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Petchprom P, Sanghan N, Khumthong R, Setthawatcharawanich S, Sathirapanya P, Leelawattana R, Korathanakhun P. Factors associated with venous collaterals in patients with cerebral venous thrombosis. PLoS One 2024; 19:e0302162. [PMID: 38626092 PMCID: PMC11020378 DOI: 10.1371/journal.pone.0302162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/27/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVES To identify the factors associated with venous collaterals in Thai patients with cerebral venous thrombosis. MATERIALS AND METHODS This retrospective 20-year cohort study enrolled patients diagnosed with cerebral venous thrombosis between January 2002 and December 2022. Data was collected from the electronic medical record, and venous collaterals were independently reviewed by two neuroradiologists using the Qureshi classification. Patients with and without venous collaterals were compared. Significant factors (P<0.05) in the univariate analysis were recruited into the multivariate logistic regression analysis to determine independently associated factors. RESULTS Among 79 patients with cerebral venous thrombosis, the prevalence of venous collaterals at the initial neuroimaging was 25.3%. In the univariate analysis, patients with cerebral venous thrombosis and venous collaterals were significantly younger (37.0±13.9 years vs. 44.9±17.4 years, P = 0.048), more often had occlusion in the superior sagittal sinus (80.0% vs. 54.2%, P = 0.041), and were associated with hormonal exposure (35.0% vs. 6.8%, P = 0.002). Multivariate logistic regression analysis revealed occlusion in the superior sagittal sinus (adjusted odds ratio [aOR] 3.581; 95% confidence interval [95% CI] 1.941-13.626; P = 0.044) and hormonal exposure (aOR 7.276, 95% CI 1.606-32.966, P = 0.010) as independent factors associated with venous collaterals in cerebral venous thrombosis. CONCLUSIONS In this cohort, the prevalence of venous collaterals was 25.3%. Occlusion in the superior sagittal sinus and hormonal exposure were independently associated with venous collaterals in patients with cerebral venous thrombosis.
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Affiliation(s)
- Phirat Petchprom
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Nuttha Sanghan
- Division of Neuroradiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Rujimas Khumthong
- Division of Neuroradiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
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Mueanchoo P, Tepparak N, Chongphattararot P, Pruphetkaew N, Setthawatcharawanich S, Korathanakhun P, Amornpojnimman T, Sathirapanya C, Sathirapanya P. Association between Bell's Palsy and Cardiometabolic Risks: An Age- and Sex-Matched Case-Control Study. J Pers Med 2024; 14:197. [PMID: 38392630 PMCID: PMC10890282 DOI: 10.3390/jpm14020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Bell's palsy is possibly an ischemic cranial neuropathy, although reactivation of herpes virus infection has been proposed. METHODS This was an age-and sex-matched and 1:2 case-control study enrolling Bell's palsy patients during 2011-2021 in a university hospital to investigate the significant associations of cardiometabolic risks (CMRs) with Bell's palsy. We analyzed the differences in waist circumference (WC), body mass index (BMI), systolic and diastolic blood pressures (SBP and DBP), fasting blood sugar (FBS), and lipid levels at 12 weeks post-Bell's palsy with those of the controls by descriptive statistics (p < 0.05). The differences in means or medians of individual CMR values across the consecutive 10-year age intervals were analyzed by ANOVA F-tests and Kruskal-Wallis tests (p < 0.05). RESULTS A total of 140 cases and 280 controls were enrolled. Bell's palsy patients had significantly higher WC, BMI, SBP, DBP, FBS, and triglyceride but lower high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Moreover, high WC, elevated FBS (≥100 mg/dL), SBP (≥130 mmHg), and total cholesterol were significantly associated with Bell's palsy cases by multivariable analysis. Only FBS in Bell's palsy patients significantly elevated across consecutive 10-year age intervals. CONCLUSION Screening and monitoring for CMRs, especially hyperglycemia, in every patient presenting with Bell's palsy is essential despite initial normoglycemia, particularly in older-onset cases.
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Affiliation(s)
- Panitta Mueanchoo
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Nualsakol Tepparak
- Songkhla Rajanakarindra Psychiatric Hospital, Meung 90000, Songkhla, Thailand
| | - Pensri Chongphattararot
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Nannapat Pruphetkaew
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | | | - Pat Korathanakhun
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Thanyalak Amornpojnimman
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Chutarat Sathirapanya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Pornchai Sathirapanya
- Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
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Yamutai S, Sornplaeng P, Sanghan N, Khumtong R, Setthawatcharawanich S, Sathirapanya P, Leelawattana R, Korathanakhun P. Factors associated with the initial intracranial hemorrhage occurrence in patients with cerebral venous thrombosis. Clin Neurol Neurosurg 2024; 236:108109. [PMID: 38218059 DOI: 10.1016/j.clineuro.2023.108109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/20/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Studies focusing on intracranial hemorrhage (ICH) in patients with cerebral venous thrombosis (CVT) are limited; thus, we aimed to identify factors associated with the occurrence of ICH in Thai patients with CVT. METHODS This retrospective cohort study recruited patients with CVT admitted to a tertiary university-based hospital between 2002 and 2022. The baseline characteristics, clinical presentations, radiographic findings, and etiologies were compared between the ICH and non-ICH groups. The factors with p < 0.2 in the univariate analysis were further analyzed using multivariable logistic regression analysis to identify independent factors associated with ICH in patients with CVT. RESULTS Of 228 screenings, 202 patients were eligible. The incidence rate of ICH was 36.63%. The ICH group showed a higher prevalence of focal neurological deficits (63.51% vs. 26.56%, p < 0.001), seizures (68.92% vs. 21.88%, p < 0.001), dependency status at admission (60.81% vs. 39.84%, p = 0.004), superior sagittal sinus thrombosis (71.62% vs. 39.07%, p < 0.001), superficial cortical vein thrombosis (36.49% vs. 10.16%, p < 0.001), and hormonal use (17.57% vs. 7.03%, p = 0.021) than the non-ICH group. In contrast, the ICH group showed a lower prevalence of isolated increased intracranial pressure (10.81% vs. 21.88%, p = 0.048) than the non-ICH group. Seizures (adjusted odds ratio [aOR], 4.537; 95% confidence interval [CI], 2.085-9.874; p < 0.001), focal neurological deficits (aOR, 2.431; 95% CI, 1.057-5.593; p = 0.037), and superior sagittal sinus thrombosis (aOR, 1.922; 95% CI, 1.913-4.045; p = 0.045) were independently associated with ICH in the multivariable logistic regression analysis. CONCLUSIONS Seizures, focal neurological deficits, and superior sagittal sinus thrombosis are associated with ICH in patients with CVT.
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Affiliation(s)
- Suppakorn Yamutai
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Pitchayaporn Sornplaeng
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Nuttha Sanghan
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Rujimas Khumtong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla 90110, Thailand.
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Wiboonpong P, Setthawatcharawanich S, Korathanakhun P, Amornpojnimman T, Pruphetkaew N, Chongphattararot P, Sathirapanya C, Sathirapanya P. Comparison of Short-Term Post-Thymectomy Outcomes by Time-Weighted Dosages of Drug Requirements between Thymoma and Non-Thymoma Myasthenia Gravis Patients. Int J Environ Res Public Health 2023; 20:3039. [PMID: 36833734 PMCID: PMC9959777 DOI: 10.3390/ijerph20043039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Early thymectomy is suggested in all clinically indicated myasthenia gravis (MG) patients. However, short-term clinical response after thymectomy in MG patients has been limitedly described in the literature. This study aimed to compare the 5-year post-thymectomy outcomes between thymoma (Th) and non-thymoma (non-Th) MG patients. (2) Methods: MG patients aged ≥18 years who underwent transsternal thymectomy and had tissue histopathology reports in Songklanagarind Hospital between 2002 and 2020 were enrolled in a retrospective review. The differences in the baseline demographics and clinical characteristics between ThMG and non-Th MG patients were studied. We compared the time-weighted averages (TWAs) of daily required dosages of pyridostigmine, prednisolone or azathioprine to efficiently maintain daily living activities and earnings between the MG patient groups during 5 consecutive years following thymectomy. Post-thymectomy clinical status, exacerbations or crises were followed. Descriptive statistics were used for analysis with statistical significance set at p < 0.05. (3) Results: ThMG patients had significantly older ages of onset and shorter times from the MG diagnosis to thymectomy. Male gender was the only significant factor associated with ThMG. TWAs of the daily MG treatment drug dosages required showed no differences between the groups. Additionally, the rates of exacerbations and crises were not different, but decremental trends were shown in both groups after the thymectomies. (4) Conclusions: The daily dosage requirements of MG treatment drugs were not different. There was a trend of decreasing adverse event rates despite no statistically significant differences during the first 5 years after thymectomy in ThMG and non-ThMG patients.
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Affiliation(s)
- Phattamon Wiboonpong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | | | - Pat Korathanakhun
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Thanyalak Amornpojnimman
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Nannapat Pruphetkaew
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pensri Chongphattararot
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Chutarat Sathirapanya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Meyer A, Troyanov Y, Korathanakhun P, Landon-Cardinal O, Leclair V, Allard-Chamard H, Bourré-Tessier J, Makhzoum JP, Isabelle C, Larue S, Grand'Maison F, Massie R, Page ML, Mansour AM, Routhier N, Zarka F, Roy F, Sonnen J, Satoh M, Fritzler M, Hudson M, Senécal JL, Karamchandani J, Ellezam B, O'Ferrall E. Myositis with prominent B cell aggregates may meet classification criteria for sporadic inclusion body myositis. Neuromuscul Disord 2023; 33:169-182. [PMID: 36649672 DOI: 10.1016/j.nmd.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
The objective of this study was to report the clinical, serological and pathological features of patients with autoimmune myositis other than dermatomyositis, who displayed both muscle weakness on physical examination and prominent B cell aggregates on muscle pathology, defined as ≥ 30 CD20+ cells/aggregate. Specifically, the presence of a brachio-cervical inflammatory myopathies or a sporadic inclusion body myositis (sIBM) phenotype was recorded. Over a three-year period, eight patients were identified from two university neuropathology referral centers. Seven of 8 (88%) patients had an associated connective tissue disease (CTD): rheumatoid arthritis (n=3), systemic sclerosis (n=2), Sjögren's syndrome (n=1) and systemic lupus erythematosus (n=1), while one patient died on initial presentation without a complete serological and cancer investigation. A brachio-cervical phenotype, i.e. neck weakness, proximal weakness more than distal and shoulder abduction weakness greater than hip flexors, was seen in two patients (25%), while one patient had both proximal and diaphragmatic weakness. In contrast, an IBM-like clinical phenotype was seen in the last five patients (63%), who either had finger flexor weakness and/or quadriceps weakness ≤ 4 on the manual muscle testing MRC-5 scale. Although these 5 patients met at least one set of classification criteria for sIBM, an integrated clinico-sero-pathological approach argued against a diagnosis of sIBM. In summary, in a weak patient with myositis plus an associated CTD and lymphoid aggregates at muscle pathology, B cell predominant aggregates may represent a morphological biomarker against a diagnosis of sIBM.
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Affiliation(s)
- Alain Meyer
- Exploration fonctionnelle musculaire, Service de physiologie, Service de rhumatologie, Centre de références des maladies autoimmunes rares, Hôpitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Yves Troyanov
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Rheumatology, Hôpital du Sacré-Coeur, Montreal, Québec, Canada
| | - Pat Korathanakhun
- Department of Neurology, McGill University, Montreal, Québec, Canada; Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - Océane Landon-Cardinal
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada; CHUM Research Center, Montreal, Québec, Canada
| | - Valérie Leclair
- Department of Medicine, McGill University, Montreal, Québec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Québec, Canada
| | - Hughes Allard-Chamard
- Department of Medicine, Sherbrooke University, Sherbrooke, Québec, Canada; Division of Rheumatology, CHUS, Sherbrooke, Québec, Canada
| | - Josiane Bourré-Tessier
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada; CHUM Research Center, Montreal, Québec, Canada
| | - Jean-Paul Makhzoum
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Internal Medicine, Hôpital du Sacré-Coeur, Montreal, Québec, Canada
| | - Catherine Isabelle
- Department of Medicine, Sherbrooke University, Sherbrooke, Québec, Canada; Division of Rheumatology, Hôpital Charles-Lemoyne, Longueuil, Québec, Canada
| | - Sandrine Larue
- Department of Medicine, Sherbrooke University, Sherbrooke, Québec, Canada; Division of Neurology, Hôpital Charles-Lemoyne, Longueuil, Québec, Canada
| | - Francois Grand'Maison
- Department of Medicine, Sherbrooke University, Sherbrooke, Québec, Canada; Division of Neurology, Hôpital Charles-Lemoyne, Longueuil, Québec, Canada
| | - Rami Massie
- Department of Neurology, McGill University, Montreal, Québec, Canada; Montreal Neurological Institute and Hospital, Montreal, Québec, Canada
| | - Matthieu Le Page
- Division of Rheumatology, Centre hospitalier régional de Lanaudière, Saint-Charles-Borromée, Québec, Canada
| | - Anne-Marie Mansour
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Internal Medicine, Hôpital du Sacré-Coeur, Montreal, Québec, Canada
| | - Nathalie Routhier
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Internal Medicine, Hôpital du Sacré-Coeur, Montreal, Québec, Canada
| | - Farah Zarka
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Internal Medicine, Hôpital du Sacré-Coeur, Montreal, Québec, Canada
| | - Flavie Roy
- Department of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Joshua Sonnen
- Department of Neurology, McGill University, Montreal, Québec, Canada; Montreal Neurological Institute and Hospital, Montreal, Québec, Canada; Department of Pathology, McGill University, Montreal, Québec, Canada
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marvin Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Québec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Québec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
| | - Jean-Luc Senécal
- Department of Medicine, University of Montreal, Montreal, Québec, Canada; Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada; CHUM Research Center, Montreal, Québec, Canada
| | - Jason Karamchandani
- Montreal Neurological Institute and Hospital, Montreal, Québec, Canada; Department of Pathology, McGill University, Montreal, Québec, Canada
| | - Benjamin Ellezam
- Department of Pathology and Cell Biology, University of Montreal, Montreal, Québec, Canada; Department of Pathology, Hôpital Sainte-Justine, Montreal, Québec, Canada
| | - Erin O'Ferrall
- Department of Neurology, McGill University, Montreal, Québec, Canada; Montreal Neurological Institute and Hospital, Montreal, Québec, Canada; Department of Pathology, McGill University, Montreal, Québec, Canada
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Sanghan N, Lin S, Tartrakoon G, Setthawatcharawanich S, Amornpojnimman T, Sathirapanya P, Khumtong R, Leelawattana R, Korathanakhun P. Factors associated with acute symptomatic seizure occurrence among patients with posterior reversible encephalopathy syndrome. Epilepsy Behav 2022; 134:108834. [PMID: 35834860 DOI: 10.1016/j.yebeh.2022.108834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We aimed to define the factors associated with acute symptomatic seizure occurrence in posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. MATERIALS AND METHODS We conducted a retrospective cohort study enrolling patients with PRES admitted to the hospital between 2006 and 2019. In addition to seizure characteristics, baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the seizure and non-seizure groups. Factors with p-value <0.05 in the univariate analysis were entered into the first model of multivariate logistic regression analysis to determine the factors associated with seizure occurrence if the p-value <0.05. The interaction of associated factors was also analyzed in the final multiple logistic regression analysis model. RESULTS Acute symptomatic seizure, which is mainly based on the clinical documentation without electroencephalography, occurred in 50.0% of 136 patients with PRES. Of these, early seizures within 14 days of PRES occurred in 98.5% which mostly developed at presentation (82.4%) with a single seizure attack (55.9%). Convulsive seizures (77.9%) were the most common seizure semiology. The seizure group was significantly younger (median [interquartile range: IQR] 36.00 years old (21.75-48.50) vs 46.50 years old (31.25-61.00), p = 0.003). In univariate analysis, the seizure group had a higher prevalence of consciousness impairment (61.76% vs 26.47%, p < 0.001), Glasgow coma scale (GCS) score of 0-13 (42.46% vs 13.23%, p < 0.001), preeclampsia (20.58% vs 4.41%, p = 0.004), autoimmune disease (17.65% vs 5.88%, p = 0.033), and frontal lesions (25.00% vs 11.76%, p = 0.046) than those in the non-seizure group. In contrast, the seizure group had a lower prevalence of headache (27.94% vs 61.76%, p < 0.001). In the final multivariate logistic regression analysis which included the interaction terms, the acute symptomatic seizure occurrence directly associated with preeclampsia (adjusted odds ratio (aOR) 6.426, 95% confidence interval (CI) 1.450-27.031, p = 0.016) and autoimmune disease (aOR 4.962, 95% CI 1.283-18.642, p = 0.025), while headache showed a reverse association (aOR 0.310, 95% CI = 0.158-0.721, p = 0.008). CONCLUSIONS Acute symptomatic seizure occurred in a half of patients with PRES in this cohort. Preeclampsia and autoimmune disease were directly associated with seizure occurrence, while headache showed a reverse association.
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Affiliation(s)
- Nattha Sanghan
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Siriporn Lin
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Gawinnart Tartrakoon
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Thanyalak Amornpojnimman
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rujimas Khumtong
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Amornpojnimman T, Suwanwong P, Setthawatcharawanich S, Sathirapanya P, Leelawattana R, Korathanakhun P. Predictors of hospital outcomes among patients with posterior reversible encephalopathy syndrome. J Stroke Cerebrovasc Dis 2022; 31:106579. [PMID: 35738219 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES We aimed to identify independent predictors of the clinical outcomes of posterior reversible encephalopathy syndrome (PRES) in the Thai-Asian population. MATERIALS AND METHODS This retrospective cohort study recruited PRES patients admitted in the hospital between 2006 and 2019. The baseline characteristics, clinical presentations, precipitating factors, neuroimaging characteristics, hospital complications, and hospital outcomes were compared between the groups with favourable (modified Rankin scale [mRS] score, 0-2) and unfavourable (mRS score, 3-6) clinical outcomes. Factors presenting with p-values < 0.5 in univariate analysis were analysed in the multiple logistic regression model to determine independent predictors of outcome. RESULTS Among 136 PRES patients, 22.80% experienced unfavourable outcomes (mRS score, 3-6), and the mortality rate was 7.35%. The common presenting symptoms in the unfavourable clinical outcome group were impairment of consciousness (90.32%) and seizures (67.74%). Sepsis as a hospital complication (adjusted odds ratio [aOR], 32.95; 95% confidence interval [CI], 4.44-244.22, p = 0.001), acute kidney injury as a hospital complication (aOR, 9.94; 95% CI, 1.71-57.66; p = 0.010), and impairment of consciousness (aOR, 10.85; 95% CI, 1.72-68.53, p = 0.011) were independent predictors of unfavourable outcomes. On the other hand, headache was an independent protective factor (aOR, 0.164; 95% CI, 0.03-0.91; p = 0.039). CONCLUSIONS Impairment of consciousness, sepsis as a hospital complication, and acute kidney injury were independent predictors of unfavourable clinical outcomes, whereas headache showed a preventive effect.
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Affiliation(s)
- Thanyalak Amornpojnimman
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pachara Suwanwong
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Suwanna Setthawatcharawanich
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pornchai Sathirapanya
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Khumtong R, Katawatee K, Amornpojnimman T, Riabroi K, Sungkaro K, Korathanakhun P. Predictors of seizure control in patients with cerebral arteriovenous malformation. Epilepsy Behav 2022; 128:108575. [PMID: 35123239 DOI: 10.1016/j.yebeh.2022.108575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We aimed to define the predictors of a 2-year seizure-free outcome among patients with cerebral arteriovenous malformation (AVM). METHODS A retrospective cohort study recruited patients diagnosed with AVM admitted in the hospital between 2002 and 2020. The demographic data, clinical presentations, seizure semiology, neuro-imaging findings, modality of treatment, and clinical outcomes were compared between the 2-year seizure-free and non-2-year seizure-free groups. A logistic regression model was applied to determine the significant predictors of a 2-year seizure-free outcome. RESULTS Of 372 radiologically confirmed patients with cerebral AVM, 105 (28.23%) experienced seizure and a 2-year seizure-free outcome was achieved in 76.19%. Most seizures presented as the initial symptom. Generalized onset seizure was the most common seizure semiology. A nidus diameter < 3 cm (adjusted odds ratio [aOR] 3.102; 95% CI 1.129-9.683; p = 0.046) was the independent predictor of a 2-year seizure-free period, whereas underlying epilepsy (aOR 0.141; 95% CI 0.010-0.688; p = 0.015) was an independent predictor against a 2-year seizure-free outcome. CONCLUSION A nidus diameter < 3 cm was the independent predictor of a 2-year seizure-free outcome, whereas underlying epilepsy was the factor against a 2-year seizure-free outcome.
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Affiliation(s)
- Rujimas Khumtong
- Neurointerventional Radiology Unit, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kesinee Katawatee
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Thanyalak Amornpojnimman
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kittipong Riabroi
- Neurointerventional Radiology Unit, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kanisorn Sungkaro
- Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Pat Korathanakhun
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand.
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Roy F, Korathanakhun P, Karamchandani J, Dubé BP, Landon-Cardinal O, Routhier N, Peyronnard C, Massie R, Leclair V, Meyer A, Bourré-Tessier J, Satoh M, Fritzler MJ, Senécal JL, Hudson M, O'Ferrall EK, Troyanov Y, Ellezam B, Makhzoum JP. Myositis with prominent B-cell aggregates causing shrinking lung syndrome in systemic lupus erythematosus: a case report. BMC Rheumatol 2022; 6:11. [PMID: 35168668 PMCID: PMC8848966 DOI: 10.1186/s41927-021-00240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Shrinking lung syndrome (SLS) is a rare manifestation of systemic lupus erythematosus (SLE) characterized by decreased lung volumes and diaphragmatic weakness in a dyspneic patient. Chest wall dysfunction secondary to pleuritis is the most commonly proposed cause. In this case report, we highlight a new potential mechanism of SLS in SLE, namely diaphragmatic weakness associated with myositis with CD20 positive B-cell aggregates. Case presentation A 51-year-old Caucasian woman was diagnosed with SLE and secondary Sjögren’s syndrome based on a history of pleuritis, constrictive pericarditis, polyarthritis, photosensitivity, alopecia, oral ulcers, xerophthalmia and xerostomia. Serologies were significant for positive antinuclear antibodies, anti-SSA, lupus anticoagulant and anti-cardiolopin. Blood work revealed a low C3 and C4, lymphopenia and thrombocytopenia. She was treated with with low-dose prednisone and remained in remission with oral hydroxychloroquine. Seven years later, she developed mild proximal muscle weakness and exertional dyspnea. Pulmonary function testing revealed a restrictive pattern with small lung volumes. Pulmonary imaging showed elevation of the right hemidiaphragm without evidence of interstitial lung disease. Diaphragmatic ultrasound was suggestive of profound diaphragmatic weakness and dysfunction. Based on these findings, a diagnosis of SLS was made. Her proximal muscle weakness was investigated, and creatine kinase (CK) levels were normal. Electromyography revealed fibrillation potentials in the biceps, iliopsoas, cervical and thoracic paraspinal muscles, and complex repetitive discharges in cervical paraspinal muscles. Biceps muscle biopsy revealed dense endomysial lymphocytic aggregates rich in CD20 positive B cells, perimysial fragmentation with plasma cell-rich perivascular infiltrates, diffuse sarcolemmal upregulation of class I MHC, perifascicular upregulation of class II MHC, and focal sarcolemmal deposition of C5b-9. Treatment with prednisone 15 mg/day and oral mycophenolate mofetil 2 g/day was initiated. Shortness of breath and proximal muscle weakness improved significantly. Conclusion Diaphragmatic weakness was the inaugural manifestation of myositis in this patient with SLE. The spectrum of myologic manifestations of myositis with prominent CD20 positive B-cell aggregates in SLE now includes normal CK levels and diaphragmatic involvement, in association with SLS.
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Affiliation(s)
- Flavie Roy
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Pat Korathanakhun
- Department of Pathology, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Jason Karamchandani
- Department of Pathology, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Bruno-Pierre Dubé
- Division of Pulmonary Medicine, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Océane Landon-Cardinal
- Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.,Department of Medicine, CHUM Research Center, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Routhier
- Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 Gouin O Blvd, Montreal, QC, H4J 1C5, Canada
| | - Caroline Peyronnard
- Division of Neurology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Rami Massie
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Valérie Leclair
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alain Meyer
- Faculté de médecine, Université de Strasbourg, Service de physiologie, explorations fonctionnelles musculaire, Service de rhumatologie et Centre de références des maladies autoimmunes rares, EA 3072, Hôpitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Josiane Bourré-Tessier
- Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.,Department of Medicine, CHUM Research Center, Université de Montréal, Montreal, QC, Canada
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean-Luc Senécal
- Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.,Department of Medicine, CHUM Research Center, Université de Montréal, Montreal, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Erin K O'Ferrall
- Department of Pathology, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, QC, Canada
| | - Yves Troyanov
- Division of Rheumatology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Benjamin Ellezam
- Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Paul Makhzoum
- Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 Gouin O Blvd, Montreal, QC, H4J 1C5, Canada.
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Amornpojnimman T, Mitarnun W, Korathanakhun P. Predictors of seizures in patients with cerebral venous thrombosis in the Thai population: A retrospective study. Seizure 2022; 96:1-5. [PMID: 35038621 DOI: 10.1016/j.seizure.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study aimed to define independent factors associated with the onset of early seizure (ES) amongst patients with cerebral venous thrombosis (CVT). METHODS This retrospective cohort study recruited patients diagnosed with CVT and hospitalised between 2002 and 2020. Demographic, clinical, and seizure characteristics; neuroimaging findings; and clinical outcomes were compared between the seizure and non-seizure groups. Factors with p-values of <0.05 in univariate analysis were included in multivariate logistic regression analysis to determine independent predictors of ES. RESULTS Amongst 180 CVT patients, the incidence of ES was 38.3%. Most seizures presented as the initial symptom. Focal to bilateral tonic-clonic seizure was the most common seizure type (82.6%). Recurrent serial seizure and non-fatal status epilepticus accounted for 56.5% and 8.7% cases, respectively. Intracerebral haemorrhage (adjusted odds ratio [aOR]=6.57, 95% confidence interval [CI], 2.25‒19.21, p = 0.001) and dependency status at admission (aOR=3.32, 95% CI, 1.08‒10.18, p = 0.036) independently predicted ES, whereas isolated increased intracranial pressure (aOR=0.05, 95% CI, 0.01‒0.24, p < 0.001), isolated headache (aOR=0.10, 95% CI, 0.02‒0.45, p = 0.002), straight sinus thrombosis (aOR=0.03, 95% CI, 0.00‒0.37, p = 0.007), and cavernous sinus thrombosis (aOR=0.50, 95% CI, 0.01‒0.53, p = 0.012) showed protective effects. CONCLUSION Intracerebral haemorrhage and dependency status at admission independently predicted seizures, whereas isolated increased intracranial pressure, isolated headache, straight sinus thrombosis, and cavernous sinus thrombosis showed preventive effects.
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Affiliation(s)
- Thanyalak Amornpojnimman
- Division of neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Wiwit Mitarnun
- Division of neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Division of neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Srisilpa S, Korathanakhun P. Predictors of clinical outcome among Thai patients with atrial fibrillation-associated acute ischemic stroke. J Stroke Cerebrovasc Dis 2020; 29:104856. [PMID: 32389560 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/11/2020] [Accepted: 03/28/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the predictors of 3-month death among an atrial fibrillation-associated acute ischemic stroke (AF-stroke). METHODS This retrospective cohort study was conducted at a university hospital in Thailand. Patients with AF-stroke admitted between 2012 and 2017 were enrolled into the study. Baseline characteristics, clinical presentations, complications, and outcomes measured by the modified Rankin scale were collected from electronic medical records. Predictors of death outcomes were analyzed by univariate and multivariate logistic regression analysis. RESULTS The mortality rate among 119 AF-stroke patients was 26.89%. The independent predictors of 3-month death were developing AKI during hospitalization (adjusted odds ratio [aOR] = 6.38, 95% CI = 1.96-20.76, p = 0.001) and age above 75 years old (aOR = 3.08, 95% CI = 1.17-8.13, p = 0.019). In contrast, receiving treatment with an oral anticoagulant prior to the stroke episode was a protective factor (aOR = 0.13, 95% CI = 0.03-0.64, p = 0.002). CONCLUSION Developing AKI and older age were the independent predictor of 3- month death among AF-stroke patients.
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Affiliation(s)
- Song Srisilpa
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Pat Korathanakhun
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Amornpojnimman T, Korathanakhun P. Predictors of clinical outcomes among patients with brain abscess in Thailand. J Clin Neurosci 2018; 53:135-139. [DOI: 10.1016/j.jocn.2018.04.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/20/2018] [Accepted: 04/22/2018] [Indexed: 12/20/2022]
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Amornpojnimman T, Korathanakhun P. 041 Predictors of clinical outcomes in patients with brain abscess. J Neurol Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionBrain abscess is an intra-parenchymal suppurative infectious condition of the brain caused by various microorganisms and potentially resulting in a life-threatening condition. Despite Thailand being located in a tropical region, studies on brain abscess are quite limited and outdated. Most of the published data in the Thai population were collected during a period when advanced neuroimaging techniques were not widely available. This issue contributed to late diagnosis and treatment that impacted the clinical outcomes. Therefore, our study aims to identify predictors of mortality among patients with brain abscess in Thailand.MethodsWe retrospectively studied patients diagnosed with brain abscess admitted to Songklanagarind hospital in Songkhla, Thailand between 2002 and 2017. Demographic data, neurological status, clinical presentations, predisposing factors, microbiological profiles, neuroimaging findings, treatments, and outcomes were collected from electrical medical records. Predictors of death outcome were analysed by univariate and multivariate logistic regression analysis.Results81 patients were enrolled in the study. Forty-seven patients (58%) were male and 34 patients (42%) were female. The overall mean age was 47.68±16.92 years. The common risk factors of brain abscess were immunocompromised state (38.3%) and the extension of a peri-cranial infection (24.7%). The common clinical presentations were headache (61.7%), fever (50.6%), and hemiplegia (34.6%). Eleven patients (13.6%) were dead at hospital discharge. The independent factor associated with death outcome identified by multivariate analysis was confusion (odds ratio 7.67, 95% CI 1.95–30.14; p=0.003).ConclusionThe current study shows that increased immunocompromised state is a predisposing factor of brain abscess. The independent factor associated with death was confusion, which correlated with septic encephalopathy.
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Korathanakhun P, Petpichetchian W, Sathirapanya P, Geater SL. Cerebral venous thrombosis: comparing characteristics of infective and non-infective aetiologies: a 12-year retrospective study. Postgrad Med J 2015; 91:670-4. [DOI: 10.1136/postgradmedj-2015-133592] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/05/2015] [Indexed: 11/04/2022]
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