Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study

INTRODUCTION

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications.

OBJECTIVE

The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain.

METHODS

We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres.

RESULTS

We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P =  .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%.

CONCLUSION

The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.

[Prognosis of patients assisted in the emergency unit by the 'TIA protocol' in a third-level hospital at 90 days]

INTRODUCTION

Care models developed for the rapid management of patients with transient ischaemic attack (TIA) are safe, effective and reduce recurrence rates. The aim is to determine the prevalence of cardiovascular events at 90 days.

PATIENTS AND METHODS

An observational, analytical, cross-sectional study was conducted. Adult male and female patients seen in the emergency department using the 'TIA protocol' between January 2016 and December 2019 were analysed. Data were collected on clinical variables, complementary tests, treatment and cardiovascular events (stroke/TIA, acute coronary syndrome or death due to cardiovascular causes) at 90 days. The study was approved by the Research Ethics Committee of Aragon.

RESULTS

The TIA protocol was performed on 163 out of 591 patients diagnosed with TIA in the emergency department. Brain CT and neurosonology scans were performed in 100% and a 24-hour Holter-electrocardiogram was carried out in 52.1%; atrial fibrillation (AF) was detected in 3.6% of them. An MRI brain scan was performed in 78.4% and acute ischaemic injury was seen in diffusion sequences (DWI+) in 13.5%. The prevalence of cardiovascular events at 90 days was 4.9% (8): stroke, 3.1% (five TIAs); acute coronary syndrome, 0.6% (one); and death from cardiovascular causes, 1.2% (two). Major adverse cardiovascular events were significantly associated with a history of ischaemic heart disease (p = 0.014). Cardiovascular death was associated with a history of AF (p = 0.008), anticoagulants at discharge (p = 0.007) and no antiplatelet therapy at discharge (p = 0.012), and there was a tendency towards an association with a history of type 2 diabetes mellitus (p = 0.05).

CONCLUSIONS

Rapid TIA protocols allow early care and avoid hospital admissions, without increasing the incidence of cardiovascular events or recurrence of stroke or TIA at 90 days.

Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study

INTRODUCTION

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications.

OBJECTIVE

The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain.

METHODS

We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres.

RESULTS

We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P=.03), focal deficits (P=.001), and encephalopathy (P <.001) showing a statistically significant association with poor prognosis (mRS> 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%.

CONCLUSION

The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.

[Degree of compliance with treatment at three months in migraine patients]

INTRODUCTION

Adherence to oral preventive treatment (OPT) in migraine is often compromised. The aim was to determine the degree of adherence to OPT in migraine patients at three months.

PATIENTS AND METHODS

We conducted a multicentre observational study of patients diagnosed with episodic or chronic migraine (criteria of the International Headache Classification, third edition) in whom OPT was initiated. Demographic data (age, gender, educational level, marital status) and disease data (number of attacks, Headache Impact Test-6 and Migraine Disability Assessment Scale scores) were collected. At three months, the Morisky-Green scale was administered, which differentiates levels of adherence: excellent (0), moderate (1-2) and low (3-4).

RESULTS

Altogether 100 patients participated in the study: 87% women aged 42 ± 13 years, 14% with chronic migraine; 53.2% of them were beginning their first OPT. Beta-blockers were initiated in 23.2%, tricyclic antidepressants in 35.4%, flunarizine in 21.2%, neuromodulators in 19.2% and antihypertensives in 1%. Severe disability was observed in 56%, and the impact was very severe in 79.5%. Adhesion at three months was excellent in 41.8%, moderate in 28.6% and low in 29.6%. The most frequent reason for discontinuing was the occurrence of adverse effects (44%). A significant relationship was found between excellent adherence and being single (p = 0.046), and between low adherence and adverse effects (p = 0.009). No significant differences were found between the OPT used and the degree of adherence or the other variables studied.

CONCLUSIONS

Although our results are better than those published in the literature, we consider that therapeutic adherence in our setting is low and educating our patients in this regard is a priority.

[Emergency department management of epileptic seizures in patients with epilepsy]

AIM

To analyse the care of patients with epilepsy (PwE) who visit the hospital emergency department (ED) due to an epileptic seizure.

MATERIALS AND METHODS

Single-centre retrospective observational study, based on the clinical history of the PwE seen in the ED for epileptic seizures between January 2016 and December 2018. Demographic, clinical and ED management variables were collected. Specifically, the results of a computed tomography (CT) brain scan and electroencephalogram and the presence of precipitating factors for epileptic seizures were analysed.

RESULTS

A total of 232 PwE were identified, with a mean age of 49.8 years. The most frequent reason for the visit was focal epileptic seizures (50.4%). In 106 cases (45.6%) possible precipitating factors were found, of which poor therapy adherence was the most frequent. An urgent CT brain scan was performed in 67 cases (28.9%) and acute alterations were found in only one patient. An electroencephalogram was carried out in 16 of them (6.9%). Adjustments were made to the antiepileptic treatment in 135 patients (58.1%). A total of 195 were discharged without being hospitalised (84.1%).

CONCLUSIONS

PwE accounted for a considerable proportion of the patients seen for epileptic seizures in the ED. The presence of a potentially controllable precipitating factor was identified in almost half of the cases, the most frequent being poor adherence to therapy. In addition, a high number of urgent complementary tests were performed, which in many cases may be unnecessary and avoidable.

[Epidemiology of migraine in Spain and Latin America]

INTRODUCTION

Migraine is a very disabling disease that has a great impact on patients' quality of life and interferes in their personal, social, work and family spheres. From a historical point of view, the connection between the Iberian Peninsula and Latin America has been very important, and so it seems reasonable to find there are parallels in the epidemiology of this disease, given the role that certain genetic and lifestyle-related determinants have in its natural history.

AIM

To conduct a detailed review of the descriptive epidemiological studies of migraine in Spain and Latin America.

DEVELOPMENT

Literature search of epidemiological studies on migraine in our country and in Latin America. The population studied, the methodology, the questionnaire used for diagnosis and the prevalence data were analysed. Altogether 23 studies were evaluated.

CONCLUSIONS

Not all countries have population-based epidemiological studies of migraine, and most of them were conducted more than 10 years ago. Moreover, a wide range of methodologies were applied. The prevalence data obtained in the selected studies, with the exception of some conducted in Brazil and Peru, are very similar to those found in Spain.