1
|
Kui L, Jiao Y, Jiang H, Wang G, Li Z, Ji X, Zhou C. Expression and metabolism profiles of CVT associated with inflammatory responses and oxygen carrier ability in the brain. CNS Neurosci Ther 2024; 30:e14494. [PMID: 37902195 PMCID: PMC11017414 DOI: 10.1111/cns.14494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/21/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
AIM As the main type of stroke, the incidence of cerebral venous thrombosis (CVT) has been rising. However, the comprehensive mechanisms behind it remain unclear. Thus, the multi-omics study is required to investigate the mechanism after CVT and elucidate the characteristic pathology of venous stroke and arterial stroke. METHODS Adult rats were subjected to CVT and MCAO models. Whole-transcriptome sequencing (RNA-seq) and untargeted metabolomics analysis were performed to construct the transcriptome and metabolism profiles of rat brains after CVT and also MCAO. The difference analysis, functional annotation, and enrichment analysis were also performed. RESULTS Through RNA-seq analysis, differentially expressed genes (DEGs) were screened. 174 CVT specific genes including Il1a, Ccl9, Cxxl6, Tnfrsf14, etc., were detected. The hemoglobin genes, including both Hba and Hbb, were significantly downregulated after CVT, compared both to the MCAO and Sham groups. Metabolism analysis showed that CVT had higher heterogeneity of metabolism compared to MCAO. Metabolites including N-stearoyltyrosine, 5-methoxy-3-indoleaceate, Afegostat, pipecolic acid, etc. were specially regulated in CVT. Through the immune infiltration analysis, it was found that CVT had a higher immune response, with the abundance of certain types of immune cells increased, especially T helper cells. It was important to find the prevalence of the activation of inflammatory chemokine, cytokine, NOD-like pathway, and neutrophil extracellular trap. CONCLUSION We explored and analyzed the gene expression and metabolomic characteristics of CVT, revealed the specific inflammatory reaction mechanism of CVT and found the markers in transcriptome and metabolism levels. It points out the direction for CVT early diagnosis and treatment.
Collapse
Affiliation(s)
- Ling Kui
- Shenzhen Qianhai Shekou Free Trade Zone HospitalShenzhenChina
| | - Yinming Jiao
- Shenzhen Qianhai Shekou Free Trade Zone HospitalShenzhenChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Guoyun Wang
- Shenzhen Qianhai Shekou Free Trade Zone HospitalShenzhenChina
| | - Zongyu Li
- Dehong People's HospitalMangshiChina
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| |
Collapse
|
2
|
Carrion AN, Allison TA, Samuel S. Is a minimum duration of 5 days of unfractionated heparin infusion necessary before transition to oral anticoagulation in cerebral venous thrombosis? a retrospective chart review. J Thromb Thrombolysis 2024; 57:691-698. [PMID: 38418744 DOI: 10.1007/s11239-024-02950-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
In managing cerebral venous sinus thrombosis (CVT), the standard approach has been administering parenteral anticoagulation for at least five days, despite limited supporting evidence. This study aimed to determine the optimal duration of parenteral anticoagulation for CVT patients and its potential impact on their functional outcomes upon discharge. This retrospective observational cohort study was conducted across multiple healthcare centers and included adult CVT patients who received varying durations of parenteral anticoagulation: less than 5 days (n = 25) or 5 days or more (n = 16). The primary focus was on the duration of acute anticoagulation treatment, with secondary endpoints including hospital stay length and functional outcomes. The study found that a shorter duration of anticoagulation treatment (< 5 days) was linked to more favorable outcomes, as measured by the modified Rankin Scale (mRS) (68% vs. 25%, RR = 0.37, CI 0.15-0.90, p = 0.007). However, regression analysis showed non statistically significant associations for all variables except gender. Female patients were significantly more likely to receive a shorter duration of anticoagulation (Odds Ratio: 2.6, 95% CI: 2.2-3.1, P-Value: <0.001). These findings suggest a potential connection between shorter anticoagulation duration (< 5 days) and improved CVT patient outcomes, as indicated by their mRS scores at discharge. The observed relationship between female gender and shorter anticoagulation duration warrants further exploration. Nevertheless, caution is necessary when interpreting these findings due to the small sample size and specific patient characteristics. Further research in a larger and more diverse cohort is essential to validate these results and understand their implications fully.
Collapse
Affiliation(s)
- Ariel N Carrion
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA
| | - Teresa A Allison
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA
| | - Sophie Samuel
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA.
| |
Collapse
|
3
|
Lai LM, Sato TS, Kandemirli SG, AlArab N, Sato Y. Neuroimaging of Neonatal Stroke: Venous Focus. Radiographics 2024; 44:e230117. [PMID: 38206831 DOI: 10.1148/rg.230117] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Perinatal venous infarcts are underrecognized clinically and at imaging. Neonates may be susceptible to venous infarcts because of hypercoagulable state, compressibility of the dural sinuses and superficial veins due to patent sutures, immature cerebral venous drainage pathways, and drastic physiologic changes of the brain circulation in the perinatal period. About 43% of cases of pediatric cerebral sinovenous thrombosis occur in the neonatal period. Venous infarcts can be recognized by ischemia or hemorrhage that does not respect an arterial territory. Knowledge of venous drainage pathways and territories can help radiologists recognize characteristic venous infarct patterns. Intraventricular hemorrhage in a term neonate with thalamocaudate hemorrhage should raise concern for internal cerebral vein thrombosis. A striato-hippocampal pattern of hemorrhage indicates basal vein of Rosenthal thrombosis. Choroid plexus hemorrhage may be due to obstruction of choroidal veins that drain the internal cerebral vein or basal vein of Rosenthal. Fan-shaped deep medullary venous congestion or thrombosis is due to impaired venous drainage into the subependymal veins, most commonly caused by germinal matrix hemorrhage in the premature infant and impeded flow in the deep venous system in the term infant. Subpial hemorrhage, an underrecognized hemorrhage stroke type, is often observed in the superficial temporal region, and its cause is probably multifactorial. The treatment of cerebral sinovenous thrombosis is anticoagulation, which should be considered even in the presence of intracranial hemorrhage. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
Collapse
Affiliation(s)
- Lillian M Lai
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Takashi Shawn Sato
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Sedat Giray Kandemirli
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Natally AlArab
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Yutaka Sato
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| |
Collapse
|
4
|
Zhang J, Liu D, Xiang J, Yang M. Combining Glial Fibrillary Acidic Protein and Neurofilament Light Chain for the Diagnosis of Major Depressive Disorder. Anal Chem 2024; 96:1693-1699. [PMID: 38231554 DOI: 10.1021/acs.analchem.3c04825] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Major depressive disorder (MDD) is a prevalent brain disorder affecting more than 2% of the world's population. Due to the lack of well-specific biomarkers, it is difficult to distinguish MDD from other diseases with similar clinical symptoms (such as Alzheimer's disease and cerebral thrombosis). In this work, we provided a strategy to address this issue by constructing a combinatorial biomarker of serum glial fibrillary acidic protein (GFAP) and neurofilament light chain (NFL). To achieve the convenient and sensitive detection of two proteins, we developed an electrochemical immunosandwich sensor using two metal-ion-doped carbon dots (Pb-CDs and Cu-CDs) as probes for signal output. Each probe contains approximately 300 Pb2+ or 200 Cu2+, providing excellent signal amplification. This method achieved detection limits of 0.3 pg mL-1 for GFAP and 0.2 pg mL-1 for NFL, lower than most of the reported detection limits. Analysis of real serum samples showed that the concentration ratio of GFAP to NFL, which is associated with the relative degree of brain inflammation and neurodegeneration, is suitable for not only distinguishing MDD from healthy individuals but also specifically distinguishing MDD from Alzheimer's disease and cerebral thrombosis. The good specificity gives the combinatorial GFAP/NFL biomarker broad application prospects in the screening, diagnosis, and treatment of MDD.
Collapse
Affiliation(s)
- JinXia Zhang
- College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, P. R. China
| | - Dan Liu
- Eye Center of Xiangya Hospital, Central South University, Changsha 410083, P. R. China
| | - Juan Xiang
- College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, P. R. China
| | - Minghui Yang
- College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, P. R. China
| |
Collapse
|
5
|
Alfakeeh FK, Alghamdi YM, Alharbi BF, Alotaibi AM, Alsaleh KA, Alshubaili AM, Mcrabi RH, Alenazi FK, Almuklass A. HbA1c and risk factors' prevalence in patients with stroke: a retrospective study in a tertiary care hospital in Saudi Arabia. Neurosciences (Riyadh) 2024; 29:18-24. [PMID: 38195130 PMCID: PMC10827011 DOI: 10.17712/nsj.2024.1.20230037] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/19/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To determine the relationship between hemoglobin A1c (HbA1c) and different types of stroke, and how different comorbidities and risk factors are related to the occurrence of stroke in a Saudi Arabian tertiary care hospital. METHODS This retrospective study was conducted at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. The study included patients who experienced either hemorrhagic stroke (HS), ischemic stroke (IS), or transient ischemic attack (TIA) between 2015 and 2020. RESULTS In total, 976 patients were included, of whom 670 were males (68.6%). The incidence of HS was significantly higher in males compared to females (14.2% vs. 6.9%), whereas the incidence of IS was higher in females (76.8% vs. 74.6%) (p=0.001). Ischemic stroke was significantly higher in the 65 years or older age group, whereas HS was comparatively higher among those aged <65 years. The means HbA1c levels in all three types of stroke were abnormally high. However, HbA1c levels were significantly higher in IS than in the other 2 stroke types (p=0.017). The HbA1c levels showed statistically significant differences between the different types of stroke, where the estimated marginal means were higher in patients with IS with a small effect size. Heart disease was also more prevalent in the IS group. Stroke-related mortality was reported in 16 patients and was significantly higher in the IS group than in the HS group. CONCLUSION The HbA1c levels were elevated in all types of stroke, significantly in IS. Controlling patients' HbA1c and other modifiable risk factors could significantly reduce the risk of stroke.
Collapse
Affiliation(s)
- Faisal K. Alfakeeh
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Yazeed M. Alghamdi
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Bassam F. Alharbi
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Abdulaziz M. Alotaibi
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Khalid A. Alsaleh
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah M. Alshubaili
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Ryan H. Mcrabi
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Farhan K. Alenazi
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| | - Awad Almuklass
- From the College of Medicine (Alfakeeh, Alghamdi, Alharbi, Alotaibi, Alsaleh, Alshubaili, Mcrabi, Alenazi, Almuklass), King Saud bin Abdulaziz University for Health Sciences, and from King Abdullah International Medical Research Center (Almuklass), Riyadh, Kingdom of Saudi Arabia.
| |
Collapse
|
6
|
Coelho ADVK, Almeida ACD, Gomes SMCDASMM, Rocha AJD, Neto HRS. IgG4-related hypertrophic pachymeningitis with cerebral venous thrombosis. Arq Neuropsiquiatr 2024; 82:1-2. [PMID: 38272042 PMCID: PMC10810699 DOI: 10.1055/s-0043-1772600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/19/2023] [Indexed: 01/27/2024]
Affiliation(s)
| | | | | | - Antonio José da Rocha
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Departamento de Radiologia, São Paulo SP, Brazil.
| | - Herval Ribeiro Soares Neto
- Hospital do Servidor Público Estadual de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.
- Hospital Israelita Albert Einstein, Departamento de Neurologia, São Paulo SP, Brazil.
| |
Collapse
|
7
|
Zhu K, Menon BK, Qiu W. Response to Letter Regarding the Article "Automated Segmentation of Intracranial Thrombus on NCCT and CTA in Patients with Acute Ischemic Stroke Using a Coarse-to-Fine Deep Learning Model". AJNR Am J Neuroradiol 2023; 45:E1. [PMID: 38164534 PMCID: PMC10756572 DOI: 10.3174/ajnr.a8075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Kairan Zhu
- Department of Clinical Neurosciences & Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgary, Alberta, Canada
- College of Electronic EngineeringXi'an Shiyou UniversityXi'an, Shaanxi, China
| | - B K Menon
- Department of Clinical Neurosciences & Hotchkiss Brain InstituteCumming School of Medicine, University of CalgaryCalgary, Alberta, Canada
| | - W Qiu
- School of Life Science and TechnologyHuazhong University of Science and TechnologyWuhan, Hubei, China
| |
Collapse
|
8
|
Moreno-Cortez KM, Chujfi-Zamora M, Reyes-Vaca JG, Rodriguez-Leyva I. Facial pain associated with vein of Trolard thrombosis Case report Neurology. BMJ Case Rep 2023; 16:e256545. [PMID: 37973537 PMCID: PMC10661060 DOI: 10.1136/bcr-2023-256545] [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] [Indexed: 11/19/2023] Open
Abstract
Cerebral venous thrombosis is a rare condition, with identified and described risk factors mainly associated with prothrombotic states, with a wide variety of symptomatology based on the site affected, the most common being intracranial hypertensive syndrome, focal or encephalopathy. Cortical veins of the superficial system are among the least frequently affected veins. The following describes a case of painful facial symptoms progressing to a focal syndrome associated with a history of chronic oral contraceptive use, with thrombosis of vein of Trolard detected and successfully treated with oral anticoagulants.
Collapse
Affiliation(s)
- Katia Mabiael Moreno-Cortez
- Neurology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Manir Chujfi-Zamora
- Neurology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Jorge Guillermo Reyes-Vaca
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Radiology and Image, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Ildefonso Rodriguez-Leyva
- Neurology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology Service, Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| |
Collapse
|
9
|
Dymm B, Wiggins W, Smith VL, El Husseini N, Pawar S, Feng W. Teaching NeuroImage: Diffuse Midline Glioma Mimicking Edema in Cerebral Venous Thrombosis. Neurology 2023; 101:e1945-e1947. [PMID: 37652698 PMCID: PMC10663001 DOI: 10.1212/wnl.0000000000207822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/10/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Braydon Dymm
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC.
| | - Walter Wiggins
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Vanessa L Smith
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Nada El Husseini
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Swaroop Pawar
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| | - Wuwei Feng
- From the Departments of Neurology (B.D., N.E.H., S.P., W.F.), Radiology (W.W.), and Pathology (V.L.S.), Duke University Hospital, Durham, NC
| |
Collapse
|
10
|
Lee JH, Ahn JM, Kang DY, Kim KW, Koo HJ, Yang DH, Jung SC, Kim B, Wong YTA, Lam CCS, Yin WH, Wei J, Lee YT, Kao HL, Lin MS, Ko TY, Kim WJ, Kang SH, Yun SC, Ko E, Park H, Lee SA, Kim DH, Park SJ, Park DW. Effect of Edoxaban Versus Antiplatelet Therapy on Leaflet Thrombosis and Cerebral Thromboembolism After TAVI According to Major Clinical and Anatomic Factors in Prespecified Subgroup Analysis from the ADAPT-TAVR Trial. Am J Cardiol 2023; 203:352-361. [PMID: 37517131 DOI: 10.1016/j.amjcard.2023.06.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 08/01/2023]
Abstract
It is unknown whether edoxaban versus dual antiplatelet therapy (DAPT) has differential treatment effects on leaflet thrombosis, cerebral thromboembolism, and neurologic or neurocognitive dysfunction according to clinical and anatomic factors after transcatheter aortic valve implantation. To investigate the relative effects of edoxaban and DAPT on leaflet and cerebral thromboembolism in patients with major risk factors. The primary end point of this study was the incidence of leaflet thrombosis on computed tomography at 6 months. The secondary end points were new cerebral lesions on brain magnetic resonance imaging and neurologic and neurocognitive dysfunction between baseline and 6-month follow-up. Cox regression models assessed the consistency of the treatment effects in the prespecified subgroups. The favorable effect of edoxaban versus DAPT on the leaflet thrombosis was consistent across multiple clinical or anatomic subgroups, without significant interaction between the drug effect and each subgroup (p for interaction for age = 0.597, gender = 0.557, body mass index = 0.866, Society of Thoracic Surgeons score = 0.307, valve type = 0.702, edoxaban reduction criteria = 0.604, and valve morphology = 0.688). However, the incidence of new cerebral lesions on brain magnetic resonance imaging and worsening of neurologic and neurocognitive function were not significantly different between the groups among the various key subgroups. The relative effects of edoxaban and DAPT on the risk of leaflet thrombosis, cerebral thromboembolism, and neurologic dysfunction were consistent across a diverse spectrum of clinical or anatomical factors. Further studies are required to define tailored antithrombotic therapy for high-risk groups with specific clinical or anatomic characteristics.
Collapse
Affiliation(s)
| | | | | | - Kyung Won Kim
- Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences
| | - Hyun Jung Koo
- Department of Radiology Research Institute of Radiology, and
| | - Dong Hyun Yang
- Department of Radiology Research Institute of Radiology, and
| | - Seung Chai Jung
- Department of Radiology Research Institute of Radiology, and
| | - Byungjun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yiu Tung Anthony Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Cheung Chi Simon Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yu Ko
- Division of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Won-Jang Kim
- Department of Cardiology, CHA Ilsan Medical Center, Goyang, Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, Seongnam, Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euihong Ko
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu-city, Fukuoka, Japan
| | - Hanbit Park
- Department of Cardiology, GangNeung Asan Hospital, GangNeung, Korea
| | | | | | | | | |
Collapse
|
11
|
Tortora M, Pacchiano F. Regarding "Automated Segmentation of Intracranial Thrombus on NCCT and CTA in Patients with Acute Ischemic Stroke Using a Coarse-to-Fine Deep Learning Model". AJNR Am J Neuroradiol 2023; 44:E41. [PMID: 37591774 PMCID: PMC10494942 DOI: 10.3174/ajnr.a7972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- M Tortora
- Department of Advanced Biomedical SciencesUniversity of Naples "Federico II"Naples, Italy
| | - F Pacchiano
- Radiology School, Department of Precision MedicineUniversity of Campania "L. Vanvitelli"Caserta, Italy
| |
Collapse
|
12
|
Mochizuki T, Ryu B, Kushi K, Shima S, Sato S, Inoue T, Okada Y, Niimi Y. Cerebral venous thrombosis associated with hyperhomocysteinemia and iron-deficiency anemia induced by autoimmune gastritis: A case report and literature review. Neuroradiol J 2023; 36:491-495. [PMID: 36536603 PMCID: PMC10588603 DOI: 10.1177/19714009221147224] [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] [Indexed: 07/20/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare disease, occurring in 0.5%-1% of all patients with strokes. Systemic and hereditary diseases and traumas are potential causes of CVT. We report a case of CVT and systemic thromboembolism complicated with hyperhomocysteinemia and iron-deficiency anemia caused by autoimmune gastritis. A 47-year-old female patient was admitted to the emergency department due to difficulty in movement, impaired consciousness, and urinary incontinence. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed bilateral thalamic edema associated with venous sinus thrombosis and embolic cerebral infarction in the deep white matter of the bilateral cerebral hemispheres. In addition, contrast enhanced whole-trunk CT scan showed deep femoral thrombosis and pulmonary artery embolism. She had no medical history of diseases or drug use that may cause thrombosis. Blood test results revealed iron-deficiency anemia and hyperhomocysteinemia, which were determined to be the cause of systemic thromboembolism. The patient tested positive for intrinsic factor antibodies. Moreover, the patient was diagnosed with autoimmune gastritis by gastrointestinal endoscopy. Therapies including anticoagulant and replacement with iron and vitamin B12 were administered. The patient was discharged from the hospital without neurological deficits. A favorable clinical course was achieved with anticoagulant administration and replacement therapy with iron and vitamin B12 for cerebral arteriovenous embolism that developed due to autoimmune gastritis.
Collapse
Affiliation(s)
- Tatsuki Mochizuki
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Bikei Ryu
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
| | - Kazuki Kushi
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Shogo Shima
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St Luke’s International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Tokyo, Japan
| |
Collapse
|
13
|
Budumuru U, R SP, Jeyaraj M, Velayutham S, Vellaichamy K, Raju SV, Krishnan M. Atypical Presentation of CVT As Orthostatic Headache. J Assoc Physicians India 2023; 71:11-12. [PMID: 37449703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
| | | | | | | | | | | | - Mugundhan Krishnan
- Professor and HOD, Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| |
Collapse
|
14
|
Vijay M, Velayutham SS, Sowmini PR, Jeyaraj KM, Saravanan RV, Kannan V, Krishnan M. Subhyaloid Hemorrhage: A Rare Manifestation of CVT. Neurol India 2023; 71:607-608. [PMID: 37322784 DOI: 10.4103/0028-3886.378655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Mangalapalli Vijay
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - S Sakthi Velayutham
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - P R Sowmini
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - K Malcolm Jeyaraj
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - R Viveka Saravanan
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - V Kannan
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Mugundhan Krishnan
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| |
Collapse
|
15
|
Frol S, Šabovič M, Oblak JP. Apixaban for the Treatment of Cerebral Venous Sinus Thrombosis: A Single-Centre Experience and Systematic Review of the Literature. CNS Drugs 2023; 37:133-141. [PMID: 36646983 DOI: 10.1007/s40263-022-00981-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Cerebral venous thrombosis (CVT) is a rare disease, and data regarding direct oral anticoagulant therapy are insufficient. Apixaban could have a safer profile than other direct oral anticoagulants. We present our case series of patients with CVT treated with apixaban and a systematic review of published real-world cases. METHODS We described our series of patients with CVT treated with apixaban and searched PubMed for similar published cases with reported complete outcome data: recanalisation rate, recurrent CVT, modified Rankin score, intracranial haemorrhage, other bleedings and mortality. RESULTS Four male patients (average age 43.5 years) with idiopathic CVT, who presented with a headache and/or seizure without neurological deficits/symptoms or cerebral infarcts/haemorrhage were treated with apixaban 5 mg twice daily for an average 28 months (18-46 months) and followed for on average 2.8 years. In two patients, a partial/complete recanalisation was achieved, there was no recurrent CVT, all patients achieved a modified Rankin score of 0, none experienced an intracranial haemorrhage, other bleedings or died. One patient, in whom anti-phospholipid syndrome was later diagnosed, had a recurrence of CVT after stopping apixaban. Our systematic review identified only 15 eligible patients (average age 39 years, 60% female). Partial/complete recanalisation was achieved in 74% of cases, there was no recurrent CVT, 95% achieved a modified Rankin score of ≤ 2, none experienced an intracranial haemorrhage, other bleedings or died. CONCLUSIONS Our cases and the review of similar published cases, albeit obtained on a smaller scale, suggest that apixaban may be a safe and effective therapy for CVT. This assumption should be tested in a large randomised study.
Collapse
Affiliation(s)
- Senta Frol
- Department of Vascular Neurology, University Clinical Centre Ljubljana, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Mišo Šabovič
- Department of Vascular Disorders, University Clinical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Pretnar Oblak
- Department of Vascular Neurology, University Clinical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
16
|
Li H, Dai Q, Shu L, Wu T, Yang D, Liu Y. Stent retriever thrombectomy in the treatment of basal artery stent thrombosis: Two case reports. Medicine (Baltimore) 2022; 101:e30541. [PMID: 36086693 PMCID: PMC10980432 DOI: 10.1097/md.0000000000030541] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Stent thrombosis is a rare but serious complication that requires timely treatment. Catheter thrombectomy is the first-line therapy for this condition; however, it may be challenging for patients with in-stent emboli located in the basilar artery. PATIENT CONCERNS Herein, we reported 2 cases with stent thrombosis in the vertebrobasilar artery, including their imaging and clinical findings. Both patients were successfully treated with stent retriever thrombectomy. DIAGNOSIS The presence of cerebral infarction was diagnosed by magnetic resonance. Cranial computed tomography excluded cerebral hemorrhage, and basilar artery occlusion was considered in combination with the medical history. INTERVENTIONS After cerebral angiography confirmed basilar artery occlusion, the stent thrombectomy was used to remove the thrombus. OUTCOMES The emboli were removed from the stent, and the angiography confirmed that the blood flow in the posterior cerebral circulation was recovered to TICI level 3. Moreover, all symptoms disappeared. LESSONS Cerebral vascular stent thrombectomy is a feasible approach for treating cerebral vascular stent thrombosis.
Collapse
Affiliation(s)
- Hang Li
- The First Clinical Medical College, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Qinghai Dai
- The First Clinical Medical College, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Lingfeng Shu
- The First Clinical Medical College, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Tao Wu
- Department of Intervention, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Dongyi Yang
- Department of Intervention, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Yangyang Liu
- Department of Intervention, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| |
Collapse
|
17
|
Lochner P, Fousse M, Goi Junior JR, Mathur S, Merzou F. Rare cerebral vein thrombosis and COVID-19 vaccine: the role of orbit ultrasound. Neurol Sci 2022; 43:2957-2959. [PMID: 35083572 PMCID: PMC8791683 DOI: 10.1007/s10072-021-05839-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/17/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany.
| | - Mathias Fousse
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| | - Joao Reinoldo Goi Junior
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| | - Shrey Mathur
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| | - Fatma Merzou
- Department of Neurology, Saarland University Medical Center, University of the Saarland, 66421, Homburg, Germany
| |
Collapse
|
18
|
Gorman JB, Field TS. ACTION-CVT: Are the Findings ACTIONable? Stroke 2022; 53:739-741. [PMID: 35143324 DOI: 10.1161/strokeaha.122.038564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Johnathon B Gorman
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada
| |
Collapse
|
19
|
Rajaonarison LA, Rasaholiarison NF, Randrianantoandro NR, Rabeony MN, Razafimahefa J, Zodaly N, Tehindrazanarivelo AD. Evolution intra-hospitalière et à trois mois des thromboses veineuses cérébrales auprès du service de neurologie de Befelatanana, Madagascar: une étude de cohorte rétrospective. Pan Afr Med J 2022; 42:93. [PMID: 36034026 PMCID: PMC9379420 DOI: 10.11604/pamj.2022.42.93.29166] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/09/2022] [Indexed: 12/05/2022] Open
Abstract
Le pronostic des thromboses veineuses cérébrales (TVC) est bien meilleur que celui des infarctus cérébraux d´origine artérielle. Nos objectifs étaient de décrire l´évolution intra-hospitalière et à trois mois des TVC auprès du Service de Neurologie de Befelatanana ainsi que la place de l´anticoagulation dans les TVC sans et avec suffusion hémorragique. Nous avons mené une étude de cohorte rétrospective des patients ayant eu une TVC du 1er janvier 2014 au 31 décembre 2019 (72 mois). Leurs caractéristiques cliniques, leurs évolutions intra-hospitalière et après 3 mois ont été collectés. Les données ont été analysées avec le logiciel R en comparant les patients ayant une TVC avec et sans suffusion hémorragique avec un p significatif ≤ 0,05. Nous avons enregistré 21/4227 (0,49%) de cas de TVC dont onze patients (52,38%) ont eu une TVC avec suffusion hémorragique. L´âge moyen était de 38,05 ans. La tranche d´âge de 18 à 34 ans (47,62%) était plus représentée. Le genre féminin prédominait dans 76,19% (n=16). A l´admission, le NIHSS < 10 était de 85,71% (n=18) et le mRS < 3 était de 61,90% (n=13). Tous les patients étaient sous anticoagulation. A la sortie de l´hôpital, le NIHSS < 10 était stable (90,47% (n=19)) avec une augmentation de patient avec un mRS < 3 (85,71% (n=18)) dont 3 étaient du groupe avec suffusion hémorragique. Le séjour hospitalier moyen était de 16,04 jours. Un patient du groupe sans suffusion hémorragique décédait pendant l´hospitalisation. A trois mois de leur sortie, seul 9 patients étaient joignables. Leur état neurologique s´améliorait (NIHSS < 10 dans 100% (n=9), mRS à 0 dans 88,89% (n=8)). Aucune différence statistiquement significative n´était trouvée entre les deux groupes en terme de handicap (p=0,757) avec un RR à 0.91 IC [0.04; 6.55] et de décès (p=0,282) (0 décès dans un groupe) entre les deux groupes mis et non mis sous anticoagulant. La mortalité et le handicap liés à la TVC anticoagulée au cours de son évolution sont très faibles. L´accessibilité à un angioscanner cérébral à faible coût permettra une meilleure prise en charge des TVC dans notre service de Neurologie.
Collapse
Affiliation(s)
- Lala Andriamasinavalona Rajaonarison
- Faculté de Médecine, Université d’Antsiranana, Antsiranana, Madagascar
- Corresponding author: Lala Andriamasinavalona Rajaonarison, Faculté de Médecine, Université d’Antsiranana, Antsiranana, Madagascar.
| | | | | | | | | | - Noël Zodaly
- Faculté de Médecine, Université d´Antananarivo, Antananarivo, Madagascar
| | | |
Collapse
|
20
|
Mourozeau L, Haution D, Vautier A, Gohier P. Sixth cranial nerve palsy secondary to spontaneous intracranial hypotension complicated by cerebral sinus venous thrombosis: Case report. J Fr Ophtalmol 2021; 45:e23-e24. [PMID: 34801274 DOI: 10.1016/j.jfo.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Affiliation(s)
- L Mourozeau
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France.
| | - D Haution
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France
| | - A Vautier
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France
| | - P Gohier
- Service d'ophtalmologie, CHU d'Angers, rue Larey, 49100 Angers, France
| |
Collapse
|
21
|
Alurkar A, Amin R, Divate P, Doshi S, Das S, Ichaporia N, Kulkarni R, Nirhale S, Pujari S, Ranade A, Sant H, Udar M, Wadia R. An Epidemiological Case Control Multi-centre Trial on Cerebral Venous Sinus Thrombosis in Western Maharashtra, India. J Assoc Physicians India 2021; 69:11-12. [PMID: 34585885] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Cerebral Sino-Venous thrombosis (CSVT) is common in India; this country has a heterogeneous population. Genetically and physio-gnomically this population differs in their diet as well as in their environment. Despite these differences CSVT has been described from all quarters of India; a common factor embracing all these patients could be nutrition. OBJECTIVES An epidemiological, case- control, multi-centre trial was carried out in patients of CSVT. A common factor underlying this could be nutrition which has not been highlighted in several studies. Hence, we studied the nutritional aspects of these patients. METHOD 63 patients of CSVT and 62 controls enrolled prospectively and followed for a year were investigated with special emphasis on their nutritional status. RESULTS The triceps skin fold thickness, energy baseline, serum Proteins, Albumin, Hemogram and Platelet counts were lower in patients than in the controls while serum Homocysteine, carbohydrates and fats were higher in patients than in controls. CONCLUSION The results of this study confirm nutritional deficiencies in patients of CSVT and it begs the question of whether nutrition in any way is causal in CSVT. Larger multi-centric trials will help establishing causality. The study also shows that routine evaluation of thrombophilia factors and immunological tests are not necessary in CSVT.
Collapse
Affiliation(s)
| | - Rajani Amin
- BJ Medical College and Navale Medical College, Pune, Maharashtra
| | - Pradeep Divate
- KEM Hospital and Sahyadri Speciality Hospital, Pune, Maharashtra; Corresponding Author
| | - Suyog Doshi
- Bharati Vidyapeeth Medical College and Sahyadri Specialty Hospital, Pune, Maharashtra
| | - Soma Das
- Jehangir Clinical Development Centre, Pune, Maharashtra
| | | | | | | | | | - Arati Ranade
- Jehangir Clinical Development Centre, Pune, Maharashtra
| | - Hemant Sant
- Sahyadri Speciality Hospital, Pune, Maharashtra
| | | | | |
Collapse
|
22
|
Abstract
Nitrous oxide (NO) is an inhalant that has become increasingly popular as a recreational drug. While it is presumed to be harmless, a number of adverse effects of NO have been described. We discuss the case of a 24-year-old man with no medical history, who initially presented to the emergency department with progressive polyneuropathy caused by vitamin B12 deficiency after NO abuse. Two days after being discharged with hydroxocobalamin supplementation, the patient returned with a severe headache, blurry vision and slurred speech. Imaging revealed cerebral venous sinus thrombosis. Hypercoagulability workup showed slightly elevated homocysteine and normalised vitamin B12 after supplementation. Genetic testing showed a heterozygous prothrombin G20210A mutation. He was treated with low-molecular-weight heparin followed by dabigatran. We hypothesise that NO use may increase the risk of developing cerebral venous thrombosis, especially in patients with multiple risk factors and elevated homocysteine levels.
Collapse
Affiliation(s)
- Laura de Valck
- Neurology, Zuyderland Medisch Centrum Sittard-Geleen, Sittard-Geleen, The Netherlands
| | | | | |
Collapse
|
23
|
Anderst J, Carpenter S, Frazier T, Appavu B, Noetzel M, Beslow LA, Sharma M. Subdural hemorrhage in a cohort with cerebral sinovenous thrombosis: Application to abusive head trauma. Child Abuse Negl 2021; 117:105119. [PMID: 34023741 DOI: 10.1016/j.chiabu.2021.105119] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cerebral sinovenous thrombosis (CSVT) is a postulated cause of subdural hemorrhage (SDH) that is hypothesized to mimic abusive head trauma (AHT). Minimal data exists directly investigating this relationship. OBJECTIVES To evaluate the frequency of SDH in children with CSVT, identify factors associated with CSVT and SDH, and to assess if any association supports the hypothesis that CSVT causes SDH. PARTICIPANTS AND SETTING The International Pediatric Stroke Study (IPSS) prospectively collects data on subjects birth to 19 years of age with intracranial thrombosis. METHODS IPSS subjects with CSVT and SDH were compared to those with CSVT and no SDH. For subjects with CSVT and SDH, neuroimaging reports further characterized the findings. In any case with no known risk factors for SDH, neuroimaging studies were reviewed by a pediatric neuroradiologist. RESULTS Of 216 subjects with CSVT, 20 (9.3%) had SDH. Those with SDH (median age 0.3 years) were younger than those without SDH (median age 4.2 years), p < 0.001. Subjects with CSVT and SDH more frequently had anoxia (OR = 10.8; 95% CI: 1.4, 81.1), head/neck injury (OR = 4.0; 95% CI: 1.3, 12.6), or abnormal consciousness (OR = 3.0; 95% CI: 1.2, 7.6). Of 20 subjects with CSVT and SDH, 19 had known risk factors for SDH. The remaining subject had a chronic SDH identified concomitantly to a newly symptomatic CSVT with accompanying venous infarctions. CONCLUSIONS SDH in the setting of CSVT is typically identified in children with independent risk factors for SDH. This study does not support the hypothesis that CSVT causes SDH.
Collapse
Affiliation(s)
- James Anderst
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States.
| | - Shannon Carpenter
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Terra Frazier
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Brian Appavu
- Department of Pediatrics, University of Arizona College of Medicine, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Michael Noetzel
- Department of Neurology, St. Louis Children's Hospital, Washington University, St. Louis, MO, United States
| | - Lauren A Beslow
- Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Mukta Sharma
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| |
Collapse
|
24
|
Dhadke VN, Dhadke SV, Kulkarni A. Clinical Profile of Cerebral Venous Sinus Thrombosis. J Assoc Physicians India 2020; 68:33-35. [PMID: 32138480] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Cerebral venous sinus thrombosis (CVT) occurs due to occlusion of the veins and sinuses which drain the brain parenchyma. It is an uncommon form of stroke, predominantly found in young patients1 . Despite advances in the recognition of CVT in recent years, diagnosis and management can be difficult because of the diversity of underlying risk factors, presenting features and the absence of a uniform treatment approach. This study aimed to ascertain the clinical presentation, various aetiologies and prognostic indicators of cerebral venous sinus thrombosis. METHODOLOGY This hospital-based descriptive study was carried out on 30 eligible patients from December 2013 to July 2015 after approval of Institutional Ethics Committee. Detailed history, clinical findings and required relevant investigations were recorded and analysed. RESULTS CVT was commonly observed in younger persons, commonly between 21-30 years. Female: Male ratio was 2.33. Altered sensorium at presentation was a poor prognostic indicator. The most common etiology was pregnancy and puerperium, followed by hyperhomocysteinemia. Superior sagittal sinus was found to be the most common site of thrombosis in this study, in 17 (56.7%) of the patients. 17 patients (56.67%) recovered completely without any neurodeficit. 24 ( 80%) and 22 (66%) subjects had cerebral infarction secondary to CVT. 5 (16.67%) patients succumbed to thrombosis or complications, most commonly due to intracerebral haemorrhage and cerebral edema. CONCLUSION CVT is a disease with multifactorial, gender-related specific causes and has a wide and varied clinical spectrum.
Collapse
Affiliation(s)
| | - Shubhangi V Dhadke
- Associate Professor, Department of Medicine, Dr. V.M. Govt. Medical College, Solapur, Maharashtra; Corresponding Author
| | - Akshay Kulkarni
- Senior Resident, Neurology Dept., Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
| |
Collapse
|
25
|
Garapati RM, Satyanarayana P, Sravani GS. Cerebral Venous Thrombosis in Women. J Assoc Physicians India 2020; 68:60. [PMID: 31979642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
26
|
Hari R. Letter to Editor - Spectrum of Cerebral Venous Thrombosis. J Assoc Physicians India 2019; 67:95. [PMID: 31562735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Radhakrishna Hari
- Consultant Neurologist, Care Hospitals, Nampally, Hyderabad, Telangana
| |
Collapse
|
27
|
Sarkar R, Paul R, Thakur I, Sau TJ, Roy D, Pandey R, Mani A, Ruia AV. Multiple Cerebral Venous Sinus Thrombosis as Fist Manifestation of Primary Anti-Phospholipid Antibody Syndrome. J Assoc Physicians India 2018; 66:11-12. [PMID: 31317720] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Antiphospholipid antibody syndrome (APS) is an autoimmune disorder, mainly found in young females, presenting with vascular thrombosis and/or obstetric complications. Thrombosis at anatomically significant sites may lead to considerable morbidity and/or mortality. We here present a case of primary APS presenting with sudden onset bilateral multiple cerebral venous sinus thrombosis. The patient, a 17 year old female with no prior rheumatological history, presented with sudden onset bilateral painful blindness and massive proptosis. MRI venography was instrumental in diagnosis. She also had significant thrombocytopenia. Except for the visual dimness, the other symptoms responded to therapy. Such massive cerebral venous thrombosis is extremely rare in primary APS.
Collapse
Affiliation(s)
- Rathindranath Sarkar
- 1 Professor and HOD, 2 Assistant Professor, 3 Professor, 4Resident, Dept. of Medicine, Medical College, Kolkata, West Bengal
| | - Rudrajit Paul
- Assistant Professor,Dept. of Medicine, Medical College, Kolkata, West Bengal
| | - Indranil Thakur
- Assistant Professor,Dept. of Medicine, Medical College, Kolkata, West Bengal
| | - Tanmay Jyoti Sau
- Professor, Dept. of Medicine, Medical College, Kolkata, West Bengal
| | - Debaditya Roy
- Resident, Dept. of Medicine, Medical College, Kolkata, West Bengal
| | - Rajesh Pandey
- Resident, Dept. of Medicine, Medical College, Kolkata, West Bengal
| | - Avinash Mani
- Resident, Dept. of Medicine, Medical College, Kolkata, West Bengal
| | | |
Collapse
|
28
|
Liberman AL, Bakradze E, Merkler AE. Response by Liberman et al to Letter Regarding Article, "Misdiagnosis of Cerebral Vein Thrombosis in the Emergency Department". Stroke 2018; 49:e280. [PMID: 29976577 PMCID: PMC6202240 DOI: 10.1161/strokeaha.118.022219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ava L. Liberman
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ekaterina Bakradze
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Alexander E. Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute
- Department of Neurology, Weill Cornell Medicine, New York, NY
| |
Collapse
|
29
|
Bhat SJ, Kashyap PV. Spectrum of Cerebral Venous Thrombosis in Uttarakhand. J Assoc Physicians India 2018; 66:43-47. [PMID: 31325261] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND CVT is an uncommon but important cause of stroke that is often misdiagnosed delaying its treatment. High suspicion is essential in early recognition and treatment. OBJECTIVE To study the clinical features and etiology of patients with Cerebral Venous Thrombosis (CVT) and relation between septic and non septic CVT if any. PATIENTS AND METHODS A prospective study was done in SMIH that enrolled 40 patients of CVT in 2 years duration (Jan 2014 to Dec 2015). The patients were diagnosed as CVT according to Magnetic Resonance Venogram (MRV) and clinical status. RESULTS Forty (40) patients of CVT were enrolled during 2 years period, most were females (22/30) and aged between 18-50 years (mean age 30.2+4.9). Most common presentation was headache followed by seizures and focal deficit. Other symptoms encountered were cranial nerve palsies, meningeal signs, papilloedema. Most common headache type was tension type headache. Most common cranial nerve involvement was abduscens nerve. Superior Sinus Thrombosis (SSS) involvement was most commonly thrombosed followed by its involvement with other sinuses. Isolated lateral sinus involvement also seen. On screening for cause, non septic CVT outnumbered septic CVT (22/8) and the most common cause of non septic CVT was unknown followed by coagulation defect. Among septic CVT group puerperial sepsis in females and mastoiditis in males were the dominant cause. CONCLUSION Septic CVT prognosis had better than non septic CVT. Hence, CVT presents with wide range of presentations and anticoagulation is the treatment. Septic CVT if intervened timely with proper antibiotics have better prognosis. Antibiotics are the mainstay of therapy for septic CVT.
Collapse
Affiliation(s)
- Sunil Jee Bhat
- Senior Resident,Shri Mahant Indiresh Hospital, Dehradun , Uttarakhand
| | - Priyanka Vikas Kashyap
- Assistant Professor, Shri Mahant Indiresh Hospital, Dehradun , Uttarakhand ;Corresponding Author
| |
Collapse
|
30
|
Fan H, Zhu JH. Pregnancy outcome after a first episode of cerebral vein thrombosis: comment. J Thromb Haemost 2017; 15:1525-1526. [PMID: 28456997 DOI: 10.1111/jth.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- H Fan
- Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang Province, China
| | - J-H Zhu
- Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang Province, China
| |
Collapse
|
31
|
Martinelli I, Abbattista M, Somigliana E, Gianniello F, Peyvandi F. Pregnancy outcome after a first episode of cerebral vein thrombosis: reply. J Thromb Haemost 2017; 15:1526. [PMID: 28457015 DOI: 10.1111/jth.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - M Abbattista
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - E Somigliana
- Center for Research in Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - F Gianniello
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - F Peyvandi
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| |
Collapse
|
32
|
Huang Y, Mei WL, Liu HQ, Li YL, Chen ZZ, Li DD, Zhang JW. [Diagnostic value of clot burden score of susceptibility vessel sign in arterial thrombosis of acute ischemic stroke and its association with prognosis]. Zhonghua Yi Xue Za Zhi 2017; 97:7-11. [PMID: 28056282 DOI: 10.3760/cma.j.issn.0376-2491.2017.01.003] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To analysis the value of susceptibility vessel sign (SVS) in susceptibility weighted imaging (SWI) in detecting thrombogenesis in middle cerebral artery (MCA) and its association with clinical prognosis. Methods: From December 2014 to December 2015 in People's Hospital of Zhengzhou University, we retrospectively examined clinical, imaging and experimental datafrom 104 consecutive patients with acute ischemic strokeand compared the consistency of detecting thrombus between SWI and magnetic resonance angiography (MRA) using Kappa analysis. Clot Burden Score (CBS) was used to analysis extent and scope of thrombus. The association between CBS and clinical prognosiswere analyzed by Spearman rank correlation. Results: Mean age was 60 years old of the 104 patients with acute cerebral infarction and female accounted for 32%. There were 39 patients (37.5%) with SVS positive in SWI and 32 patients (30.8%) with both SVS positive and MRA occlusion or severe stenosis. The consistency in predicting arterial thrombosis of occlusion or severe stenosis between MRA and SVS in SWI was statistically significant (Kappa=0.502, P<0.001). There were 6 cases with SVS positive and none stenosis in MRA, and all the clots in this 6 case were located in distal artery. CBS was significantly associated with 3-month outcome (Spearman ρ =-0.472; P<0.001). Conclusion: SWI is superior to MRA for the detection of intracranial distal thrombus in patients with acute ischemic stroke of the MCA territory. Higher clot burden(lower CBS) could be an important clinical tool to estimate poor outcome in patients with acutecerebral infarction.
Collapse
Affiliation(s)
- Y Huang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou 450003, China
| | | | | | | | | | | | | |
Collapse
|
33
|
Tufano A, Macarone Palmieri N, Cimino E, Alfinito F, Cerbone AM. Budd-Chiari syndrome in a paroxysmal nocturnal hemoglobinuria patient with previous cerebral venous thrombosis. Intern Emerg Med 2009; 4:75-7. [PMID: 18677447 DOI: 10.1007/s11739-008-0182-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
|
34
|
Abstract
Unilateral thalamic infarction is a rare condition in adults. This is a case report of a young child presenting with left-sided hemiparesis of sudden onset due to an unilateral venous thalamic infarction. This was attributed to an asymmetric thrombosis of the cerebral internal veins, a partial thrombosis of the vein of Galen and straight sinus. Magnetic resonance imaging resulted primarily in the differential diagnosis of a cerebral tumor or an intracerebral abscess, leading to stereotactic puncture. Subsequent magnetic resonance venography facilitated the correct diagnosis. Heparin-induced thrombocytopenia necessitated anticoagulation treatment with hirudin and later, warfarin. The patient made a complete recovery. We conclude that unclear unilateral thalamic lesions might be symptomatic of a cerebral deep venous thrombosis and might mimic a thalamic tumor. In uncertain cases, we suggest rapid performance of magnetic resonance angiography.
Collapse
Affiliation(s)
- Verena Haug
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Germany.
| | | | | | | | | | | |
Collapse
|
35
|
PERRIER H. [Intracranial venous thrombosis]. Confin Neurol 2008; 8:39-52. [PMID: 18910050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
36
|
DE SOUSA PEREIRA A. [Sympathetic surgery in the treatment of embolism and cerebral thrombosis]. P V Expo Discuss Congr Soc Int Chir 2008; 12 Congr. (1 vol.):375-387. [PMID: 18123000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
37
|
|
38
|
Eliasson A, Bergqvist D, Björck M, Acosta S, Sternby NH, Ogren M. Incidence and risk of venous thromboembolism in patients with verified arterial thrombosis: a population study based on 23,796 consecutive autopsies. J Thromb Haemost 2006; 4:1897-902. [PMID: 16881933 DOI: 10.1111/j.1538-7836.2006.02152.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between atherothrombotic disease and venous thromboembolism (VTE) remains unclear. PATIENTS AND METHODS In a cohort of 23,796 consecutive autopsies, performed using a standardized procedure and representing 84% of all in-hospital deaths between 1970 and 1982 in an urban Swedish population, we investigated the relationship between verified arterial thrombosis and VTE, with the hypothesis that patients with thrombosis in major artery segments have increased odds of VTE. RESULTS We found an increased risk of VTE in patients with arterial thrombosis (Odds ratio; OR adjusted for gender and age 1.4, 95% confidence interval; CI 1.3-1.5) (P < 0.001). Patients with cervico-cranial and peripheral artery thrombosis had an excess risk even when controlling for age and major concomitant diseases. A negative association between coronary thrombosis and VTE in the univariate analysis (OR 0.7; 95% CI 0.6-0.8) (P < 0.001), was less pronounced in the multivariate analysis (OR 0.8; 95% CI 0.7-1.0) (P = 0.016). CONCLUSIONS A positive association between atherothrombosis and VTE was confirmed, except in patients with coronary thrombosis, where IHD as competing death cause is a possible confounder. Our findings indicate a potential for directed prevention, but may also imply similarities in etiology.
Collapse
Affiliation(s)
- A Eliasson
- Department of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Venous thromboembolism has become an increasingly recognized clinical entity in children over the past decade. Recently, important efforts have been made to track post thrombotic outcomes. The present review discusses the knowledge gained from seminal studies in the field over the past decade, with particular emphasis on the findings of numerous published reports on outcomes of various types of venous thromboembolism in the pediatric literature from January 2003 to January 2005. RECENT FINDINGS Large cohort studies involving acute venous thromboembolism of all types in children have recently confirmed a rather low frequency of recurrent venous thromboembolism, but have shown a lack of thrombus resolution following standard-duration anticoagulant therapy in as many as 50% of patients. In addition, the development of the post thrombotic syndrome has been demonstrated in greater than one third of children with venous thromboembolism involving the extremities. Persistent thrombosis despite adequate anticoagulation has been independently associated with complete vaso-occlusion at diagnosis. Furthermore, the presence of elevated levels of factor VIII and D-dimer either at diagnosis or following three to six months anticoagulation has now been defined as a predictor of adverse long-term outcomes of pediatric thrombosis. SUMMARY This body of work indicates that the various forms of venous thromboembolism in children are in general associated with a considerable degree of adverse outcomes, particularly in the form of venous thromboembolism-related mortality, recurrent thromboembolism, and development of post thrombotic syndrome. Advances in the prediction of post thrombotic outcomes have begun, and must continue to facilitate a risk-stratified approach to antithrombotic management in children, and to ultimately achieve meaningful improvements in long-term outcomes.
Collapse
Affiliation(s)
- Neil A Goldenberg
- Section of Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, University of Colorado Health Sciences Center / The Children's Hospital, Denver, CO 80045-0507, USA.
| |
Collapse
|
40
|
|
41
|
NATH K, SARIKWAL VK. A CASE OF SUSPECTED SYPHILITIC CEREBRAL THROMBOSIS WITH HEMIPLEGIA ON THE LEFT SIDE. J Indian Med Assoc 1965; 44:136-40. [PMID: 14271940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
|
42
|
PUGLIESE L, DEJORIO PL. [ON A CASE OF ANOSOGNOSIA IN A PATIENT WITH RIGHT MIDDLE CEREBRAL THROMBOSIS]. Riv Neurobiol 1964; 10:496-508. [PMID: 14287595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
|
43
|
PHILIPPE Y, REY M, GIORDANO C, NOUHOUAYI A. [CEREBRAL ANGIOMA. SPONTANEOUS THROMBOSIS (APROPOS OF 1 CASE)]. Bull Soc Med Afr Noire Lang Fr 1964; 9:483-6. [PMID: 14306050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
|
44
|
MOUCHETTE R, THIBAUT A. [CEREBRAL THROMBOSIS]. Rev Med Liege 1963; 18:787-96. [PMID: 14105758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|
45
|
SKINHOJ E. [ANTICOAGULANT TREATMENT IN CEREBRAL THROMBOSIS]. Nord Med 1963; 70:1146-7. [PMID: 14060596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|
46
|
|
47
|
ORENGO AM, MATTERA RS. [EVOLUTIVE COURSE OF CEREBRAL THROMBOSES TREATED WITH NICOTINATE OF 7-(3-(N-METHYL-2-HYDROXYETHYLAMINO)-2-HYDROXYPROPYL)-1,3-DIMETHYLXANTHINE. (PRELIMINARY COMMUNICATION)]. Sem Med 1963; 122:1558-60. [PMID: 14070126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|
48
|
BILLET R, GACHES J, BROCAS J. [Paraclinical examination in cerebral arterial thrombosis]. Sem Hop 1963; 39:1299-304. [PMID: 13968264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
|
49
|
KIM SW. [Cerebral thrombosis and hypotension]. Taehan Uihak Hyophoe Chi 1962; 5:827-33. [PMID: 14032684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|
50
|
UEDA H, GOTO H, KATAYAMA S, SUGIMOTO T, YAMAMOTO H. [Examination of a misdiagnosed case of cerebrovascular disorder: brain neoplasm or cerebral thrombosis?]. Naika 1962; 10:503-7. [PMID: 13995128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
|