical outcome were found in CVT patients with SBP > 146 mmHg or DBP > 79.5 mmHg compared to those with SBP ≤ 146 mmHg or DBP ≤ 79.5 mmHg. Conclusion: SBP > 129.5 mmHg and DBP > 77.5 mmHg suggested the presence of IH in CVT patients. DBP > 79.5 mmHg predicted a poor clinical outcome.
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Affiliation(s)
- Min Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaogang Gao
- Department of Medicine, Tianjin Huanhu Hospital, Tianjin, China
| | - Jiaojiao Hou
- Department of Neurology, Rongcheng City People's Hospital, Baoding, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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40
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Anvekar P, Lohana P, Kalaiger AM, Ali SR, Galinde RS. The Unfamiliar Case of COVID-19 Induced Cerebral Venous Sinus Thrombosis in a Pediatric Patient. Cureus 2021; 13:e17209. [PMID: 34540436 PMCID: PMC8442808 DOI: 10.7759/cureus.17209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/28/2022] Open
Abstract
The SARS-CoV-2 virus responsible for COVID-19 infection has affected the world from the end of 2019 with pulmonary and extrapulmonary manifestations. Hematologic complications are a rare but severe complication of the COVID-19 infection. There have been very few cases reported in the past showing thrombotic complications in the pediatric age group. We present a case of a 12-year-old male child showing cerebral venous sinus thrombosis (CVST) who tested positive for COVID-19 at the same time. We highlight the potential of this complication in the pediatric age group and discuss the treatment, which is an infrequent phenomenon.
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Affiliation(s)
- Priyanka Anvekar
- Medicine and Surgery, MGM Medical College and Hospital, Mumbai, IND
| | - Petras Lohana
- Internal Medicine, Liaquat University of Medical and Health Sciences Hospital, Karachi, PAK
| | | | - Syed R Ali
- Internal Medicine, Civil Hospital, Dow University of Health Sciences, Karachi, PAK
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Petrović J, Švabić T, Zidverc-Trajković J, Stanarčević P, Jovanović D, Mijajlović M. Cerebral venous thrombosis: a retrospective unicentric analysis of clinical and neuroimaging characteristics. Neurol Sci 2021; 43:1839-1847. [PMID: 34347215 DOI: 10.1007/s10072-021-05514-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/18/2021] [Indexed: 01/30/2023]
Abstract
Thrombosis of dural sinuses and/or cerebral veins (CVT) is an uncommon form of stroke, usually affecting young individuals. It has a variable clinical presentation ranging from mild cases presenting only headaches, to severe cases featuring encephalopathy, coma or status epilepticus. A retrospective cross-sectional study of patients treated in the outpatient department and in-hospital during the period from 2014 to 2020 at the Neurology Clinic-University Clinical Centre of Serbia was conducted. Forty-nine patients (24 men; 25 women) were included in the study. Twenty-three patients (46.9%) suffered a subacute form of CVT (48 h-4 weeks), 19 (38.8%) presented with an acute form (< 48 h) and 7 (14.3%) with a chronic form (> 4 weeks). Around 75% of patients reported headaches during disease course. Focal neurological deficit (FND) was observed in 27 (55.1%) patients. Patients who did not report headaches (22.4%) presented with more severe symptoms (seizures and coma). More than 70% of patients had no radiologically evident brain parenchymal lesion. The most frequent locations of CVT were transverse sinus (79.6%), sigmoid sinus (44.9%) and superior sagittal sinus (36.7%). Thrombosis of more than one sinus/vein occurred in 33 (67.3%) patients. Hereditary thrombophilia was observed in 9 (18.4%) patients, 11 (22.4%) patients had some type of infection and 20% of women reported OCT usage. As much as 25% of cases remained without evident risk factors. The most common symptom in our cohort was acute unilateral throbbing headache of high intensity, while patients without headaches had more severe symptoms.
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Affiliation(s)
- Jovan Petrović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Švabić
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jasna Zidverc-Trajković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Dejana Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milija Mijajlović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia.
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Liu L, Xing Y, Chen Y, Ji X, Ge J, Wang L. Eye-Neck Integrated Ultrasound in Idiopathic Intracranial Hypertension and Cerebral Venous Sinus Thrombosis. Front Neurol 2021; 12:696665. [PMID: 34354665 PMCID: PMC8334180 DOI: 10.3389/fneur.2021.696665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical presentation of cerebral venous sinus thrombosis (CVST) overlaps with that of idiopathic intracranial hypertension (IIH), but no screening tool exists. We investigated the role of eye-neck integrated ultrasound in the diagnosis and differentiation of IIH and CVST. Methods: Twenty IIH patients, 30 CVST patients, and 40 healthy controls were retrospectively analyzed. The ultrasonographic optic nerve sheath diameter (ONSD) and hemodynamic characteristics of the internal jugular veins (IJVs) were recorded. The cerebrospinal fluid opening pressure was measured after ultrasonic examination. Results: The ONSD was significantly larger in IIH patients than in controls (4.71 ± 0.41 vs. 3.93 ± 0.24 mm, p < 0.001). The ONSD cut-off for IIH diagnosis was 4.25 mm (AUC = 0.978; 95% CI: 0.95–1.0, p < 0.001, sensitivity: 90%, specificity: 93%). In the CVST group, 22 (73.3%) patients had elevated intracranial pressure (ICP); the mean ONSD was significantly higher in patients with increased ICP than in those without (4.43 ± 0.33 vs. 3.95 ± 0.17 mm, p < 0.001). The mean blood flow volume (BFV) was significantly reduced in CVST patients (425.17 ± 349.83 mL/min) compared to that in controls (680.37 ± 233.03 mL/min, p < 0.001) and IIH patients (617.67 ± 282.96 mL/min, p = 0.008). The optimal BFV cut-off for predicting CVST was 527.28 mL/min (AUC = 0.804, 95% CI: 0.68–0.93, p < 0.001, sensitivity: 80%, specificity: 78%). The velocity of the unilateral IJVs-J3 segment decreased or remained constant during deep inspiration (abnormal respiratory modulate blood flow test, ARMT) in 32.5% of controls, with no bilateral ARMT. The prevalence of bilateral ARMT was 25% in IIH patients (χ2 = 12.9, p = 0.005) and 27% in CVST patients (χ2 = 17.6, p = 0.001). Conclusion: Eye-neck integrated ultrasound is an easily available bedside technique to assess ICP and hemodynamic characteristics of IJVs. ONSD measurement can identify patients with increased ICP, and reduced IJV BFV may aid the differentiation of CVST and IIH.
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Affiliation(s)
- Li Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neurology, Changchun People's Hospital, Changchun, China
| | - Yingqi Xing
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xiaorui Ji
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jiaojiao Ge
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Lijuan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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Khorvash F, Farajpour-Khanaposhtani MJ, Hemasian H, Saadatnia SM. Evaluation of rivaroxaban versus warfarin for the treatment of cerebral vein thrombosis: A case-control blinded study. CURRENT JOURNAL OF NEUROLOGY 2021; 20:125-130. [PMID: 38011461 PMCID: PMC8984779 DOI: 10.18502/cjn.v20i3.7687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022]
Abstract
Background: Anticoagulation therapy following cerebral vein thrombosis (CVT) can improve mortality and morbidity. Vitamin K antagonists are currently the routine oral anticoagulant used for CVT; while by introduction of rivaroxaban, a direct factor Xa inhibitor, the attentions have been deviated toward novel agents, but the evidence is not strong. The current study is aimed to compare the efficacy and safety of rivaroxaban versus warfarin for anticoagulation therapy of CVT. Methods: The current randomized clinical trial has been conducted on 50 patients with CVT among which, 25 ones were randomly allocated to rivaroxaban treatment (20 mg per day for three months) and remained 25 ones to warfarin treatment [adjusted based on international normalized ratio (INR) of 2-3]. The Modified Rankin Scale (mRS) and clinical investigations, including the incidence of seizure, papilledema, intra/extra-cranial bleeding, blurred vision, headache, nausea and vomiting, and death were evaluated at discharge time and within 3 and 6 months following CVT incidence; eventually, two groups were compared. Results: Comparison of mRS scores between the groups revealed significant differences in none of the interval assessments, at the time of admission (P = 0.510), within three months (P = 0.630), and within six months (P = 0.990), while both of the approaches led to significant decrease in mRS scores following both of the treatments (P < 0.001). The comparison of drug-related adverse effects showed insignificant difference between warfarin versus rivaroxaban (P > 0.050). Conclusion: Based on this study, rivaroxaban is an efficacious agent for the treatment of CVT without remarkable adverse effects.
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Affiliation(s)
- Fariborz Khorvash
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Helia Hemasian
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Wu Z, Feng Q, Liu M, Li J, Sun X, Shi Q, Zhan Y, Dan W, Yang B, Zheng D, Xia Y, Xie Y, Jiang L. Artery and venous sinus occlusion image score (AVOIS): A novel method to evaluate occlusive cerebral arteries and venous diseases. CNS Neurosci Ther 2021; 27:1077-1084. [PMID: 34145753 PMCID: PMC8339536 DOI: 10.1111/cns.13689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/04/2021] [Accepted: 05/15/2021] [Indexed: 12/01/2022] Open
Abstract
AIM To establish an artery and venous sinus occlusion image score (AVOIS) which is compatible in both cerebral arteries and venous system diseases. METHODS A total of 188 consecutive patients with the final diagnosis of anterior circulation infarct (ACI) and 56 consecutive patients with cerebral venous and sinus thrombosis (CVST) were retrospectively studied. The AVOIS was developed based on the severity of occlusive changes of main intracranial arteries and venous sinuses (present = 0, partial occlusion = 1, absent = 2), and divided into four groups (CVST group: 0, 1-5, 6-10, >10. ACI group: 0, 1-5, 6-10, >10) arbitrarily. A receiver operating characteristic (ROC) curve was applied to discover the sensitivity and specificity of AVOIS. The National Institutes of Health Stroke Scale (NIHSS), Clot Burden Score (CBS) were set as the reference. Logistic regression models were developed to adjust for baseline clinical variables and AVOIS. Length of hospital stay (LOS) was also evaluated using the Kaplan-Meier estimator. RESULTS For the CVST group, a positive correlation between AVOIS and NIHSS was discovered (Spearman's ρ = 0.54, p < 0.001). For the ACI group, ROC showed relatively high sensitivity (84.8%) and specificity (81.8%). Besides, the probability of time to discharge was significantly different among the AVOIS subgroups as well (p < 0.001). CONCLUSION The AVOIS can be used to evaluate the treatment of patients with acute stroke caused by cerebral venous sinus thrombosis and anterior circulation large vessel occlusion. It is a reliable and convenient method that may help prompt prognosis and guide the treatment of individual patients.
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Affiliation(s)
- Zhimin Wu
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Qinglin Feng
- Department of NeurosurgeryChongqing University Three Gorges HospitalChongqingChina
| | - Mengqi Liu
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jie Li
- Institution of Intelligent Technology and EngineeringChongqing University of Science and TechnologyChongqingChina
| | - Xiaochuan Sun
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Quanhong Shi
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yan Zhan
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Wei Dan
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Bocheng Yang
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Dinghao Zheng
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yulong Xia
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yanfeng Xie
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Li Jiang
- Department of NeurosurgeryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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45
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Kim IS, Hwang CW, Yang WS, Kim CH. Current Perspectives on the Physiological Activities of Fermented Soybean-Derived Cheonggukjang. Int J Mol Sci 2021; 22:5746. [PMID: 34072216 PMCID: PMC8198423 DOI: 10.3390/ijms22115746] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/11/2022] Open
Abstract
Cheonggukjang (CGJ, fermented soybean paste), a traditional Korean fermented dish, has recently emerged as a functional food that improves blood circulation and intestinal regulation. Considering that excessive consumption of refined salt is associated with increased incidence of gastric cancer, high blood pressure, and stroke in Koreans, consuming CGJ may be desirable, as it can be made without salt, unlike other pastes. Soybeans in CGJ are fermented by Bacillus strains (B. subtilis or B. licheniformis), Lactobacillus spp., Leuconostoc spp., and Enterococcus faecium, which weaken the activity of putrefactive bacteria in the intestines, act as antibacterial agents against pathogens, and facilitate the excretion of harmful substances. Studies on CGJ have either focused on improving product quality or evaluating the bioactive substances contained in CGJ. The fermentation process of CGJ results in the production of enzymes and various physiologically active substances that are not found in raw soybeans, including dietary fiber, phospholipids, isoflavones (e.g., genistein and daidzein), phenolic acids, saponins, trypsin inhibitors, and phytic acids. These components prevent atherosclerosis, oxidative stress-mediated heart disease and inflammation, obesity, diabetes, senile dementia, cancer (e.g., breast and lung), and osteoporosis. They have also been shown to have thrombolytic, blood pressure-lowering, lipid-lowering, antimutagenic, immunostimulatory, anti-allergic, antibacterial, anti-atopic dermatitis, anti-androgenetic alopecia, and anti-asthmatic activities, as well as skin improvement properties. In this review, we examined the physiological activities of CGJ and confirmed its potential as a functional food.
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Affiliation(s)
- Il-Sup Kim
- Advanced Bio-Resource Research Center, Kyungpook National University, Daegu 41566, Korea;
| | - Cher-Won Hwang
- Global Leadership School, Handong Global University, Pohang 37554, Korea
| | | | - Cheorl-Ho Kim
- Molecular and Cellular Glycobiology Unit, Department of Biological Sciences, SungKyunKwan University, Suwon 16419, Korea
- Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 06351, Korea
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46
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Elnahry AG, Talbet JH, El Mahgoub IR, Elnahry GA. Optic Nerve Sheath Fenestration for Papilledema Due to Cerebral Venous Sinus Thrombosis Associated with Antiphospholipid Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930497. [PMID: 34029308 PMCID: PMC8164882 DOI: 10.12659/ajcr.930497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Male, 21-year-old Final Diagnosis: Antiphospholipid antibody syndrome • cerebral venous sinus thrombosis Symptoms: Blurring of vision • confusion • fever • headache Medication: — Clinical Procedure: Laboratory • magnetic resonance imaging Specialty: Neurology • Ophthalmology
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Iman R El Mahgoub
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehad A Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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47
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Abstract
Headache has been consistently reported as the most common symptom of cerebral venous thrombosis and as the most frequent presenting feature. It is often the heralding symptom, preceding other manifestations of the disease by days or even weeks. This aspect highlights the importance of recognizing headache due to cerebral venous thrombosis, as early recognition of the disease can lead to a rapid diagnosis with appropriate imaging techniques and as early treatment with heparin can dramatically change the course of the disease and alter the prognosis. Unfortunately, although common, the headache has no specific features, and the clinical presentation of CVT is highly variable, making the correct diagnosis in the emergency setting a challenging task for clinicians, even in the case of highly specialized ones such as neurologists. In this review, we will briefly summarize the epidemiology and physiopathology of CVT, and then we will discuss in more details the causes, features, and course of headache, focusing on its relevance for differential diagnosis and on red flags that should suggest the possibility of CVT as the cause of the headache.
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48
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Cheng CF, Li KJ. Clinical Images: Cerebral venous sinus thrombosis as one of the initial presentations of systemic lupus erythematous. ACR Open Rheumatol 2021; 3:395. [PMID: 33934573 PMCID: PMC8207691 DOI: 10.1002/acr2.11262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chiao-Feng Cheng
- National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Ko-Jen Li
- National Taiwan University Hospital, Taipei, Taiwan
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49
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Garone G, Ferro V, Barbato M, Vanacore N, Papini L, Pro S, Boni A, Scialanga B, Nacca R, Evangelisti M, Di Nardo G, Parisi P, Raucci U. Acute strabismus in neurological emergencies of childhood: A retrospective, single-centre study. Eur J Paediatr Neurol 2021; 32:80-85. [PMID: 33857732 DOI: 10.1016/j.ejpn.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Acute strabismus (AS) is the most common ocular motility disorder in children. In the emergency setting evaluation, the primary concern is to exclude a potentially dangerous underlying condition, requiring immediate intervention. Our first aim was to describe the epidemiology, clinical features, and underlying causes of AS in a cohort of children presenting to the emergency department (ED). Our second aim was to identify clinical features associated with a significant risk of underlying neurological emergencies (NEs). DESIGN AND SETTING Clinical records of all patients under 18 years presenting for AS to the ED of the Bambino Gesù Children's Hospital over a 10-year period were retrospectively reviewed. A logistic regression model was applied to detect predictive variables associated with a higher risk of NEs. RESULTS 208 patients (M:F = 1.19) were identified (0.35 cases per 1000 admission). Commonly associated symptoms included diplopia (18.3%), headache (23.1%), nausea or vomit (8.6%). Other ocular or neurological abnormalities were associated in 47.6% of patients. NEs accounted for 24.03% of all cases, mostly represented by brain tumours (8.65%). Ptosis, optic disk blurring, vomit, gait abnormalities and consciousness disorders were found to confer a significantly greater risk of an underlying NE. CONCLUSIONS Potentially severe neurological conditions may affect almost one in four children presenting to the ED for AS. Brain malignancies are the most common dangerous cause. Presence of ptosis, papilledema, vomit, gait disorders, consciousness impairment, pupillary defects and multiple cranial nerves involvement should be considered as red flags.
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Affiliation(s)
- Giacomo Garone
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valentina Ferro
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Barbato
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Laura Papini
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Pro
- Neurophysiology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Boni
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Barbara Scialanga
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaella Nacca
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Melania Evangelisti
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Di Nardo
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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50
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Shahjouei S, Tsivgoulis G, Farahmand G, Koza E, Mowla A, Vafaei Sadr A, Kia A, Vaghefi Far A, Mondello S, Cernigliaro A, Ranta A, Punter M, Khodadadi F, Naderi S, Sabra M, Ramezani M, Amini Harandi A, Olulana O, Chaudhary D, Lyoubi A, Campbell BCV, Arenillas JF, Bock D, Montaner J, Aghayari Sheikh Neshin S, Aguiar de Sousa D, Tenser MS, Aires A, Alfonso MDL, Alizada O, Azevedo E, Goyal N, Babaeepour Z, Banihashemi G, Bonati LH, Cereda CW, Chang JJ, Crnjakovic M, De Marchis GM, Del Sette M, Ebrahimzadeh SA, Farhoudi M, Gandoglia I, Gonçalves B, Griessenauer CJ, Murat Hanci M, Katsanos AH, Krogias C, Leker RR, Lotman L, Mai J, Male S, Malhotra K, Malojcic B, Mesquita T, Mir Ghasemi A, Mohamed Aref H, Mohseni Afshar Z, Moon J, Niemelä M, Rezai Jahromi B, Nolan L, Pandhi A, Park JH, Marto JP, Purroy F, Ranji-Burachaloo S, Carreira NR, Requena M, Rubiera M, Sajedi SA, Sargento-Freitas J, Sharma VK, Steiner T, Tempro K, Turc G, Ahmadzadeh Y, Almasi-Dooghaee M, Assarzadegan F, Babazadeh A, Baharvahdat H, Cardoso FB, Dev A, Ghorbani M, Hamidi A, Hasheminejad ZS, Hojjat-Anasri Komachali S, Khorvash F, Kobeissy F, Mirkarimi H, Mohammadi-Vosough E, Misra D, Noorian AR, Nowrouzi-Sohrabi P, Paybast S, Poorsaadat L, Roozbeh M, Sabayan B, Salehizadeh S, Saberi A, Sepehrnia M, Vahabizad F, Yasuda TA, Ghabaee M, Rahimian N, Harirchian MH, Borhani-Haghighi A, Azarpazhooh MR, Arora R, Ansari S, Avula V, Li J, Abedi V, Zand R. SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group. Stroke 2021; 52:e117-e130. [PMID: 33878892 PMCID: PMC8078130 DOI: 10.1161/strokeaha.120.032927] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.
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Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.)
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Ashkan Mowla
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.).,Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Switzerland (A.V.S.)
| | - Arash Kia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York City, NY (A.K.)
| | - Alaleh Vaghefi Far
- Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy (S. Mondello)
| | | | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Martin Punter
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Faezeh Khodadadi
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Soheil Naderi
- Department of Neurosurgery (S.N.), Tehran University of Medical Sciences, Iran
| | - Mirna Sabra
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy)
| | - Mahtab Ramezani
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Ali Amini Harandi
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Oluwaseyi Olulana
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Durgesh Chaudhary
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Aicha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint-Denis, France (A.L.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.)
| | - Juan F Arenillas
- Department of Neurology, University of Valladolid, Spain (J.F.A., M.D.L.A.)
| | - Daniel Bock
- Department of Cardiology, Klinikum Frankfurt Höchst, Germany (D.B.)
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J. Montaner)
| | | | - Diana Aguiar de Sousa
- Department of Neurology (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S.)
| | - Matthew S Tenser
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Ana Aires
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | | | - Orkhan Alizada
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | | | - Gelareh Banihashemi
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | - Leo H Bonati
- Department of Neurology and Stroke Unit, University Hospital Basel, Switzerland (L.H.B.)
| | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC (J.J.C.)
| | - Miljenko Crnjakovic
- Intensive Care Unit, Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia (M.C.)
| | - Gian Marco De Marchis
- Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland (G.D.M.)
| | | | | | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Iran (M.F.)
| | | | - Bruno Gonçalves
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | - Christoph J Griessenauer
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Mehmet Murat Hanci
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.).,Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K.)
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany (C.K.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Lev Lotman
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Jeffrey Mai
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, DC (J. Mai)
| | - Shailesh Male
- Department of Neurosurgery, Vidant Medical Center, Greenville, NC (S. Male)
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Branko Malojcic
- Department of Neurology, TIA Clinic, University Hospital Centre Zagreb, Zagreb School of Medicine, University of Zagreb, Croatia (B.M.)
| | - Teresa Mesquita
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | | | - Hany Mohamed Aref
- Department of Neurology, Ain Shams University, Cairo, Egypt (H.M.A.)
| | - Zeinab Mohseni Afshar
- Infection Disease Research Center, Kermanshah University of Medical Sciences, Iran (Z.M.A.)
| | - Jusun Moon
- Department of Neurology, National Medical Center, Seoul, South Korea (J. Moon)
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Lawrence Nolan
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, South Korea (J.-H.P.)
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Sakineh Ranji-Burachaloo
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | - Nuno Reis Carreira
- Department of Internal Medicine (N.E.C.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Seyed Aidin Sajedi
- Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Iran (S.A.S.)
| | - João Sargento-Freitas
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal (J.S.-F.)
| | - Vijay K Sharma
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore (V.K.S.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.).,Department of Neurology, Heidelberg University Hospital, Germany (T.S.)
| | - Kristi Tempro
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | | | - Mostafa Almasi-Dooghaee
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Divisions of Vascular and Endovascular Neurosurgery (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran
| | | | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Iran (A.B.)
| | - Humain Baharvahdat
- Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Iran (H.B.)
| | | | - Apoorva Dev
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran
| | - Ava Hamidi
- Neurology Ward, Gheshm Hospital, Iran (A.H.)
| | - Zeynab Sadat Hasheminejad
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | | | - Fariborz Khorvash
- Neurology Department, Isfahan University of Medical Sciences, Iran (F. Khorvash)
| | - Firas Kobeissy
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy).,Program of Neurotrauma, Neuroproteomics and Biomarker Research, University of Florida (F. Kobeissy)
| | | | | | - Debdipto Misra
- Steele Institute of Health and Innovation, Geisinger Health System, PA (D.M.)
| | - Ali Reza Noorian
- Department of Neurology, Southern California Permanente Medical Group, Irvine, CA (A.R.N.)
| | | | - Sepideh Paybast
- Department of Neurology, Bou Ali Hospital, Qazvin University of Medical Sciences, Iran (S.P.)
| | - Leila Poorsaadat
- Department of Neurology, Arak University of Medical Sciences, Iran (L.P.)
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Roozbeh)
| | - Behnam Sabayan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (B.S.)
| | - Saeideh Salehizadeh
- Neurology Department, Salahadin Ayubi Hospital, Baneh, Iran (S. Salehizadeh)
| | - Alia Saberi
- Neurology Department, Poursina Hospital, Rasht, Guilan, Iran (S.A.S.N., A.S.)
| | - Mercedeh Sepehrnia
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | - Fahimeh Vahabizad
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | | | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Nasrin Rahimian
- Department of Neurology, Yasrebi Hospital, Kashan, Iran (N.R.)
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | | | | | - Rohan Arora
- Department of Neurology, Long Island Jewish Forest Hills, Queens, NY (R.A.)
| | - Saeed Ansari
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.)
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
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