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Ordieres-Ortega L, Moragón-Ledesma S, Demelo-Rodríguez P. Cerebral venous thrombosis. Rev Clin Esp 2024; 224:237-244. [PMID: 38428733 DOI: 10.1016/j.rceng.2024.02.015] [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: 03/03/2024]
Abstract
Cerebral venous thrombosis is part of the so-called thrombosis in unusual sites. It is defined as an occlusion in the cerebral venous territory. Its incidence is progressively increasing, especially in developing countries. It is more frequently observed in young women, with hormonal factors such as pregnancy or hormonal contraception being significant risk factors in the development of this condition. The clinical presentation will depend fundamentally on the topography of the thrombosis, with a confirmatory diagnosis based mainly on imaging tests. The treatment generally consists of anticoagulation, and other options may be considered depending on the severity of the case. Overall, the prognosis is better than that of other intracranial vascular disorders. This review describes the current evidence available regarding cerebral venous thrombosis.
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Affiliation(s)
- L Ordieres-Ortega
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - S Moragón-Ledesma
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - P Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Spain.
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2
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Xu L, Fu G. Cerebral venous thrombosis presented with symmetrical crescent-shaped intracranial hemorrhage in alcoholic liver disease: Case reports. Medicine (Baltimore) 2024; 103:e37441. [PMID: 38457541 PMCID: PMC10919519 DOI: 10.1097/md.0000000000037441] [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: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Cerebral venous thrombosis (CVT) is a relatively uncommon but fatal disease. It can be caused by a variety of hereditary or acquired thrombotic diseases. Initial presentation with intracranial hemorrhage (ICH) in CVT is rare but can further complicate the therapeutic measures and prognosis. Cases of CVT presented with ICH in patients with alcoholic liver disease (ALD) have not been described in the literature, and it might be related with hemostatic abnormalities in ALD patients. PATIENT CONCERNS We report 2 cases of men admitted to our hospital who were diagnosed with CVT but initially presented with symmetrical crescent-shaped ICH; both of them were ALD patients. DIAGNOSES Cerebral imaging revealed extended CVT in both cases. The first case was a 64-year-old man with ALD deteriorated with unconsciousness and convulsions; computed tomography showed symmetrical crescent-shaped ICH in the right temporal lobe, and magnetic resonance venography revealed CVT. Another 50-year-old man with ALD complained about dizziness and weakness of his right limbs; computed tomography revealed symmetrical crescent-shaped ICH in bilateral parietal and occipital lobes, and magnetic resonance venography revealed CVT. INTERVENTIONS The first patient was referred to the endovascular thrombectomy. Both of them were treated with anticoagulation treatment. OUTCOMES Favorable outcomes were observed in both patients. LESSONS Symmetrical or multiple crescent-shaped ICH requires a high suspicion in the diagnosis of CVT; even with hemorrhage, it is still important to initiate anticoagulation therapy promptly. The crescent-shaped ICH might be a new sign for CVT, and further studies are needed in the underlying mechanisms of ALD and potential thrombophilia.
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Affiliation(s)
- Lingjia Xu
- Department of Neurology, Shaoxing Second Hospital, The Second Affiliated Hospital of Shaoxing University Medical College, Shaoxing, Zhejiang, China
| | - Guoping Fu
- Department of Neurology, Shaoxing Second Hospital, The Second Affiliated Hospital of Shaoxing University Medical College, Shaoxing, Zhejiang, China
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Shi Y, Chen K, Sui Y, Huang C. Posttraumatic delayed cerebral venous thrombosis with thrombocytopenia leading to multiple delayed intracranial hemorrhage. Asian J Surg 2023; 46:5619-5620. [PMID: 37599130 DOI: 10.1016/j.asjsur.2023.08.008] [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: 07/18/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Yu Shi
- Department of Neurosurgery, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China
| | - Kai Chen
- Department of Neurosurgery, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China
| | - Yihang Sui
- Department of Neurology, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China
| | - Changren Huang
- Department of Neurosurgery, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China; Neurosurgical Clinical Research Center of Sichuan Province Luzhou, China; Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Laboratory of Neurological Diseases and Brain Functions, The Affliated Hospital of Southwest Medical University, Luzhou, China.
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Tashiro T, Kira Y, Maeda N. Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension. Intern Med 2023; 62:3021-3025. [PMID: 36792193 PMCID: PMC10641184 DOI: 10.2169/internalmedicine.1113-22] [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: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023] Open
Abstract
A 38-year-old woman with untreated Graves' disease was admitted to our hospital because of headache and diplopia for 3 months. A neuro-ophthalmic examination showed bilateral papilledema and abducens nerve paralysis. The cerebrospinal fluid pressure was extremely high. Brain magnetic resonance imaging showed cerebral venous thrombosis in the superior sagittal and right transverse and sigmoid sinuses. Laboratory investigations revealed elevated factor VIII and von Willebrand factor levels. The patient recovered after propylthiouracil and anticoagulation therapy. We herein report a rare case of cerebral venous thrombosis with hyperthyroidism presenting as chronic isolated intracranial hypertension. Hyperthyroidism can induce a hypercoagulable state and lead to venous thromboembolism.
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Affiliation(s)
- Takumi Tashiro
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Yuichi Kira
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
| | - Norihisa Maeda
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
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Ashraf VV, Salam KA, Kizhedath R, Puthussery K. Hereditary Antithrombin Deficiency Presenting with Cerebral Venous Thrombosis in Three Members of a Family. Neurol India 2023; 71:984-986. [PMID: 37929439 DOI: 10.4103/0028-3886.388110] [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: 11/07/2023]
Abstract
Hereditary antithrombin (AT) deficiency is a rare thrombophilia associated with cerebral vein thrombosis (CVT). We report a case study of hereditary AT deficiency causing CVT in three members of a family. A 29-year-old female presented with features of CVT. Her mother and a sister had CVT in the past and investigation for hereditary thrombophilia revealed low blood AT activity in all of them. The index patient (proband) was positive for the SERPINC1 gene mutation confirming the diagnosis of hereditary AT deficiency. She recovered well with anticoagulation and was advised to continue it lifelong. Diagnosing hereditary thrombophilia like AT deficiency is important in planning anticoagulation and proper counseling of asymptomatic family members regarding prophylaxis for venous thromboembolism (VTE) in high-risk situations.
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Affiliation(s)
- V V Ashraf
- Department of Neurology, Meitra Hospital, Edakkad PO, Calicut, Kerala, India
| | - K Abdul Salam
- Department of Neurology, Meitra Hospital, Edakkad PO, Calicut, Kerala, India
| | - Rajesh Kizhedath
- Department of Radiology, Meitra Hospital, Edakkad PO, Calicut, Kerala, India
| | - Krishnan Puthussery
- Department of Radiology, Meitra Hospital, Edakkad PO, Calicut, Kerala, India
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Grigore I, Miron I, Gavrilovici C, Lupu VV, Antal DC, Schreiner TG, Prazaru C, Lupu A, Dragan F, Grigore E. SARS-CoV-2 Possible Etiology of Cerebral Venous Thrombosis in a Teenager: Case Report and Review of Literature. Viruses 2023; 15:v15020405. [PMID: 36851619 PMCID: PMC9965073 DOI: 10.3390/v15020405] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Cerebral venous thrombosis in pediatric patient has a varied etiology. The authors present the case of a teenager who, since the debut of SARS-CoV-2 infection, has accused intermittent right side hemicrania, which has become persistent in association with nausea and vomiting since the 5th day of quarantine. She was hospitalized in the 9th day since the debut. Neuroimaging revealed extended venous cerebral thrombosis affecting the right sigmoid sinus, the transverse sinus bilaterally, the confluence of the transverse sinuses and the right internal jugular vein. The evolution was favorable under anticoagulant and symptomatic treatment. Laboratory tests excluded other etiological causes for the cerebral venous thrombosis, thus the authors consider that cerebral thrombosis is a possible complication of SARS-CoV-2 infection in teenagers.
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Affiliation(s)
- Ioana Grigore
- “St. Mary” Children Emergency Hospital, 700309 Iasi, Romania
| | - Ingrith Miron
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Gavrilovici
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (V.V.L.); (A.L.)
| | - Dorin Cristian Antal
- Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Catalin Prazaru
- “St. Mary” Children Emergency Hospital, 700309 Iasi, Romania
| | - Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (V.V.L.); (A.L.)
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Ecaterina Grigore
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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M O, JK CG, I G, NR K, CM C, W B. Prevalence of cerebral vein thrombosis among patients with spontaneous intracranial hypotension. Interv Neuroradiol 2022; 28:719-725. [PMID: 34904470 PMCID: PMC9706257 DOI: 10.1177/15910199211065912] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/17/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis (CVST) is a rare condition but an important complication of spontaneous intracranial hypotension (SIH). We reviewed our experience of patients with SIH and assessed for the presence of CVST. METHODS We reviewed the medical records and imaging studies from our tertiary referral institution, assessing patients with clinically suspected SIH as well as imaging findings of intracranial hypotension. All relevant brain MRIs were reviewed for the presence of brain sag, pachymeningeal enhancement, and CVST. RESULTS Among 563 patients with a clinical diagnosis of SIH, 431 (76%) demonstrated brain sag. In the overall patient cohort, a total of 5 patients had CVST (0.9%) and all 5 of these patients demonstrated findings of brain sag. Of the patients with CVST, 3 had significant complications, including dural arteriovenous fistulas (2 patients) and lobar hemorrhage with seizure (1 patient). CONCLUSION SIH is a risk factor for the development of CVST. In our review of 563 patients with clinical and/or imaging findings of SIH, 0.9% of patients were diagnosed with CVST and 3 of these patients (60%) had additional severe complications.
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Affiliation(s)
- Oien M
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Garza I
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Kissoon NR
- Neurology, Mayo Clinic, Rochester, MN, USA
| | - Carr CM
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Brinjikji W
- Departments of Radiology, Mayo Clinic, Rochester, MN, USA
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Raharimaminjatovosoa DA, Randrianantoandro NR, Rahamefy Randrianasolo O, Rafararison Onihariliva F, Zodaly N, Razafimahefa J, Tehindrazanarivelo AD. Cerebral venous thrombosis associated with infective endocarditis in a young patient. J Med Vasc 2022; 47:191-194. [PMID: 36344030 DOI: 10.1016/j.jdmv.2022.09.001] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Cerebral venous thrombosis (CVT) is a rare complication of infective endocarditis. It constitutes a diagnostic and therapeutic emergency. We report a case of cerebral thrombophlebitis due to infective endocarditis in order to discuss the diagnosis and management of this situation. The patient was a 19-year-old man presenting with sudden explosive headaches with meningeal syndrome, right hemiparesis and right hypoesthesia. The cerebral CT angiography showed a left parieto-occipital and intraventricular hematoma without classic aneurysm or mycotic aneurysm or arteriovenous malformation. The injected brain magnetic resonance imaging found a CVT in front of a stopped opacification of the left lateral branch of the superior sagittal sinus. The presence of fever, poor oral status and a heart murmur justified the prescription of transthoracic echodoppler. It showed vegetations on healthy aortic valves. The patient was put on antibiotics and anticoagulants with favorable evolution. The absence of usual risk factors for CVT, the negativity of thrombophilia tests, the inflammatory and prothrombotic state associated with the infection reinforce the causal link of infective endocarditis to CVT formation. The etiology of CVT is variable, can be multiple and requires a comprehensive assessment. Infective endocarditis is one of the rare etiologies of CVT. In this case, anticoagulation and antibiotic drugs are indicated, taking into account the risk of intracerebral bleeding.
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Affiliation(s)
| | | | | | | | - Noel Zodaly
- Neurology department Befelatanana University Hospital, Antananarivo, Madagascar
| | - Julien Razafimahefa
- Neurology department Befelatanana University Hospital, Antananarivo, Madagascar
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Affiliation(s)
- Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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10
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Domingo RA, Ramos-Fresnedo A, Perez-Vega C, Tripathi S, Pullen MW, Martinez JL, Erben YM, Meschia J, Tawk RG. Cerebral venous thrombosis during the COVID-19 Pandemic: A multi-center experience. Clin Neurol Neurosurg 2022; 217:107256. [PMID: 35462303 PMCID: PMC9017058 DOI: 10.1016/j.clineuro.2022.107256] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
Objective To describe the clinical characteristics and outcomes of CVT in patients with history of recent COVID-19 infection or vaccination. Methods We reviewed demographic, clinical, and radiographic characteristics of non-pyrogenic, non-traumatic CVT cases at our multi-center institution between March 2020 and December 2021. Patients were grouped according to their history of recent COVID-19 infection or vaccination into group-I (+COVID-19 association) and group-II (-COVID-19 association). Results Fifty-one patients with CVT were included, of which 14 (27.4%) had a positive COVID-19 association: 10 with infection and 4 with mRNA-COVID-vaccine. Nine patients in group-I had COVID-19 infection or vaccine within 30 days of CVT diagnosis, including 3 patients with active infection at the time of CVT diagnosis. Half of the patients in group-I (n = 7,50.0%) and 32.4% (n = 12) of group-II were male, and mean age was 52.6 years in group-I and 51.4 years in group-II. Fever at presentation was noted in one patient who had active COVID infection (I=1 (7.1%), II= 0 (0%)). Higher rates of comorbidities were observed in group-II: hypertension (I= 2 (14.3%), II= 13 (35.1%)), deep venous thrombosis(I=1(7.1%), II= 10 (27.0%)), pulmonary emboli (I=1(7.1%), II= 8(21.6%)), or stroke(I=0(0%), II= 6(16.4%)). Three patients had thrombocytopenia at the time of CVT diagnosis (5.4%) and most patients (n = 37, 72.5%) were treated medically with anticoagulation. Complication rate during hospitalization was 17.6% (n = 6), and no mortality was noted. Conclusion Twenty-seven percent of CVT patients were associated with COVID-19 infection or vaccination, and the majority presented within 30 days of infection/vaccination.
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Affiliation(s)
- Ricardo A Domingo
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Carlos Perez-Vega
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Shashwat Tripathi
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael W Pullen
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Jaime L Martinez
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Young M Erben
- Neurology Department, Mayo Clinic, Jacksonville, Florida, USA
| | - James Meschia
- Neurology Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Rabih G Tawk
- Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA.
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Abstract
Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease that impairs people’s wellbeing and quality of life. Inflammation is considered to play an important role in CVT initiation and progression. Several studies have reported the important role of leukocytes, proinflammatory cytokines, and adherence molecules in the CVT-related inflammatory process. Moreover, inflammatory factors exacerbate CVT-induced brain tissue injury leading to poor prognosis. Based on clinical observations, emerging evidence shows that peripheral blood inflammatory biomarkers—especially neutrophil-to-lymphocyte ratio (NLR) and lymphocyte count—are correlated with CVT [mean difference (MD) (95%CI), 0.74 (0.11, 1.38), p = 0.02 and −0.29 (−0.51, −0.06), p = 0.01, respectively]. Moreover, increased NLR and systemic immune-inflammation index (SII) portend poor patient outcomes. Evidence accumulated since the outbreak of coronavirus disease-19 (COVID-19) indicates that COVID-19 infection and COVID-19 vaccine can induce CVT through inflammatory reactions. Given the poor understanding of the association between inflammation and CVT, many conundrums remain unsolved. Further investigations are needed to elucidate the exact relationship between inflammation and CVT in the future.
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Affiliation(s)
- Jiayue Ding
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Baoying Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiran Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xaingyu Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhiying Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Duo Lan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- *Correspondence: Ran Meng,
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Tu TM, Yi SJ, Koh JS, Saffari SE, Hoe RHM, Chen GJ, Chiew HJ, Tham CH, Seet CYH, Yong MH, Yong KP, Hui ACF, Fan BE, Tan BYQ, Quek AML, Seet RCS, Yeo LLL, Tan K, Thirugnanam UN. Incidence of Cerebral Venous Thrombosis Following SARS-CoV-2 Infection vs mRNA SARS-CoV-2 Vaccination in Singapore. JAMA Netw Open 2022; 5:e222940. [PMID: 35297971 PMCID: PMC8931554 DOI: 10.1001/jamanetworkopen.2022.2940] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Reports of cerebral venous thrombosis (CVT) after messenger RNA (mRNA)-based SARS-CoV-2 vaccination has caused safety concerns, but CVT is also known to occur after SARS-CoV-2 infection. Comparing the relative incidence of CVT after infection vs vaccination may provide a better perspective of this complication. OBJECTIVE To compare the incidence rates and clinical characteristics of CVT following either SARS-CoV-2 infection or mRNA-based SARS-CoV-2 vaccines. DESIGN, SETTING, AND PARTICIPANTS Between January 23, 2020, and August 3, 2021, this observational cohort study was conducted at all public acute hospitals in Singapore, where patients hospitalized with CVT within 6 weeks of SARS-CoV-2 infection or after mRNA-based SARS-CoV-2 vaccination (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) were identified. Diagnosis of SARS-CoV-2 infection was based on quantitative reverse transcription-polymerase chain reaction or positive serology. National SARS-CoV-2 infection data were obtained from the National Centre for Infectious Disease, Singapore, and vaccination data were obtained from the National Immunisation Registry, Singapore. EXPOSURES SARS-CoV-2 infection or mRNA-based SARS-CoV-2 vaccines. MAIN OUTCOMES AND MEASURES Clinical characteristics, crude incidence rate (IR), and incidence rate ratio (IRR) of CVT after SARS-CoV-2 infection and after mRNA SARS-CoV-2 vaccination. RESULTS Among 62 447 individuals diagnosed with SARS-CoV-2 infections included in this study, 58 989 (94.5%) were male; the median (range) age was 34 (0-102) years; 6 CVT cases were identified (all were male; median [range] age was 33.5 [27-40] years). Among 3 006 662 individuals who received at least 1 dose of mRNA-based SARS-CoV-2 vaccine, 1 626 623 (54.1%) were male; the median (range) age was 50 (12-121) years; 9 CVT cases were identified (7 male individuals [77.8%]; median [range] age: 60 [46-76] years). The crude IR of CVT after SARS-CoV-2 infections was 83.3 per 100 000 person-years (95% CI, 30.6-181.2 per 100 000 person-years) and 2.59 per 100 000 person-years (95% CI, 1.19-4.92 per 100 000 person-years) after mRNA-based SARS-CoV-2 vaccination. Six (66.7%) received BNT162b2 (Pfizer-BioNTech) vaccine and 3 (33.3%) received mRNA-1273 (Moderna) vaccine. The crude IRR of CVT hospitalizations with SARS-CoV-2 infection compared with those who received mRNA SARS-CoV-2 vaccination was 32.1 (95% CI, 9.40-101; P < .001). CONCLUSIONS AND RELEVANCE The incidence rate of CVT after SARS-CoV-2 infection was significantly higher compared with after mRNA-based SARS-CoV-2 vaccination. CVT remained rare after mRNA-based SARS-CoV-2 vaccines, reinforcing its safety.
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Affiliation(s)
- Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Shen Jia Yi
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Seyed Ehsan Saffari
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Yong
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
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Calcaterra G, Bassareo PP, Barilla' F, Romeo F, Mehta JL. Concerning the unexpected prothrombotic state following some coronavirus disease 2019 vaccines. J Cardiovasc Med (Hagerstown) 2022; 23:71-74. [PMID: 34366403 DOI: 10.2459/jcm.0000000000001232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/05/2022]
Abstract
Currently, the world is coping with the COVID-19 pandemic with a few vaccines. So far, the European Medicine Agency has approved four of them. However, following widespread vaccination with the recombinant adenoviral vector-based Oxford-AstraZeneca vaccine, available only in the United Kingdom and Europe, many concerns have emerged, especially the report of several cases of the otherwise rare cerebral sinus vein thrombosis and splanchnic vein thrombosis. The onset of thrombosis particularly at these unusual sites, about 5--14 days after vaccination, along with thrombocytopenia and other specific blood test abnormalities, are the main features of the vaccine side effects. The acronym vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) has been coined to name this new condition, with the aim of highlighting the difference from the classic heparin-induced thrombocytopenia (HIT). VIPIT seems to primarily affect young to middle-aged women. For this reason, the vaccine administration has been stopped or limited in a few European countries. Coagulopathy induced by the Oxford-AstraZeneca vaccine (and probably by Janssen/Johnson & Johnson vaccine as well in the USA) is likely related to the use of recombinant vector DNA adenovirus, as experimentally proven in animal models. Conversely, Pfizer and Moderna vaccines use mRNA vectors. All vaccine-induced thrombotic events should be treated with a nonheparin anticoagulant. As the condition has some similarities with HIT, patients should not receive any heparin or platelet transfusion, as these treatments may potentially worsen the clinical course. Aspirin has limited rational use in this setting and is not currently recommended. Intravenous immunoglobulins may represent another potential treatment, but, most importantly, clinicians need to be aware of this new unusual postvaccination syndrome.
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Affiliation(s)
| | - Pier Paolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital and Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | | | | | - Jawahar L Mehta
- University of Arkansas for Medical Sciences and the VA Medical Center, Little Rock, Arkansas, USA
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14
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Patwardhan AA, Joshi TH, Ramakrishnan S. Clinical and Imaging Features of Cerebral Venous Thrombosis Associated with COVID-19: A Brief Review. Neurol India 2022; 70:441-442. [PMID: 35263944 DOI: 10.4103/0028-3886.338659] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ameya A Patwardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Tarachand H Joshi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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15
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Pilipenko YV, Eliava SS, Abramyan AA. [Thrombectomy without temporary clipping for giant partially thrombosed saccular aneurysms]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:17-22. [PMID: 35758074 DOI: 10.17116/neiro20228603117] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED Cerebral aneurysm thrombosis is one of the factors increasing the risk of microsurgical treatment. Thrombi and calcifications within the aneurysm neck prevent adequate clipping and should be removed before the procedure. At the same time, the process of thrombectomy is difficult and time consuming that increases duration of temporary arterial clipping and risk of cerebral ischemia. OBJECTIVE To evaluate the results of thrombectomy without temporary arterial clipping for giant aneurysms of anterior brain circulation. MATERIAL AND METHODS Four patients with giant partially thrombosed saccular aneurysms underwent thrombectomy without temporary clipping followed by neck clipping. In all cases, the aneurysm was thrombosed by more than 80-90% of its baseline volume, and aneurysm neck contained parietal thrombi from all sides. Mean duration of thrombectomy from aneurysm opening to bleeding and temporary clipping of the parent artery was 82 minutes, time of temporary clipping was about 12 minutes. RESULTS Favorable clinical and radiological postoperative results were obtained in all patients. The authors present a scheme of surgical stages and video presentation involving the main surgical aspects of this procedure. CONCLUSION Thrombectomy without temporary clipping of the parent artery is an effective technique for microsurgical treatment of giant partially thrombosed saccular intracranial aneurysms. Since most thrombi are removed without bleeding, duration of temporary blood flow discontinuation in the parent artery is significantly reduced. Therefore, we decrease the risk of cerebral ischemia. This technique can be useful in microsurgical treatment of complex aneurysms of the middle cerebral and internal carotid arteries, as well as other aneurysms.
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16
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Göb V, Voll MG, Zimmermann L, Hemmen K, Stoll G, Nieswandt B, Schuhmann MK, Heinze KG, Stegner D. Infarct growth precedes cerebral thrombosis following experimental stroke in mice. Sci Rep 2021; 11:22887. [PMID: 34819574 PMCID: PMC8613266 DOI: 10.1038/s41598-021-02360-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2021] [Indexed: 01/12/2023] Open
Abstract
Ischemic stroke is among the leading causes of disability and death worldwide. In acute ischemic stroke, successful recanalization of occluded vessels is the primary therapeutic aim, but even if it is achieved, not all patients benefit. Although blockade of platelet aggregation did not prevent infarct progression, cerebral thrombosis as cause of secondary infarct growth has remained a matter of debate. As cerebral thrombi are frequently observed after experimental stroke, a thrombus-induced impairment of the brain microcirculation is considered to contribute to tissue damage. Here, we combine the model of transient middle cerebral artery occlusion (tMCAO) with light sheet fluorescence microscopy and immunohistochemistry of brain slices to investigate the kinetics of thrombus formation and infarct progression. Our data reveal that tissue damage already peaks after 8 h of reperfusion following 60 min MCAO, while cerebral thrombi are only observed at later time points. Thus, cerebral thrombosis is not causative for secondary infarct growth during ischemic stroke.
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Affiliation(s)
- Vanessa Göb
- Institute of Experimental Biomedicine I, University Hospital Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Maximilian G Voll
- Institute of Experimental Biomedicine I, University Hospital Würzburg, Würzburg, Germany
| | - Lena Zimmermann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Katherina Hemmen
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Guido Stoll
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine I, University Hospital Würzburg, Würzburg, Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | | | - Katrin G Heinze
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany.
| | - David Stegner
- Institute of Experimental Biomedicine I, University Hospital Würzburg, Würzburg, Germany.
- Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany.
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17
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Drábková L. Cerebral venous thrombosis after caesarean section. Ceska Gynekol 2021; 86:339-342. [PMID: 34736333 DOI: 10.48095/cccg2021339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Case report of a patient with cerebral venous thrombosis after caesarean section. CASE REPORT We present a case of a 22-year-old patient after an acute caesarean section, which was complicated by cerebral venous thrombosis. The etiology of the thrombosis was multifactorial. Dia-gnosis was determined using imaging methods once the neurological symptoms were expressed. Follow-up care for the patient included comprehensive care in the intensive care unit, including a temporary decompresive craniectomy. CONCLUSION Cerebral venous thrombosis is a rare disease with a varied clinical manifestation whose development is affected by a number of acquired and congenital factors. The incidence is increased in women in the puerperium, but we can also see it in gynecological practice in young contraception users. Contextual knowledge is essential in early dia-gnosis as well as using a correct treatment strategy with a multidisciplinary approach and interdisciplinary collaboration.
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18
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Lamtahri R, Hazime M, Gowing EK, Nagaraja RY, Maucotel J, Alasoadura M, Quilichini PP, Lehongre K, Lefranc B, Gach-Janczak K, Marcher AB, Mandrup S, Vaudry D, Clarkson AN, Leprince J, Chuquet J. The Gliopeptide ODN, a Ligand for the Benzodiazepine Site of GABA A Receptors, Boosts Functional Recovery after Stroke. J Neurosci 2021; 41:7148-7159. [PMID: 34210784 PMCID: PMC8372017 DOI: 10.1523/jneurosci.2255-20.2021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/14/2020] [Accepted: 03/25/2021] [Indexed: 11/21/2022] Open
Abstract
Following stroke, the survival of neurons and their ability to reestablish connections is critical to functional recovery. This is strongly influenced by the balance between neuronal excitation and inhibition. In the acute phase of experimental stroke, lethal hyperexcitability can be attenuated by positive allosteric modulation of GABAA receptors (GABAARs). Conversely, in the late phase, negative allosteric modulation of GABAAR can correct the suboptimal excitability and improves both sensory and motor recovery. Here, we hypothesized that octadecaneuropeptide (ODN), an endogenous allosteric modulator of the GABAAR synthesized by astrocytes, influences the outcome of ischemic brain tissue and subsequent functional recovery. We show that ODN boosts the excitability of cortical neurons, which makes it deleterious in the acute phase of stroke. However, if delivered after day 3, ODN is safe and improves motor recovery over the following month in two different paradigms of experimental stroke in mice. Furthermore, we bring evidence that, during the subacute period after stroke, the repairing cortex can be treated with ODN by means of a single hydrogel deposit into the stroke cavity.SIGNIFICANCE STATEMENT Stroke remains a devastating clinical challenge because there is no efficient therapy to either minimize neuronal death with neuroprotective drugs or to enhance spontaneous recovery with neurorepair drugs. Around the brain damage, the peri-infarct cortex can be viewed as a reservoir of plasticity. However, the potential of wiring new circuits in these areas is restrained by a chronic excess of GABAergic inhibition. Here we show that an astrocyte-derived peptide, can be used as a delayed treatment, to safely correct cortical excitability and facilitate sensorimotor recovery after stroke.
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Affiliation(s)
- Rhita Lamtahri
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
| | - Mahmoud Hazime
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
| | - Emma K Gowing
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, 76000, 9054, New Zealand
| | - Raghavendra Y Nagaraja
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, 76000, 9054, New Zealand
| | - Julie Maucotel
- Normandie Université, UNIROUEN, Animal Facility, Rouen, 76000, France
| | - Michael Alasoadura
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
| | | | - Katia Lehongre
- Inserm U 1127, Centre National de la Recherche Scientifique Unite Mixte de Recherche 7225, Sorbonne Universités, UPMC Univ Paris 06 Unite Mixte de Recherche S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, F-75013, France
| | - Benjamin Lefranc
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
- Institute for Research and Innovation in Biomedicine, Normandie Université, PRIMACEN, Rouen, 76000, France
| | - Katarzyna Gach-Janczak
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
- Department of Biomolecular Chemistry, Medicinal University of Łódź, Łódź, 90-137, Poland
| | - Ann-Britt Marcher
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, 5230, Denmark
| | - Susanne Mandrup
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, 5230, Denmark
| | - David Vaudry
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
- Institute for Research and Innovation in Biomedicine, Normandie Université, PRIMACEN, Rouen, 76000, France
| | - Andrew N Clarkson
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, 76000, 9054, New Zealand
| | - Jérôme Leprince
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
- Institute for Research and Innovation in Biomedicine, Normandie Université, PRIMACEN, Rouen, 76000, France
| | - Julien Chuquet
- Normandie Université, UNIROUEN, Institut National de la Santé et de la Recherche Médicale U1239, Neuronal and Neuroendocrine Differentiation and Communication, Rouen, France
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19
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Affiliation(s)
- Allan H Ropper
- From the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Joshua P Klein
- From the Department of Neurology, Brigham and Women's Hospital, Boston
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20
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Affiliation(s)
- Alfonso Ciccone
- Department of Neurology with neurosurgical activity and stroke unit, ASST di Mantova, Mantova, Italy.
| | - Bruno Zanotti
- Department of Neurology with neurosurgical activity and stroke unit, ASST di Mantova, Mantova, Italy
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21
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Kortman H, Bhatia KD, Wälchli T, Nicholson P, Krings T. Symptomatic Unruptured Arteriovenous Malformations: Focal Edema, Thrombosis, and Vessel Wall Enhancement: A Retrospective Cohort Study. World Neurosurg 2021; 152:e467-e475. [PMID: 34089913 DOI: 10.1016/j.wneu.2021.05.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/27/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Focal brain edema in unruptured brain arteriovenous malformations (AVMs) is rare and associated with venous outflow abnormalities and aneurysm growth. These patients have an increased rate of progressive neurologic symptoms, as well as a potentially increased risk of hemorrhage. In this study, we aim to assess in further detail the relationship between perifocal edema and enhancement of the vessel wall in symptomatic patients with an unruptured brain AVM. METHODS A single-center retrospective cohort study of all patients presenting with an unruptured AVM at Toronto Western Hospital from 2009 to 2019 was performed. Patients were included for review if they had focal edema surrounding an AVM on magnetic resonance imaging (MRI) and a contrast-enhanced MRI scan. Associated digital subtraction angiography studies were reviewed. RESULTS A total of 122 patients presented with an unruptured AVM. Twelve symptomatic patients presented with focal edema surrounding the AVM. Six patients had focal edema and contrast-enhanced MRI performed. All 6 demonstrated luminal thrombosis at the level of the brain edema on MRI. Moreover, the vessel wall demonstrated enhancement at the level of the luminal thrombus in all. CONCLUSIONS Vessel wall enhancement, perifocal edema, and luminal thrombosis demonstrated in all patients with unruptured AVM points towards a common mechanism. We suspect an interplay between vascular hypoxia, the innate immune system, and thrombosis formation. Current research in the field of immunothrombosis supports this theory. Unravelling the mechanisms involved is important because it might guide therapy for patients with an unruptured AVM towards noninvasive options.
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Affiliation(s)
- Hans Kortman
- Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Neuroradiology, ETZ Elisabeth Hospital, Tilburg, Noord-Brabant, the Netherlands.
| | - Kartik Dev Bhatia
- Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Wälchli
- Division of Neurosurgery, University Health Network, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, University Health Network, Ontario, Canada
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22
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Ghosh R, Roy D, Mandal A, Pal SK, Chandra Swaika B, Naga D, Pandit A, Ray BK, Benito-León J. Cerebral venous thrombosis in COVID-19. Diabetes Metab Syndr 2021; 15:1039-1045. [PMID: 34015627 PMCID: PMC8128714 DOI: 10.1016/j.dsx.2021.04.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Initially, novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) was considered primarily a respiratory pathogen. However, with time it has behaved as a virus with the potential to cause multi-system involvement, including neurological manifestations. Cerebral venous sinus thrombosis (CVT) has increasingly been reported in association with coronavirus infectious disease of 2019 (COVID-19). Here, we have shed light upon CVT and its possible mechanisms in the backdrop of the ongoing COVID-19 pandemic. METHODS In this review, data were collected from PubMed, EMBASE and Web of Science, until March 30, 2021, using pre-specified searching strategies. The search strategy consisted of a variation of keywords of relevant medical subject headings and keywords, including "COVID-19", "SARS-CoV-2", "coronavirus", and "cerebral venous sinus thrombosis". RESULTS COVID-19 has a causal association with a plethora of neurological, neuropsychiatric and psychological effects. CVT has gained particular importance in this regard. The known hypercoagulable state in SARS-CoV-2 infection is thought to be the main mechanism in COVID-19 related CVT. Other plausible mechanisms may include vascular endothelial dysfunction and altered flow dynamics. CONCLUSIONS Although there are no specific clinical characteristics, insidious or acute onset headache, seizures, stroke-like, or encephalopathy symptoms in a patient with, or who has suffered COVID-19, should prompt the attending physician to investigate for CVT. The treatment of COVID-19 associated CVT does not differ radically from the therapy of CVT without the infection, i.e. urgent initiation of parenteral unfractionated heparin or low molecular weight heparin followed by conventional or mostly newer oral anticoagulants.
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Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Arpan Mandal
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Shyamal Kanti Pal
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Bikash Chandra Swaika
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Dinabandhu Naga
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Alak Pandit
- Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain.
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23
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Guendouz C, Quenardelle V, Riou-Comte N, Welfringer P, Wolff V, Zuily S, Jager L, Humbertjean Selton L, Mione G, Pop R, Gory B, Richard S. Pathogeny of cerebral venous thrombosis in SARS-Cov-2 infection: Case reports. Medicine (Baltimore) 2021; 100:e24708. [PMID: 33725828 PMCID: PMC7969213 DOI: 10.1097/md.0000000000024708] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Pathogeny of thrombosis in COVID-19 is related to interaction of SARS-Cov-2 with vascular wall through the angiotensin converting enzyme 2 (ACE2) receptor. This induces 2 pathways with immunothrombosis from activated endothelium (cytokine storm, leukocyte and platelet recruitment, and activation of coagulation extrinsic pathway), and rise of angiotensin II levels promoting inflammation. While thrombosis is widely described in COVID-19 patients admitted in intensive care unit, cerebrovascular diseases remains rare, in particular cerebral venous thrombosis (CVT). PATIENT CONCERNS We describe 2 cases of women admitted during the spring of 2020 for intracranial hypertension signs, in stroke units in Great-east, a French area particularly affected by COVID-19 pandemia. DIAGNOSES Cerebral imaging revealed extended CVT in both cases. The first case described was more serious due to right supratentorial venous infarction with hemorrhagic transformation leading to herniation. Both patients presented typical pneumonia due to SARS-Cov-2 infection, confirmed by reverse transcription polymerase chain reaction on a nasopharyngeal swab in only one. INTERVENTIONS The first patient had to undergo decompressive craniectomy, and both patients were treated with anticoagulation therapy. OUTCOMES Favorable outcome was observed for 1 patient. Persistent coma, due to bi thalamic infarction, remained for the other with more serious presentation. LESSONS CVT, as a serious complication of COVID-19, has to be searched in all patients with intracranial hypertension syndrome. Data about anticoagulation therapy to prevent such serious thrombosis in SARS-Cov-2 infection are lacking, in particular in patients with mild and moderate COVID-19.
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Affiliation(s)
- Cécile Guendouz
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERMU1116, Nancy
| | | | - Nolwenn Riou-Comte
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERMU1116, Nancy
| | | | - Valérie Wolff
- Stroke Unit, Strasbourg University Hospital, EA3072, Strasbourg
| | - Stéphane Zuily
- Université de Lorraine, Inserm, DCAC and CHRU-Nancy, Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Nancy
| | | | | | - Gioia Mione
- Department of Neurology, CHRU-Nancy, Stroke Unit, Nancy
| | - Raoul Pop
- Department of Interventional Neuroradiology, University Hospital of Strasbourg, Strasbourg
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, INSERM U1254, IADI, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERMU1116, Nancy
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24
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Demir KK, Simard C, Lipes J, Yang SS. Life and Limb: a Case of COVID-19-Associated Multisystem Thrombosis and Review of the Literature. J Gen Intern Med 2021; 36:802-806. [PMID: 33403619 PMCID: PMC7784618 DOI: 10.1007/s11606-020-06496-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/17/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Koray K Demir
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Camille Simard
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jed Lipes
- Department of Medicine, Division of Critical Care, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Stephen Su Yang
- Department of Anesthesia, Division of Critical Care, Jewish General Hospital, McGill University, Montreal, QC, Canada.
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25
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Lo MY, Chen MS, Jen HM, Chen CC, Shen TY. A rare complication of cerebral venous thrombosis during simple percutaneous coronary intervention: A case report. Medicine (Baltimore) 2021; 100:e24008. [PMID: 33530197 PMCID: PMC7850649 DOI: 10.1097/md.0000000000024008] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cerebrovascular accidents (CVAs) after percutaneous coronary intervention (PCI), although rare, are associated with high in-hospital morbidity and mortality rates. Cerebral venous thrombosis (CVT) is an uncommon cause of CVAs compared with arterial disease but is associated with favorable outcomes in most cases. We present a rare case of CVT following a simple PCI procedure with stent implantation, which has not been previously reported in the literature. PATIENT CONCERNS A 78-year-old woman with hypertension, hyperlipidemia, and coronary artery disease received simple PCI with stent implantation. After PCI, she developed a throbbing headache with nausea and vomiting, with her blood pressure increasing to 190/100 mmHg. Drowsiness, disorientation, and neck stiffness were noted. Neurological complication due to the PCI procedure was highly suspected. DIAGNOSIS Noncontrast brain computed tomography was performed along with emergency neurological consultation, and the patient was diagnosed as having acute CVT. INTERVENTIONS The patient was treated with anti-intracranial pressure therapy and anticoagulation therapy through low-molecular-weight heparin and was subsequently treated with warfarin. OUTCOMES After treatment, the patient's symptoms and signs gradually subsided, and her clinical condition improved. She was discharged with full recovery thereafter. LESSONS A case of acute CVT, a rare, and atypical manifestation of venous thromboembolism and CVA, complicated simple PCI with stent implantation. During PCI, identifying patients with a high risk of a CVA is critical, and special care should be taken to prevent this devastating complication.
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Affiliation(s)
- Ming Yuan Lo
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Shiu Chen
- Cardiology Department, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua County, Taiwan
| | - Hsuan-Ming Jen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chien-Cheng Chen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Thau-Yun Shen
- Cardiovascular Center, Show Chwan Memorial Hospital, Changhua, Taiwan
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Ha SH, Chang JY, Lee SH, Lee KM, Heo SH, Chang DI, Kim BJ. Mechanism of Stroke According to the Severity and Location of Atherosclerotic Middle Cerebral Artery Disease. J Stroke Cerebrovasc Dis 2020; 30:105503. [PMID: 33271485 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/02/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Strategy for secondary prevention of ischemic stroke depends on the mechanism of stroke. The aim of this study was to compare the stroke mechanism according to the location and severity of middle cerebral artery (MCA) disease. METHODS We analyzed acute ischemic stroke patients within 7 days of onset with symptomatic MCA disease. The location of MCA disease was classified into proximal MCA M1 (pMCA) and distal MCA M1/proximal M2 (dMCA). The mechanism of stroke was categorized according to the pattern of ischemic lesion: local branch occlusion, artery-to-artery embolism/hemodynamic infarction, in situ-thrombosis, or a combined mechanism. The mechanism and imaging characteristics of stroke were compared according to the location and severity. The factors associated with the stroke mechanism were also investigated. RESULTS A symptomatic MCA disease was observed in 126 patients (74 pMCA and 52 dMCA). The mechanism of stroke differed according to the location (p < 0.001); the combined mechanism was most common in pMCA disease (54.1%), especially in those who presented with MCA occlusion and with a susceptible vessel sign. Artery-to-artery embolism/hemodynamic infarction was most common in dMCA disease (46.2%). A longer length of stenosis was observed in local branch occlusion than in other mechanisms (p = 0.04) and was an independent factor associated with local branch occlusion (OR=1.631, 95% CI=1.161-2.292; p = 0.005). CONCLUSIONS The mechanism of stroke differed according to the location of MCA disease: occlusion caused by plaque rupture with combined mechanism of stroke type was predominant in pMCA. Longer length of stenosis was associated with local branch occlusion.
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Affiliation(s)
- Sang Hee Ha
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | | | - Sang Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Kyung Mi Lee
- Department of Neurology and Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea.
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Mowla A, Sizdahkhani S, Sharifian-Dorche M, Selvan P, Emanuel BA, Tenser MS, Amar AP, Mack WJ. Unusual Pattern of Arterial Macrothrombosis Causing Stroke in a Young Adult Recovered from COVID-19. J Stroke Cerebrovasc Dis 2020; 29:105353. [PMID: 33039770 PMCID: PMC7518116 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105353] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/20/2020] [Accepted: 09/17/2020] [Indexed: 01/23/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Neurological manifestations related to COVID-19, including acute ischemic Stroke (AIS), have been reported in recent studies. In most of these, the patients are older, have multiple co-morbidities as risk factors for AIS and have developed a severe respiratory illness. Herein, we report a 36-year-old man with no significant past medical history who recently recovered from a mild COVID-19 infection and presented with unusual pattern of arterial macrothrombosis causing AIS. When the AIS happened, he had no COVID-19 related symptoms, had two negative screening tests for the infection and his chest CT was unremarkable.
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Affiliation(s)
- Ashkan Mowla
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA.
| | - Saman Sizdahkhani
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Maryam Sharifian-Dorche
- Departments of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Prad Selvan
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Benjamin A Emanuel
- Department of Neurology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Matthew S Tenser
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Arun P Amar
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
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Saito K, Ishii K, Furuta K, Kobayashi M, Wada Y, Morishita E. Recurrent Cerebral Venous Thrombosis Treated with Direct Oral Anticoagulants in a Japanese Man with Hereditary Protein C Deficiency. J Stroke Cerebrovasc Dis 2020; 30:105320. [PMID: 33131982 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/29/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 01/05/2023] Open
Abstract
We herein report a case involving a 32-year-old Japanese man with recurrent cerebral venous thrombosis due to hereditary protein C deficiency. He was admitted to our hospital with impaired consciousness. Brain magnetic resonance imaging demonstrated high intensities diffusely along the bilateral sulci and magnetic resonance venography revealed left transverse sinus and superior sagittal sinus stenoses. His father had a history of cerebral infarction and venous thrombosis. The protein C activity level examined by chromogenic synthetic substrate assay was markedly reduced. He was diagnosed with protein C deficiency, and a genetic analysis revealed a heterozygous mutation at exon 3 c.199G>A,p.Glu67Lys on the protein C gene. Four months later, at his second admission, he had transient aphasia, and his protein C activity was under 10%. We switched warfarin to the direct oral anticoagulants edoxaban. He remains fully recovered with no adverse events after the administration of edoxaban for a year. Direct oral anticoagulants may be a new tool for treating cerebral venous thrombosis due to hereditary protein C deficiency.
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Affiliation(s)
- Kazuyuki Saito
- Department of Neurology, Nissan Tamagawa Hospital, Seta 4-8-1, Setagaya, Tokyo 158-0095, Japan.
| | - Kazuyuki Ishii
- Department of Emergency, Nissan Tamagawa Hospital, Setagaya, Tokyo, Japan
| | - Konosuke Furuta
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Masaki Kobayashi
- Department of Neurology, Nissan Tamagawa Hospital, Seta 4-8-1, Setagaya, Tokyo 158-0095, Japan
| | - Yoshiaki Wada
- Department of Neurology, Nissan Tamagawa Hospital, Seta 4-8-1, Setagaya, Tokyo 158-0095, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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AlSheef M, Alotaibi M, Zaidi ARZ, Alshamrani A, Alhamidi A, Zaidi SZA, Alanazi N, Alhathlool S, Alarfaj O, AlHazzaa M, Kullab G, Alboghdadly A, Abu-Shaheen A. Prevalence of cerebral venous thrombosis with the use of oral contraceptive pills during the Holy month of Ramadan. Saudi Med J 2020; 41:1063-1069. [PMID: 33026046 PMCID: PMC7841506 DOI: 10.15537/smj.2020.10.25397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: To identify the epidemiologic profile of cerebral vein thrombosis (CVT) among fasting women using oral contraceptive pills (OCPs) during the holy month of Ramadan. Methods: This retrospective study was conducted on all patients diagnosed with CVT and using OCPs from records at a tertiary care hospital in Riyadh, Saudi Arabia during 2016-2017. The study participants were categorized into 2 groups (an intermittently fasting group during the holy month of Ramadan and a non-fasting group). Results: Out of 108 female patients with CVT, 36.1% were secondary to OCP, of whom 41% participants were fasting. The most affected site was the transverse sinus. Holocephalic headache was more common amongst fasting group (68.8%) compared to non-fasting group (30.4%) (p=0.025). Dehydration (p=0.003) amongst the fasting group and protein S deficiency (p=0.027) in the non-fasting group were identified as the 2 prominent risk factors. Unfractionated heparin was the most common anticoagulant therapies used during the initiation phase for non-fasting (36.4%) and fasting groups (50%). Conclusion: All women who are using OCP should undergo formal written risk assessments for factors of CVT. Our study suggests that the negative effects of OCPs use might outweigh its benefits; thus, it should be prescribed with caution, more so in fasting patients.
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Affiliation(s)
- Mohammed AlSheef
- Department of Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Ospel JM, Brouwer P, Dorn F, Arthur A, Jensen ME, Nogueira R, Chapot R, Albuquerque F, Majoie C, Jayaraman M, Taylor A, Liu J, Fiehler J, Sakai N, Orlov K, Kallmes D, Fraser JF, Thibault L, Goyal M. Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement. AJNR Am J Neuroradiol 2020; 41:1856-1862. [PMID: 32943417 DOI: 10.3174/ajnr.a6814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE There is a paucity of data regarding antiplatelet management strategies in the setting of stent-assisted coiling/flow diversion for ruptured intracranial aneurysms. This study aimed to identify current challenges in antiplatelet management during stent-assisted coiling/flow diversion for ruptured intracranial aneurysms and to outline possible antiplatelet management strategies. MATERIALS AND METHODS The modified DELPHI approach with an on-line questionnaire was sent in several iterations to an international, multidisciplinary panel of 15 neurointerventionalists. The first round consisted of open-ended questions, followed by closed-ended questions in the subsequent rounds. Responses were analyzed in an anonymous fashion and summarized in the final manuscript draft. The statement received endorsement from the World Federation of Interventional and Therapeutic Neuroradiology, the Japanese Society for Neuroendovascular Therapy, and the Chinese Neurosurgical Society. RESULTS Data were collected from December 9, 2019, to March 13, 2020. Panel members achieved consensus that platelet function testing may not be necessary and that antiplatelet management for stent-assisted coiling and flow diversion of ruptured intracranial aneurysms can follow the same principles. Preprocedural placement of a ventricular drain was thought to be beneficial in cases with a high risk of hydrocephalus. A periprocedural dual, intravenous, antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor was preferred as a standard approach. The panel agreed that intravenous medication can be converted to oral aspirin and an oral P2Y12 inhibitor within 24 hours after the procedure. CONCLUSIONS More and better data on antiplatelet management of patients with ruptured intracranial aneurysms undergoing stent-assisted coiling or flow diversion are urgently needed. Panel members in this DELPHI consensus study preferred a periprocedural dual-antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor.
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Affiliation(s)
- J M Ospel
- Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Radiology (J.M.O.), University Hospital of Basel, Basel, Switzerland
| | - P Brouwer
- Department of Interventional Neuroradiology (P.B.), Karolinksa Hospital, Stockholm, Sweden
- University NeuroVascular Center (P.B.), Leiden University Medical Center, Haaglanden Medical Center, Leiden, the Netherlands
| | - F Dorn
- Institute of Neuroradiology (F.D.), University of Bonn, Bonn, Germany
| | - A Arthur
- Department of Neurosurgery (A.A.), Semmes-Murphey Clinic/University of Tennessee, Memphis, Tennessee
| | - M E Jensen
- Departments of Neurological Surgery, Radiology, and Medical Imaging (M.E.J.), University of Virginia Health, Charlottesville, Virginia
| | - R Nogueira
- Marcus Stroke & Neuroscience Center (R.N.), Grady Health System, Atlanta, Georgia
- Department of Neurology (R.N.), Emory University School of Medicine, Atlanta, Georgia
| | - R Chapot
- Department of Neuroradiology (R.C.), Alfred Krupp Krankenhaus Essen, Essen, Germany
| | - F Albuquerque
- Department of Neurosurgery (F.A.), Barrow Neurological Institute, Phoenix, Arizona
| | - C Majoie
- Department of Radiology (C.M.), Academic Medical Center, Amsterdam, the Netherlands
| | - M Jayaraman
- Departments of Diagnostic Imaging, Neurology, and Neurosurgery (M.J.), Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - A Taylor
- Groote Schuur Hospital (A.T.), University of Cape Town, Cape Town, South Africa
| | - J Liu
- Department of Neurosurgery (J.L.), Changhai Hospital Naval Medical University, Shanghai, China
| | - J Fiehler
- Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Sakai
- Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Orlov
- Meshalkin National Medical Research Center (K.O.), Novosibirsk, Russian Federation
| | - D Kallmes
- Department of Radiology (D.K.), Mayo Clinic, Rochester, Minnesota
| | - J F Fraser
- Departments of Neurosurgery, Neurology, Radiology, and Neuroscience (J.F.F.), University of Kentucky, Lexington, Kentucky
| | - L Thibault
- Member of the Scientific Committee of the World Federation of Interventional and Therapeutic Neuroradiology (L.T.)
| | - M Goyal
- Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Diagnostic Imaging (M.G.), University of Calgary, Calgary, Alberta, Canada
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Jin C, Pu J, Zhou Z, Chen X, Wu J, Zhang B. Rapidly progressive cognitive impairment: an unusual presentation of cerebral venous thrombosis caused by JAK2 V617F-positive primary myelofibrosis: A case report. Medicine (Baltimore) 2020; 99:e21757. [PMID: 32846801 PMCID: PMC7447497 DOI: 10.1097/md.0000000000021757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition, which mainly manifests as headaches, seizures, and focal neurological deficits. JAK2 mutation in myeloproliferative diseases increases the risk of CVT. PATIENT CONCERNS This 40-year-old woman suffered from rapidly progressive cognitive impairment and limb weakness. Her symptoms worsened while being treated with mannitol with the diagnose of cerebral hemorrhage. DIAGNOSIS The patient was diagnosed with CVT and multiple intracranial hemorrhage caused by JAK2 V617F mutation-positive primary myelofibrosis by neuroimage and whole-exome sequencing. INTERVENTION She received low-molecular-weight heparin sodium 3800 IU twice a day followed by oral anticoagulant therapy. OUTCOMES The patient showed full recovery from limb weakness and in the follow-up period she noticed no change in her memory. LESSONS Clinicians should be aware of the possibility of the JAK2 V617F mutation in CVT patients without known causes or risk factors.
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Affiliation(s)
- Chongyao Jin
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Jiali Pu
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Zhijian Zhou
- Department of Neurology, Affiliated Shaoxing Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Shaoxing, Zhejiang
| | - Xia Chen
- Department of Neurology, Shangrao People's Hospital, Jiangxi, China
| | - Jimin Wu
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
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Cavalcanti DD, Raz E, Shapiro M, Dehkharghani S, Yaghi S, Lillemoe K, Nossek E, Torres J, Jain R, Riina HA, Radmanesh A, Nelson PK. Cerebral Venous Thrombosis Associated with COVID-19. AJNR Am J Neuroradiol 2020; 41:1370-1376. [PMID: 32554424 PMCID: PMC7658892 DOI: 10.3174/ajnr.a6644] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/14/2020] [Indexed: 12/23/2022]
Abstract
Despite the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. We report a unique series of young patients with COVID-19 presenting with cerebral venous system thrombosis. Three patients younger than 41 years of age with confirmed Severe Acute Respiratory Syndrome coronavirus 2 (SARS-Cov-2) infection had neurologic findings related to cerebral venous thrombosis. They were admitted during the short period of 10 days between March and April 2020 and were managed in an academic institution in a large city. One patient had thrombosis in both the superficial and deep systems; another had involvement of the straight sinus, vein of Galen, and internal cerebral veins; and a third patient had thrombosis of the deep medullary veins. Two patients presented with hemorrhagic venous infarcts. The median time from COVID-19 symptoms to a thrombotic event was 7 days (range, 2-7 days). One patient was diagnosed with new-onset diabetic ketoacidosis, and another one used oral contraceptive pills. Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavir-ritonavir. All patients had a fatal outcome. Severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19. We urge awareness of this atypical manifestation.
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Affiliation(s)
- D D Cavalcanti
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - E Raz
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - M Shapiro
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - S Dehkharghani
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - S Yaghi
- Neurology (S.Y., K.L., J.T.)
| | | | - E Nossek
- Neurosurgery (E.N., H.A.R.), NYU Grossman School of Medicine, New York, New York
| | | | - R Jain
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - H A Riina
- Neurosurgery (E.N., H.A.R.), NYU Grossman School of Medicine, New York, New York
| | - A Radmanesh
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - P K Nelson
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
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Leker RR, Farraj A, Sacagiu T, Honig A, ElHasan HA, Gomori JM, Cohen JE. Atrial Fibrillation Treatment Adequacy and Outcome after Endovascular Thrombectomy. J Stroke Cerebrovasc Dis 2020; 29:104948. [PMID: 32689630 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104948] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/30/2020] [Revised: 04/12/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) often leads to large vessel occlusions (LVO) which may necessitate endovascular thrombectomy (EVT). Whether the adequacy of treatment with oral anticoagulants (OAC) prior to LVO modifies outcomes remains unknown. PATIENTS AND METHODS Consecutive EVT-treated LVO patients were recruited and the data was analyzed retrospectively. We combined patients with known AF that were untreated with OAC or inadequately treated with those with new-onset AF to form a group of undertreated-AF patients and compared them to adequately treated AF patients. RESULTS Of the 230 patients included, 109 (47%) had AF (86 known AF, 23 new-onset AF). AF patients were significantly older and more often reached favorable recanalization but less often had favorable outcomes compared to those without AF. Most patients with known AF (76%) were inadequately treated at stroke onset. Patients with undertreated-AF more often received tPA prior to EVT (26% vs. 4% p=0.009), more often had favorable collaterals (65% vs. 33% p<0.001) and more often reached favorable outcomes (28% vs. 9%, p=0.047) compared to adequately treated AF patients. On multivariate analyses adequately treated AF did not impact survival (Odds Ration [OR] 0.89 95% Confidence Interval [CI] 0.23-3.43), chances for favorable recanalization (OR 0.57 95%CI 0.15-2.13) or favorable outcome (OR 5.95 95%CI 0.62-57.39). CONCLUSIONS Treatment adequacy does not affect the rates of favorable functional outcome or survival in AF patients with LVO.
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Affiliation(s)
- R R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - A Farraj
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - T Sacagiu
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - A Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - H Abu ElHasan
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - J M Gomori
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - J E Cohen
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Polster SP, Lyne SB, Mansour A. Case Demonstrating the Nuances of Acute Cortical Venous Thrombosis Anticoagulation Guidelines. World Neurosurg 2020; 139:215-218. [PMID: 32304887 DOI: 10.1016/j.wneu.2020.03.220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/26/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The American Stroke Association and the European Stroke Organization have established guidelines on cerebral venous thrombosis (CVT); however, questions remain when an individual case does not fall within the inclusion criteria on which these guidelines are based. This is relevant when considering the use of anticoagulation in cases of CVT regarding whether or not associated hemorrhage is present and whether the hemorrhage is currently expanding. CASE DESCRIPTION A 16-year-old right-handed female G2P2 (gravidity 2 [2 pregnancies] and parity 2 [2 live births after at least 24 weeks) presented 8 days postpartum with complaints of slurred speech, right facial droop, and right upper extremity numbness that had progressed over the course of 4 hours before presentation. On imaging the patient had a CVT with associated hemorrhage progressing in size at serial 6-hour stability computed tomography scans for 24 hours post arrival. At 24 hours the patient went into disseminated intravascular coagulation and demonstrated signs of herniation. The patient underwent an emergency hemicraniectomy along with a right frontal external ventricular drain for intracranial pressure monitoring. Most recently, the patient had a Glasgow Coma Scale score of 15 and had a modified Rankin Scale score of 4 and was ultimately discovered to have antiphospholipid syndrome. CONCLUSIONS This case of CVT demonstrates the need for critically reading guidelines, as in this case the time to anticoagulation treatment was shorter than in cases included in guideline construction and repeated computed tomography examination demonstrated expansion suggesting it is unsuitable for immediate anticoagulation. Certain cases may fall outside of the study parameters on which guidelines are constructed, and clinicians should be aware of these exceptions.
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Affiliation(s)
- Sean P Polster
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA.
| | - Seán B Lyne
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Ali Mansour
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
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35
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Naveed U, Iqbal A, Hamdani MA, Butt MURA, Ashraf MA. Behcet's Disease Presenting With Life Threatening Manifestation Of Cerebral Venous Thrombosis. J Ayub Med Coll Abbottabad 2020; 32:124-126. [PMID: 32468770] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Behcet's disease (BD) presents as uncommon inflammatory disorder involving multiple systems, identified by longstanding relapsing path. Its chief manifestations are oral and genital ulcers together with involvement of the eyes, skin and joints. Neurological and vascular complications are significant. We report a case of a twenty-four years old young male who presented with headache, fever, and vomiting along with decreased vision; and repeated oral and genital ulcers. Diagnosis of BD complicated with cerebral venous thrombosis (CVT) was made. He was treated with corticosteroids, immunosuppression therapy and colchicine along with anticoagulation therapy. He responded well to the given treatment. Cerebral venous thrombosis complications in with BD can lead to serious consequences. Early recognition and treatment may lessen poor outcomes.
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Affiliation(s)
- Ushna Naveed
- Department of Medicine, Shalamar Hospital Lahore, Pakistan
| | - Aneela Iqbal
- Department of Medicine, Shalamar Hospital Lahore, Pakistan
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36
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Alami B, Boujraf S, Quenum L, Oudrhiri A, Alaoui Lamrani MY, Haloua M, Boubbou M, Maâroufi M. [Cerebral venous thrombosis: Clinical and radiological features, about 62 cases]. J Med Vasc 2019; 44:387-399. [PMID: 31761306 DOI: 10.1016/j.jdmv.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/03/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
UNLABELLED The work's purpose is to make a general review on the various clinical-radiological aspects and the management of cerebral venous thrombosis (CVT) in our hospital and compare them to those described in the literature. MATERIAL AND METHOD Our series included 62 patients aged over 18 years, collected over 7 years (2009-2016) in the radiology department of the CHU Hassan II of Fez (Morocco), in which the radiological diagnosis of TVC was retained. Our patients have benefited from a brain CT scan and brain MRI. Clinical and radiological characteristics and post-treatment progression were described. RESULTS The average age was 35 years with a female predominance; sex ratio 3.76 (49F/13H). The symptomatology was non-specific, made mainly of headaches, comic crises, disturbances of consciousness and focal signs. The upper longitudinal sinus was dominant topography (51.61%). The etiological factors were varied: infectious (sinusitis, chronic otitis media, oto-mastoiditis, bacterial meningitis, and septicemia), gyneco-obstetrical (oral contraception, pregnancy, and postpartum), systemic (Behçet diseases, polycythemia of Vaquez, paraneoplastic syndrome, antiphospholipid syndrome), local (head trauma), undetermined etiological factors. The CT scan, but especially the cerebral MRI, made it possible to make the diagnosis but also to direct towards the etiology. CONCLUSION Cerebral MRI is currently the best imaging in the diagnosis of CTV, allowing an accurate assessment of its location, extent and impact on the cerebral parenchyma. Multiple conditions are responsible for CTVs. Therapeutic management is based on heparinotherapy and etiological treatment.
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Affiliation(s)
- B Alami
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc; Laboratoire de biophysique et méthodes IRM, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, Fès, Maroc
| | - S Boujraf
- Laboratoire de biophysique et méthodes IRM, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, Fès, Maroc
| | - L Quenum
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc.
| | - A Oudrhiri
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Y Alaoui Lamrani
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Haloua
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Boubbou
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
| | - M Maâroufi
- Service de radiologie, faculté de médecine et de pharmacie, université Sidi Mohammed Ben Abdellah, CHU Hassan II Fès, Fès, Maroc
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Abstract
A 19-year-old previously healthy man presented with convulsions, fever, headache, diarrhea, and vomiting. Brain magnetic resonance imaging revealed cerebral hemorrhaging in the right parietal lobe and thrombotic occlusion of the right great cerebral vein. Blood cultures were positive for nontyphoidal Salmonella. The patient was successfully treated with antibiotics and anticoagulants. Nontyphoidal Salmonella bacteremia can cause cerebral venous thrombosis and physicians therefore need to consider nontyphoidal Salmonella bacteremia as a potential cause of cerebral venous thrombosis.
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Affiliation(s)
- Kenta Taneda
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
- Department of Neurology, Japanese Red Cross Matsue Hospital, Japan
| | - Tadashi Adachi
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Yasuhiro Watanabe
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
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38
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Gaye NM, Ndiaye-Diop MT, Fall M, Ka M, Fall SAA, Diop AM, Kahwaji J, Cissé-Diallo VMP, Mbaye M, Thioub M, Mbodji AB, Mbaye KA, Diagne R, Bakhoum M, Cissé O, Bâ EHM, Diagne NS, Diop-Sène MS, Basse-Faye AM, Sow AD, Sarr MM, Seck LB, Touré K, Ndiaye M, Diop AG. [Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. Bull Soc Pathol Exot 2019; 112:137-146. [PMID: 31825191 DOI: 10.3166/bspe-2019-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/20/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.
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Affiliation(s)
- N M Gaye
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - M T Ndiaye-Diop
- Service de dermatologie, hôpital Institut d'hygiène social de Dakar, Sénégal
| | - M Fall
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - M Ka
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - S A A Fall
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - A M Diop
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - J Kahwaji
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - V M P Cissé-Diallo
- Service des maladies infectieuses et tropicales, centre hospitalier national universitaire de Fann, Dakar, Sénégal
| | - M Mbaye
- Service de neurochirurgie, centre hospitalier national universitaire de Fann, Dakar, Sénégal
| | - M Thioub
- Service de neurochirurgie, centre hospitalier national universitaire de Fann, Dakar, Sénégal
| | - A B Mbodji
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - K A Mbaye
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - R Diagne
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - M Bakhoum
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - O Cissé
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - E H M Bâ
- Service de psychiatrie, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - N S Diagne
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - M S Diop-Sène
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - A M Basse-Faye
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - A D Sow
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - M M Sarr
- UFR des sciences de la santé, université de Thiès, Sénégal
| | - L B Seck
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - K Touré
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - M Ndiaye
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
| | - A G Diop
- Clinique neurologique, centre hospitalier national universitaire de Fann, BP 5035, Dakar, Sénégal
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Sugahara Y, Ono N, Morishita E, Takashima H. [A case of recurrent cerebral vein thrombosis with protein C gene mutation identified]. Rinsho Shinkeigaku 2018; 58:764-766. [PMID: 30487363 DOI: 10.5692/clinicalneurol.cn-001221] [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: 06/09/2023]
Abstract
We reported a 31-year-old man with recurrent cerebral venous thrombosis caused by congenital protein C deficiency. He was diagnosed with cerebral venous thrombosis before 7 months. He was transferred to our hospital with numbness of right hand and right side of face, and dysarthria. The blood examination showed that his protein C antigen level and protein C activity were decreased than the lower limits of normal. Brain magnetic resonance venography showed poor visualization of the superior sagittal sinus and cortical veins. Genetic analysis revealed a single-base substitution (C>T) at the codon 811 (Arg to Trp) in the 9th exon portion of the protein C gene. Taking those results, he was diagnosed with recurrent cerebral venous thrombosis due to congenital protein C deficiency. Cerebral venous sinus thrombosis that occurred in the absence of an incidents of disease or internal history when there is a juvenile onset, a past history, or a family history, is suspected of congenital thrombophilia and needs blood tests and genetic tests.
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Affiliation(s)
| | - Natsuki Ono
- Department of Neurology, Saga-ken Medical Centre Koseikan
| | - Eriko Morishita
- Department of Clinical Laboratory Science, Graduate School of Medical Science, Kanazawa University
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40
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Martinez ARM, Martins CR, Resende LND, Cardoso TAMO, Reis F, França MC. Lemierre's syndrome leading to cerebral venous thrombosis. Arq Neuropsiquiatr 2018; 76:358. [PMID: 29898085 DOI: 10.1590/0004-282x20180029] [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: 01/02/2018] [Accepted: 02/03/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Lucas N De Resende
- Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brasil
| | | | - Fabiano Reis
- Universidade de Campinas, Departamento de Radiologia, Campinas SP, Brasil
| | - Marcondes C França
- Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brasil
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41
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Roriz M, Crassard I, Lechtman S, Saadoun D, Champion K, Wechsler B, Chabriat H, Sène D. Can anticoagulation therapy in cerebral venous thrombosis associated with Behçet's disease be stopped without relapse? Rev Neurol (Paris) 2018. [PMID: 29523353 DOI: 10.1016/j.neurol.2017.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/15/2022]
Abstract
There is as yet no consensus on the treatment of cerebral venous thrombosis (CVT) in Behçet's disease, and the place of anticoagulation is also still being debated. This report is of a series of seven patients with Behçet's disease (BD)-associated CVT, for which anticoagulation was stopped, and discusses the possibility of stopping anticoagulation during follow-up while receiving optimal treatment for BD. The diagnosis of BD was established during follow-up, which lasted a median of 120 [range: 60-1490] days after CVT diagnosis. The median duration of anticoagulation therapy was 29.5 months. On stopping anticoagulation, concomitant treatment then included colchicine, steroids and azathioprine, all introduced after BD was diagnosed. With a median follow-up of 25 months after anticoagulation interruption, only one relapse of CVT was observed. No relapse of CVT or other venous thrombosis was observed in the six patients treated by steroids associated with an immunosuppressant or colchicine. Our results emphasize that corticosteroids are essential for the treatment of BD-associated CVT, and that anticoagulant therapy may be safely stopped during follow-up in the presence of optimal BD treatment (steroids alone or with immunosuppressive drugs).
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Affiliation(s)
- M Roriz
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France.
| | - I Crassard
- Neurology Department, Lariboisière Hospital, Paris VII University, DHU NeuroVasc, 2 rue Ambroise Paré, 75475 Paris, France
| | - S Lechtman
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
| | - D Saadoun
- Internal Medicine Department, La Pitié-Salpétrière Hospital, Paris VI University, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - K Champion
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
| | - B Wechsler
- Internal Medicine Department, La Pitié-Salpétrière Hospital, Paris VI University, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - H Chabriat
- Neurology Department, Lariboisière Hospital, Paris VII University, DHU NeuroVasc, 2 rue Ambroise Paré, 75475 Paris, France
| | - D Sène
- Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France
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42
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Abstract
RATIONALE Cerebral venous thrombosis (CVT) comprises a group of cerebral vascular diseases resulting from cerebral venous outflow obstruction caused by various etiologies. The etiology of CVT is complex, including infectious and noninfectious factors. The diagnosis is difficult. As a result, many patients are misdiagnosed or never diagnosed. This patient was diagnosed with CVT due to unilateral internal jugular vein compression. PATIENT CONCERNS In this report, we present a case of acute onset CVT in a 15-year-old female patient who presented with a headache, nausea, and vomiting as the main clinical manifestations. INTERVENTIONS This patient was administered with conventional anticoagulants and treated for dehydration, but the effect of conventional therapy was not obvious. OUTCOMES We recommended that this patient undergo left local decompression of the internal jugular vein to inhibit the thrombosis. But regretfully, due to economic reasons and surgical risk, the patient and her mother refused operation. LESSONS This case report demonstrates the importance of considering jugular vein lesions as an etiology of CVT. Furthermore, computed tomography venography of the jugular vein and jugular vein ultrasound were instrumental in detecting the abnormal structure of the jugular vein and hemodynamic changes.
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Affiliation(s)
- Chunxiao Li
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, Jilin, China
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43
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Teresa Sartori M, Briani C, Munari M, Amistà P, Pagnan A, Zampieri P. Cerebral venous thrombosis as a rare onset of Churg-Strauss syndrome. Thromb Haemost 2017; 96:90-2. [PMID: 16807658 DOI: 10.1160/th06-02-0084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Maria Teresa Sartori
- 2nd Chair of Internal Medicine, Department of Medical and Surgical Sciences, University Hospital, Padova, Italy.
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Zimny A, Dziadkowiak E, Bladowska J, Chojdak-Łukasiewicz J, Loster-Niewińska A, Sąsiadek M, Paradowski B. Cerebral venous thrombosis as a diagnostic challenge: Clinical and radiological correlation based on the retrospective analysis of own cases. ADV CLIN EXP MED 2017; 26:1113-1122. [PMID: 29211360 DOI: 10.17219/acem/66778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/24/2022]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a rare condition which constitutes 0.5-1% of all strokes. The clinical and radiological picture of CVT is non-specific and can mimic other disorders. OBJECTIVES The aim of the study was to retrospectively evaluate and correlate clinical and radiological symptoms presented by patients with CVT, both in the initial and follow-up neurological and neuroimaging examinations, with a special emphasis on diagnostic difficulties. MATERIAL AND METHODS Material consisted of 11 patients with CVT (7 women, 4 men). The average age was 43.5, ranging from 23 to 69 years. Clinical symptoms, laboratory findings, risk factors and the results of neuroimaging examinations including CT, MRI and DSA were retrospectively analyzed and correlated. RESULTS All subjects developed superficial CVT and 1 also deep CVT, with no parenchymal lesions in 2 cases, non-hemorrhagic infarctions in 3 and hemorrhagic lesions in 6 subjects. The most frequent symptoms were headache, seizures and hemiparesis. The major risk factors were hormonal therapies in women and congenital thrombophilia. Factors influencing the clinical course and outcome the most were location and type of brain lesions, with hemorrhagic cortical infarctions bringing the worst prognosis and being associated with the highest rate of persistent neurological deficits, despite the rate of vessel recanalization. CONCLUSIONS In our opinion, quick diagnosis before parenchymal hemorrhagic lesions are visible on CT is of crucial importance and requires a constant alertness and good cooperation of neurologists and radiologists, especially in emergency settings.
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Affiliation(s)
- Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
| | - Edyta Dziadkowiak
- Department of Neurology, Medical University Hospital, Wrocław, Poland
| | - Joanna Bladowska
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
| | | | | | - Marek Sąsiadek
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
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Meira AT, Froehner GS, Trindade AP, Bazan SGZ, Braga GP, Bazan R. Multiple Lacunar Infarcts in Paroxysmal Nocturnal Hemoglobinuria. J Stroke Cerebrovasc Dis 2017; 26:e199-e202. [PMID: 28781057 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/23/2016] [Revised: 03/21/2017] [Accepted: 07/05/2017] [Indexed: 01/28/2023] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disease characterized by clonal hematopoietic stem cell disorder, with increased mortality and morbidity. Venous thrombosis is the most common cause of mortality in PNH. The relationship between PNH and cerebrovascular disease is unclear; few cases are reported in the literature, most of them related to cerebral venous thrombosis; In PNH the involvement of intracranial and extracranial arterial sites is very rare. We report a case of a 49-year-old woman who has a medical history of diabetes mellitus, hypertension, and PNH and presented multiple lacunar strokes in a routine consultation with a hematologist. A brain computed tomography (CT) scan showed lacunar infarcts, and magnetic resonance image showed acute ischemic stroke, multiple territory lacunar infarctions, and focal area of microbleeds in gradient echo sequence. A CT angiography showed V3 and V4 branches of the left vertebral artery occluded by a thrombus, and the posterior inferior cerebellar artery occluded, whereas the carotid system was normal. We discuss the presentation and physiopathology of stroke in PNH and other cases reported in the literature review.
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Affiliation(s)
- Alex Tiburtino Meira
- Medical Resident at Clinics Hospital, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
| | | | - André Petean Trindade
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
| | - Gabriel Pereira Braga
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
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46
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Lim HY, Ng C, Donnan G, Nandurkar H, Ho P. Ten years of cerebral venous thrombosis: male gender and myeloproliferative neoplasm is associated with thrombotic recurrence in unprovoked events. J Thromb Thrombolysis 2017; 42:423-31. [PMID: 27085541 DOI: 10.1007/s11239-016-1362-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Indexed: 02/02/2023]
Abstract
Cerebral venous thrombosis (CVT) is a rare venous thrombotic event. We review our local experience in the management of CVT in comparison to other venous thromboembolism (VTE) with specific focus on risk factors for thrombotic recurrence. Retrospective evaluation of consecutive CVT presentations from January 2005 to June 2015, at two major tertiary hospitals in Northeast Melbourne, Australia. This population was compared to a separate audit of 1003 consecutive patients with DVT and PE. Fifty-two patients (30 female, 22 male) with a median age of 40 (18-83) years, presented with 53 episodes of CVT. Twenty-nine episodes (55 %) were associated with an underlying risk factor, with hormonal risk factors in females being most common. The median duration of anticoagulation was 6 months with 11 receiving life-long anticoagulation. Eighty-one percent had residual thrombosis on repeat imaging, which was not associated with recurrence at the same or distant site. Nine (17 %) had CVT-related haemorrhagic transformation with two resultant CVT-related deaths (RR 22.5; p = 0.04). All three VTE recurrences occured in males with unprovoked events (RR 18.2; p = 0.05) who were subsequently diagnosed with myeloproliferative neoplasm (MPN). Compared to the non-cancer VTE population, non-cancer CVT patients were younger, had similar rate of provoked events and VTE recurrence, although with significantly higher rate of MPN diagnosis (RR 9.30 (2.29-37.76); p = 0.002) CVT is a rare thrombotic disorder. All recurrences in this audit occurred in male patients with unprovoked events and subsequent diagnosis of MPN, suggesting further evaluation for MPN may be warranted in patients with unprovoked CVT.
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Affiliation(s)
- H Y Lim
- Department of Haematology, Northern Health, 185 Cooper Street, Epping, Melbourne, VIC, Australia
- Austin Health, Heidelberg, Melbourne, VIC, Australia
| | - C Ng
- Austin Health, Heidelberg, Melbourne, VIC, Australia
| | - G Donnan
- Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia
| | - H Nandurkar
- Australian Centre for Blood Diseases, Prahran, VIC, Australia
- Monash University, Clayton, VIC, Australia
| | - Prahlad Ho
- Department of Haematology, Northern Health, 185 Cooper Street, Epping, Melbourne, VIC, Australia.
- Austin Health, Heidelberg, Melbourne, VIC, Australia.
- Florey Institute of Neurosciences and Mental Health, Parkville, VIC, Australia.
- University of Melbourne, Parkville, VIC, Australia.
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47
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Abstract
We report a case of cerebral venous thrombosis related to the ingestion of tadalafil. A 45-year-old man presented with posterior headache and was diagnosed with tension headache. Five days later, he was transported to our hospital via ambulance due to a tonic-clonic seizure. Head MRI showed cerebral venous thrombosis (CVT). He confessed to having recently taken a large doses of tadalafil. His anti-cardiolipin antibody and anti-caldiolipin-β2-glycoprotein-I complex antibody levels were elevated. Our case suggests the possibility that tadalafil is related to both cardiovascular complications and CVT in patients with hypercoagulability. Patients with conditions associated with hypercoagulability, including antiphospholipid syndrome may be better advised to avoid the use of tadalafil.
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Affiliation(s)
- Kenji Numata
- Department of General Medicine, Mito Kyodo General Hospital, Japan
| | - Kouhei Shimoda
- Department of General Medicine, Mito Kyodo General Hospital, Japan
| | - Yasushi Shibata
- Department of Neurosurgery, Mito Kyodo General Hospital, Japan
| | - Ayako Shioya
- Department of Neurology, Mito Kyodo General Hospital, Japan
| | - Yasuharu Tokuda
- Department of General Medicine, Mito Kyodo General Hospital, Japan
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48
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Lo YC, Tsai JL, Tsai IT, Hsu CW. Headache, oestrogens, homocysteinaemia and cerebral venous thrombosis. QJM 2016; 109:685-686. [PMID: 27516232 DOI: 10.1093/qjmed/hcw146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y-C Lo
- From the Department of Emergency Medicine, E-Da Hospital, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - J-L Tsai
- From the Department of Emergency Medicine, E-Da Hospital, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - I-T Tsai
- From the Department of Emergency Medicine, E-Da Hospital, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - C-W Hsu
- From the Department of Emergency Medicine, E-Da Hospital, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
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49
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Kashyap PV, Bhat SJ. Polycythemia causing Cerebral Venous Thrombosis-A Case Series. J Assoc Physicians India 2016; 64:101. [PMID: 27762534] [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: 06/06/2023]
Affiliation(s)
| | - Sunil Jee Bhat
- Senior Resident (Internal Medicine), Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand
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Maurelli M, Bergamaschi R, Candeloro E, Todeschini A, Micieli G. Cerebral venous thrombosis and demyelinating diseases: report of a case in a clinically isolated syndrome suggestive of multiple sclerosis onset and review of the literature. Mult Scler 2016; 11:242-4. [PMID: 15794401 DOI: 10.1191/1352458505ms1125cr] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/05/2022]
Abstract
Cerebral venous thrombosis (CVT) has been described in several cases of clinically definite multiple sclerosis (MS). In the majority of these, lumbar puncture followed by intravenous corticosteroid treatment was suspected as the cause. We report what is, to our knowledge, the first case of a patient with a multifocal clinically isolated syndrome suggestive of MS onset, who developed multiple CVT after lumbar puncture and during high-dose i.v. corticosteroid treatment. We conclude that the sequence ‘lumbar puncture followed by corticosteroid treatment’ may be a contributory risk factor for the development of CVT when associated with other risk factors.
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Affiliation(s)
- Maurizia Maurelli
- Multiple Sclerosis Centre, IRCCS C Mondino Institute of Neurology, Pavia, Italy.
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