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Schuchardt FF, Lützen N, Küchlin S, Reich M, Lagrèze WA, Mast H, Weigel M, Meckel S, Urbach H, Weiller C, Harloff A, Demerath T. Clinical value of neuroimaging indicators of intracranial hypertension in patients with cerebral venous thrombosis. Neuroradiology 2024:10.1007/s00234-024-03363-6. [PMID: 38676750 DOI: 10.1007/s00234-024-03363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Intracranial hypertension (IH) frequently complicates cerebral venous thrombosis (CVT). Distinct neuroimaging findings are associated with IH, yet their discriminative power, reversibility and factors favoring normalization in prospective CVT patients are unknown. We determined test performance measures of neuroimaging signs in acute CVT patients, their longitudinal change under anticoagulation, association with IH at baseline and with recanalization at follow-up. METHODS We included 26 consecutive acute CVT patients and 26 healthy controls. Patients were classified as having IH based on CSF pressure > 25 cmH2O and/or papilledema on ophthalmological examination or ocular MRI. We assessed optic nerve sheath diameter (ONSD), optic nerve tortuousity, bulbar flattening, lateral and IVth ventricle size, pituitary configuration at baseline and follow-up, and their association with IH and venous recanalization. RESULTS 46% of CVT patients had IH. ONSD enlargement > 5.8 mm, optic nerve tortuousity and pituitary grade ≥ III had highest sensitivity, ocular bulb flattening and pituitary grade ≥ III highest specificity for IH. Only ONSD reliably discriminated IH at baseline. Recanalization was significantly associated with regressive ONSD and pituitary grade. Other neuroimaging signs tended to regress with recanalization. After treatment, 184.9 ± 44.7 days after diagnosis, bulbar flattening resolved, whereas compared with controls ONSD enlargement (p < 0.001) and partially empty sella (p = 0.017), among other indicators, persisted. CONCLUSION ONSD and pituitary grading have a high diagnostic value in diagnosing and monitoring CVT-associated IH. Given their limited sensitivity during early CVT and potentially persistent alterations following IH, neuroimaging indicators can neither replace CSF pressure measurement in diagnosing IH, nor determine the duration of anticoagulation.
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Affiliation(s)
- Florian F Schuchardt
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Niklas Lützen
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Küchlin
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjörg Mast
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Allschwil, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Diagnostic and Interventional Neuroradiology, RKH Kliniken Ludwigsburg, Ludwigsburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kerscher SR, Zipfel J, Haas-Lude K, Bevot A, Tellermann J, Schuhmann MU. Transorbital point-of-care ultrasound versus fundoscopic papilledema to support treatment indication for potentially elevated intracranial pressure in children. Childs Nerv Syst 2024; 40:655-663. [PMID: 37962632 PMCID: PMC10890976 DOI: 10.1007/s00381-023-06186-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To compare transorbital point-of-care ultrasound techniques -optic nerve sheath diameter (US-ONSD) and optic disc elevation (US-ODE)- with fundoscopic papilledema to detect potentially raised intracranial pressure (ICP) with treatment indication in children. METHODS In a prospective study, 72 symptomatic children were included, 50 with later proven disease associated with raised ICP (e.g. pseudotumour cerebri, brain tumour, hydrocephalus) and 22 with pathology excluded. Bilateral US-ONSD and US-ODE were quantified by US using a 12-MHz-linear-array transducer. This was compared to fundoscopic optic disc findings (existence of papilledema) and, in 28 cases, invasively measured ICP values. RESULTS The sensitivity and specificity of a cut-off value of US-ONSD (5.73 mm) to detect treatment indication for diseases associated with increased ICP was 92% and 86.4%, respectively, compared to US-ODE (0.43 mm) with sensitivity: 72%, specificity: 77.3%. Fundoscopic papilledema had a sensitivity of 46% and a specificity of 100% in this context. Repeatability and observer-reliability of US-ODE examination was eminent (Cronbach's α = 0.978-0.989). Papilledema was detected fundoscopically only when US-ODE was > 0.67 mm; a US-ODE > 0.43 mm had a positive predictive value of 90% for potentially increased ICP. CONCLUSION In our cohort, transorbital point-of-care US-ONSD and US-ODE detected potentially elevated ICP requiring treatment in children more reliably than fundoscopy. US-ONSD and US-ODE indicated the decrease in ICP after treatment earlier and more reliably than fundoscopy. The established cut-off values for US-ONSD and US-ODE and a newly developed US-based grading of ODE can be used as an ideal first-line screening tool to detect or exclude conditions with potentially elevated ICP in children.
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Affiliation(s)
- Susanne Regina Kerscher
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany.
| | - Julian Zipfel
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| | - Karin Haas-Lude
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Jonas Tellermann
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
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Ma H, Gu Y, Bian T, Song H, Liu Z, Ji X, Duan J. Dabigatran etexilate versus warfarin in cerebral venous thrombosis in Chinese patients (CHOICE-CVT): An open-label, randomized controlled trial. Int J Stroke 2024:17474930241234749. [PMID: 38353219 DOI: 10.1177/17474930241234749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND The efficacy and safety of dabigatran etexilate for Chinese patients with cerebral venous thrombosis (CVT) has not been well established. METHODS CHOICE-CVT was an exploratory, single-center, randomized, open-label study in the National Center for Neurological Disorders involving Chinese patients with CVT aged 18 to 80 years who were randomly assigned (1:1) to either dabigatran etexilate or warfarin. Oral anticoagulants were initiated after 10-15 days of LMWH. The primary efficacy and safety endpoints included the number of patients with recurrent CVT and/or deep venous thrombosis (DVT) and major clinical bleeding within 180 days. Secondary efficacy endpoints included venous recanalization and change in papilledema at day 180. Secondary safety outcomes comprised death, clinical nonmajor bleeding, and any bleeding. The study was registered with ClinicalTrials.gov under NCT03930940. RESULTS Between October 2017 and February 2023, a total of 89 patients were enrolled and randomly assigned to receive either dabigatran etexilate (n = 44) or warfarin (n = 45). At day 180, the dabigatran etexilate group showed a statistically nonsignificant but likely clinically significant number of patients with recurrent CVT and/or DVT (8 (18.2%; 95% CI, 6.3-30.0) vs 3 (6.7%; 95% CI, 0.0-14.2), p = 0.099, with a power (1-β) of 38.401%) compared with the warfarin group. The dabigatran etexilate group showed a comparable number of patients with clinical major bleeding (0 (0) vs 0 (0) p = 1.000), and clinical nonmajor bleeding (1 (2.3%; 95% CI, 0.0-6.9) vs 1 (2.2%; 95% CI, 0.0-6.7)) but demonstrated a lower risk of any bleeding (1 (2.3%; 95% CI, 0.0-6.9) vs 9 (20.0%; 95% CI, 7.8-32.2)) compared with the warfarin group. Most patients in both groups achieved venous recanalization according to the Modified Qureshi scale (27 (75%; 95% CI, 60.1-89.9) in the dabigatran etexilate group vs 34 (82.9%; 95% CI, 70.9-95.0) in the warfarin group) and exhibited improvement in papilledema as per the Frisén classification (35 (97.2%; 95% CI, 91.6-100.0) in the dabigatran etexilate group vs 37 (88.1%, 95% CI, 77.9-98.3) in the warfarin group). CONCLUSIONS These findings regarding efficacy and safety support the consideration of dabigatran etexilate therapy as a viable treatment option for Chinese patients with CVT.
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Affiliation(s)
- Hongrui Ma
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yaqin Gu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tingting Bian
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Fengtai You'anmen Hospital, Beijing, China
| | - Haiqing Song
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Sun JA, Estrela T, Gise R. Clinical Course and Visual Outcomes of Papilledema in Pediatric Cerebral Venous Sinus Thrombosis. Am J Ophthalmol 2024; 263:126-132. [PMID: 38395330 DOI: 10.1016/j.ajo.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening event with significant neurologic and visual morbidity. In this study, we report on the natural history and visual outcomes of papilledema in children with CVST. DESIGN Retrospective case series. METHODS Patients with CVST evaluated by the Department of Ophthalmology between 2000 and 2023 were included. Records were reviewed for presence and course of papilledema, treatment, and final visual outcomes following papilledema resolution. RESULTS The study included 35 patients with a mean age of 9 ± 5 years and 40% were female. The most common risk factors for CVST were infection (69%), dehydration (26%), and hypercoagulability (23%). 31 patients (89%) had papilledema. Of these patients, 9 (29%) had progression of papilledema despite treatment, 17 patients (55%) did not have progression, and 5 patients (16%) lacked follow-up records. Initial Frisén grade among all cases was 2 ± 1, and cases with progression reached a grade of 4 ± 1 between 10 and 32 days following initial identification. Most patients (97%) were treated with anticoagulation and 100% required acetazolamide and/or lumbar puncture. Among 26 patients with follow-up, papilledema resolved in 107 ± 128 days. Fifty-four percent of patients had permanent ophthalmic sequelae. An initial Frisén grade ≥3 (odds ratio 7.54, 95% confidence interval 6.53-8.70, P< .001) was significantly associated with eventual optic atrophy. CONCLUSIONS Children with CVST are at high risk for ophthalmologic sequelae. Papilledema can progress despite appropriate therapy. Our results highlight the importance of ophthalmologic follow-up during treatment course to prevent irreversible vision loss.
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Affiliation(s)
- Jessica A Sun
- From the Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tais Estrela
- From the Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan Gise
- From the Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Remolí-Sargues L, Monferrer-Adsuara C, López-Salvador B, García-Villanueva C, Gracia-García A, Castro-Navarro V, Cervera-Taulet E. Optical coherence tomography angiography analysis in patients with intracranial hypertension. Eur J Ophthalmol 2024:11206721241228349. [PMID: 38258450 DOI: 10.1177/11206721241228349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Evidence on peripapillary microvasculature in intracranial hypertension (IH) after the regression of papilledema is still scarce. The aim of this preliminary study was to determine the association between structural changes in the optic nerve and the retina and peripapillary microvasculature in patients with IIH. METHODS We conducted a retrospective study. The study included 39 eyes of 21 patients with IIH. Treatment for IIH and history of obesity were registered from each patient. Moreover, OCT analysis including retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GCIPL) thickness, and OCTA analysis including perfusion density (PD) and flux index (FI) of the radial peripapillary capillary plexus were performed. RESULTS Correlation analysis revealed a high correlation between GCIPL thickness and peripapillary PD and FI (p < 0,05, r > 0,7), whereas the degree of correlation between RNFL thickness and peripapillary microvascular parameters was low (p < 0,05, r < 0,7). Patients with regressed papilledema had significantly lower GCIPL thickness and peripapillary PD than control subjects (p < 0,05). CONCLUSION Peripapillary microvascular measurements are highly correlated with GCIPL thickness in patients with IIH. Moreover, GCIPL thickness and peripapillary PD are significantly inferior in patients with regressed papilledema compared to control group. Thus, we suggested that peripapillary microvascular parameters may be an early indicator of optic nerve atrophy in patients with IIH.
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Affiliation(s)
- Lidia Remolí-Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Clara Monferrer-Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Belén López-Salvador
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Carolina García-Villanueva
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Alicia Gracia-García
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Verónica Castro-Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
| | - Enrique Cervera-Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014, Valencia, Spain
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Kerscher SR, Tellermann J, Zipfel J, Bevot A, Haas-Lude K, Schuhmann MU. Influence of sex and disease etiology on the development of papilledema and optic nerve sheath extension in the setting of intracranial pressure elevation in children. BRAIN & SPINE 2023; 4:102729. [PMID: 38510611 PMCID: PMC10951694 DOI: 10.1016/j.bas.2023.102729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Abstract
Introduction Dilatation of the optic nerve sheath diameter and swelling of the optic disc are known phenomena associated with intracranial pressure elevation. Research question Do sex and disease etiology have an impact on the development of optic disc elevation and optic nerve sheath extension in children in the setting of ICP elevation? Fundoscopic papilledema and point-of-care-ultrasound techniques-optic nerve sheath diameter (US-ONSD) and optic disc elevation (US-ODE) - were compared in this regard. Material and methods 72 children were included in this prospective study; 50 with proven pathology (e.g. pseudotumor cerebri, tumor), 22 with pathology excluded. Bilateral US-ONSD and US-ODE were quantified by US using a 12-MHz-linear-array-transducer. This was compared with fundoscopic optic disc findings and in 28 patients with invasive ICP values, stratified for sex and etiology. Results In patients with proven disease, significant more girls (69%) had fundoscopic papilledema compared with boys (37%, p < 0.05). Girls had also larger US-ODE values (0.86 ± 0.36 mm vs. 0.65 ± 0.40 mm in boys). 80% of tumor patients had initial papilledema (100% girls, 79% boys), compared with 50% in pseudotumor cerebri (PTC) (83% girls, 30% boys). US-ONSD had no sex- and no etiology-specificity. Discussion and conclusion Presence of papilledema appears to be influenced by sex and etiology, whereas US-ONSD is not. Girls seem more likely to develop papilledema under similar conditions. Male sex and PTC appear as risk factors for being undetected by fundoscopic findings. US-ONSD and US-ODE seem useful tools to identify pathologies with potentially increased ICP requiring treatment in children regardless of sex and etiology.
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Affiliation(s)
- Susanne Regina Kerscher
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Jonas Tellermann
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
| | - Julian Zipfel
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, University Children’ s Hospital of Tuebingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, University Children’ s Hospital of Tuebingen, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery and Neurotechnology, Division of Pediatric Neurosurgery, University Hospital of Tuebingen, Germany
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Paudyal MB, Bhattarai M, Mehta N, Gautam N, Baral B, Sharma NK, Basnet R, Ghimire B. Coexistence of cerebral venous thrombosis and dural arteriovenous fistula in an adolescent: A case report. Clin Case Rep 2023; 11:e7916. [PMID: 37720711 PMCID: PMC10500052 DOI: 10.1002/ccr3.7916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
Key Clinical Message Clinicians should consider central venous thrombosis (CVT) as a differential diagnosis in young adolescents with persistent headaches. It is essential to assess for concurrent CVT and dural arteriovenous fistula (DAVF), particularly in those with a history of CVT. Abstract Cerebral venous thrombosis (CVT) and dural arteriovenous fistula (DAVF) are uncommon vascular disorders with diverse clinical presentations. The coexistence of CVT and DAVF is a rare but important association that may impact the management and prognosis of affected patients. Prothrombotic conditions generally ranging from acquired to genetic, oral contraceptives, malignancy, puerperium, infection, and head injury are the common risk factors for cerebral venous thrombosis. Here, we present a case of 18 years males who developed recurrent cerebral thrombosis on the background of the presence of an arteriovenous fistula.
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Affiliation(s)
- Man Bahadur Paudyal
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Madhur Bhattarai
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Neha Mehta
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Niraj Gautam
- Department of NeurologyTribhuvan University Teaching Hospital, Institute of MedicineMaharajgunjNepal
| | - Bikas Baral
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Niraj Kumar Sharma
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
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8
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Park MG, Roh J, Ahn SH, Park KP, Baik SK. Papilledema and venous stasis in patients with cerebral venous and sinus thrombosis. BMC Neurol 2023; 23:175. [PMID: 37118674 PMCID: PMC10148469 DOI: 10.1186/s12883-023-03228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/25/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Cerebral venous and sinus thrombosis (CVST) can cause increased intracranial pressure, often leading to papilledema. In this study, we investigated the association between papilledema and venous stasis on susceptibility weighted imaging (SWI) in CVST. METHODS Patients with CVST between 2008 and 2020 were reviewed. Patients without fundoscopic examination or SWI were excluded in this study. Venous stasis was evaluated and scored for each cerebral hemisphere: each hemisphere was divided into 5 regions according to the venous drainage territories (superior sagittal sinus, Sylvian veins, transverse sinus and vein of Labbé, deep cerebral veins, and medullary veins) and 1 point was added if venous prominence was confirmed in one territory on SWI. The venous stasis score on SWI between cerebral hemispheres with and without papilledema was compared. RESULTS Eight of 19 patients with CVST were excluded because of the absence of fundoscopic examination or SWI. Eleven patients (26.5 ± 2.1 years) were included in this study. Papilledema was identified in 6 patients: bilateral papilledema in 4 patients and unilateral papilledema in 2 patients. The venous stasis score on SWI was significantly higher (P = 0.013) in the hemispheres with papilledema (median, 4.0; 95% CI, 3.038-4.562) than in the hemispheres without papilledema (median, 2.5; 95% CI, 0.695-2.805). CONCLUSIONS This study shows that higher score of venous stasis on SWI is associated with papilledema. Therefore, the venous stasis on SWI may be an imaging surrogate marker of increased intracranial pressure in patients with CVST.
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Affiliation(s)
- Min-Gyu Park
- Department of Neurology, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, 20 Geumo-Ro, Mulgeum, 50612, Yangsan, Republic of Korea.
| | - Jieun Roh
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sung-Ho Ahn
- Department of Neurology, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, 20 Geumo-Ro, Mulgeum, 50612, Yangsan, Republic of Korea
| | - Kyung-Pil Park
- Department of Neurology, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, 20 Geumo-Ro, Mulgeum, 50612, Yangsan, Republic of Korea
| | - Seung Kug Baik
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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9
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Schuchardt F, Demerath T, Lützen N, Elsheikh S, Lagrèze W, Reich M, Küchlin S, Urbach H, Meckel S, Harloff A. Risk factors for the development of secondary intracranial hypertension in acute cerebral venous thrombosis. Neuroradiology 2023; 65:463-477. [PMID: 36445465 DOI: 10.1007/s00234-022-03091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Intracranial hypertension (IH) can complicate cerebral venous thrombosis (CVT), potentially causing permanent visual loss. Current knowledge on risk factors for the development of IH following CVT is scarce. We applied a compound classifier (CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI) as a surrogate for IH and studied the predictive value of thrombus location, the number of thrombosed segments, and thrombus volume. METHODS We prospectively included 26 patients with acute CVT and complete MRI data. IH was defined by CSF opening pressure > 25 cmH2O, papilledema, or optic disc protrusion on MRI. Using high-resolution contrast-enhanced venography, we determined the thrombus location, number of thrombosed segments, and thrombus volume. We analyzed their association with IH by logistic regression, their predictive power by the area under the receiver operating characteristic curve, and their association with CSF opening pressure by linear regression. RESULTS IH occurred in 46% of CVT patients and was associated with higher thrombus volume (AUC 0.759, p = 0.025) and superior sagittal sinus thrombosis both alone (OR 2.086, p = 0.049) and combined with transverse sinus thrombosis (OR 2.014, p = 0.028). Effects in patients presenting CSF opening pressure > 25 cm H2O and the compound classifier were consistent. Thrombus volume > 4 ml was the single most important predictor of higher CSF opening pressure (ß = 0.566, p = 0.035), increasing IH risk. CONCLUSION Larger thrombus volume, dominant transverse sinus occlusion, and extensive superior sagittal combined with transverse sinus thrombosis were associated with IH. Thrombus volumetry might identify patients at risk for IH and direct further clinical evaluation.
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Affiliation(s)
- Florian Schuchardt
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
| | - T Demerath
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Lützen
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Elsheikh
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - W Lagrèze
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Reich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Küchlin
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Meckel
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Diagnostic and Interventional Neuroradiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - A Harloff
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
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Dural Venous Sinus Thrombosis and Papilledema Related to JAK2 Mutation: A Case Series. Can J Neurol Sci 2023; 50:194-200. [PMID: 34906267 DOI: 10.1017/cjn.2021.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dural venous sinus thrombosis (DVST) is an important cause of papilledema. Patients diagnosed with DVST should undergo work-up for underlying hypercoagulable state, including genetic causes. One important prothrombotic mutation is in the JAK2 gene, which is a driver of myeloproliferative neoplasms including polycythemia vera (PV). We aimed to determine the prevalence of JAK2 mutation in patients in presenting to neuro-ophthalmology clinic with DVST and papilledema. METHODS Retrospective case series of patients seen in a tertiary neuro-ophthalmology practice who presented with papilledema due to DVST and were investigated for presence of JAK2 mutation. RESULTS Four out of 15 patients with DVST (26%) were found to have JAK2 V617F mutation which led to subsequent diagnosis of PV in 2. One additional patient had a known diagnosis of essential thrombocytosis. We describe the clinical presentation of these four patients with papilledema and JAK2 mutation. CONCLUSIONS A significant proportion of patients with papilledema secondary to DVST will harbor mutations in the JAK2 gene. Clinicians should be aware of this mutation as early testing will facilitate timely diagnosis and treatment of myeloproliferative disease to improve prognosis and reduce risk of recurrent thrombotic events.
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Optic Nerve Sheath Fenestration for Progressive Visual Loss in Cerebral Venous Sinus Thrombosis: A Long-Term Retrospective Observational Study. Neurol Ther 2023; 12:441-457. [PMID: 36609961 PMCID: PMC10043064 DOI: 10.1007/s40120-022-00434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Progressive cerebral venous sinus thrombosis (CVST)-induced visual loss remains problematic, despite decreasing overall mortality owing to early diagnosis and aggressive treatment. Optic nerve sheath fenestration (ONSF) improves or stabilizes visual function in patients with idiopathic intracranial hypertension; however, its role in CVST awaits elucidation. We evaluated the efficacy and safety of ONSF in resolving CVST-induced visual impairment based on long-term observation. METHODS This observational study included 18 patients with progressive CVST-induced visual loss, who had undergone ONSF between 2012 and 2021. Patients received maximum medical therapy, including anticoagulants and intracranial pressure (ICP)-lowering medications. The best-corrected visual acuity (BCVA), visual fields (VFs), and optic nerve head were assessed at baseline, at 1 week after ONSF, and over 6 months after ONSF. Activities of daily living (ADL) and National Eye Institute Visual Function Questionnaire-25 (VFQ-25) scores were assessed at final follow-up. RESULTS Thirty-one ONSF-treated eyes of 18 patients were included. The mean follow-up duration was 35.6 months (range 1 week-8 years). Two patients were lost to follow-up. Before ONSF, all patients were still experiencing progressive visual loss despite receiving adequate anticoagulation and ICP-lowering therapy. Postoperative BCVA remained stable or improved in 25/31 eyes (80.6%) 1 week postoperatively and 17/28 eyes (60.7%) upon final follow-up. All papilledema resolved postoperatively. No complications were reported except for one transient postoperative diplopia. The median ADL score was 100 (range 25-100), and the mean total VFQ-25 score was 40.6 (range 9.5-87.3). CONCLUSION This was the largest study to describe ONSF's role in CVST based on a long-term follow-up. Considering its efficacy and favorable safety, ONSF can be considered an important adjunctive approach to resolving progressive visual loss of CVST patients, on the basis of anticoagulation and ICP-lowering therapy.
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Reier L, Fowler JB, Arshad M, Hadi H, Whitney E, Farmah AV, Siddiqi J. Optic Disc Edema and Elevated Intracranial Pressure (ICP): A Comprehensive Review of Papilledema. Cureus 2022; 14:e24915. [PMID: 35698673 PMCID: PMC9187153 DOI: 10.7759/cureus.24915] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Papilledema is a swelling of the optic disc secondary to elevated intracranial pressure (ICP). We analyzed 79 peer-review journal articles and provided a concise summary of the etiology, epidemiology, pathophysiology, clinical presentation, evaluation, natural history, differential diagnosis, treatment, and prognosis of papilledema. Only studies written in English with the full text available were included. Although many etiologies of papilledema exist, idiopathic intracranial hypertension is the most common and, thus, a large focus of this review.
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Hmila L, Bonnafous M, Albornoz D, Renaudier P, Merle H. Leucémie aiguë promyélocytaire révélée par des taches de Roth et un œdème papillaire bilatéral au fond d’œil : à propos d’un cas. J Fr Ophtalmol 2022; 45:e217-e220. [DOI: 10.1016/j.jfo.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 10/18/2022]
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Leong YY, Vasseneix C, Finkelstein MT, Milea D, Najjar RP. Artificial Intelligence Meets Neuro-Ophthalmology. Asia Pac J Ophthalmol (Phila) 2022; 11:111-125. [PMID: 35533331 DOI: 10.1097/apo.0000000000000512] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
ABSTRACT Recent advances in artificial intelligence have provided ophthalmologists with fast, accurate, and automated means for diagnosing and treating ocular conditions, paving the way to a modern and scalable eye care system. Compared to other ophthalmic disciplines, neuro-ophthalmology has, until recently, not benefitted from significant advances in the area of artificial intelligence. In this narrative review, we summarize and discuss recent advancements utilizing artificial intelligence for the detection of structural and functional optic nerve head abnormalities, and ocular movement disorders in neuro-ophthalmology.
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Affiliation(s)
| | - Caroline Vasseneix
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Dan Milea
- Singapore National Eye Center, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Guarnizo A, Albreiki D, Cruz JP, Létourneau-Guillon L, Iancu D, Torres C. Papilledema: A Review of the Pathophysiology, Imaging Findings, and Mimics. Can Assoc Radiol J 2022; 73:557-567. [PMID: 35044276 DOI: 10.1177/08465371211061660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Increased intracranial pressure is the most common cause of papilledema. Multiple etiologies such as cerebral edema, hydrocephalus, space occupying lesions, infection, and idiopathic intracranial hypertension among others should be considered. Imaging plays a critical role in the detection of pathologies that can cause papilledema. MRI with contrast and CE-MRV, in particular, are key for the diagnosis of idiopathic intracranial hypertension. This review will focus in common and infrequent causes of papilledema, the role of imaging in patients with papilledema as well as its potential mimickers.
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Affiliation(s)
- Angela Guarnizo
- Division of Neuroradiology, Department of Radiology, 58629Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Danah Albreiki
- Department of ophthalmology, The Ottawa Hospital Civic and General Campus, 27337University of Ottawa, Ottawa, ON, Canada
| | - Juan Pablo Cruz
- Division of Neuroradiology, Department of Radiology, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Dana Iancu
- Division of Interventional Neuroradiology, Department of Radiology, 5622University of Montreal, Montreal, QC, Canada
| | - Carlos Torres
- Division of Neuroradiology, Department of Radiology, The Ottawa Hospital Civic and General Campus, 6363University of Ottawa, Ottawa, ON, Canada
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Lin TY, Chien KH. Delayed Onset Bilateral Papilledema in a Young Boy's Eyes after Trauma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010140. [PMID: 35056449 PMCID: PMC8780981 DOI: 10.3390/medicina58010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare venous thromboembolic disease that affects young adults in their thirties, with a female predilection. Head trauma accounts for only 1-3% of cases among possible etiologies. Here, we present a particular case of trauma-related CVST with delayed-onset symptoms and signs in a young boy. A 12-year-old boy presented to the emergency department with non-specific visual symptoms 11 days after head trauma. Apart from mild-grade disc swelling in the right eye and dyschromatopsia in both eyes, no significant findings were revealed during physical examinations and a non-contrast cranial computed tomography (CT) scan. Unfortunately, the patient suffered multiple seizure attacks the following day. Trauma-related CVST, complicated by delayed-onset increased intracranial pressure, and bilateral papilledema were finally diagnosed. Physicians need increased awareness of a possible CVST diagnosis if a patient with a history of head trauma shows persistent or worsening neurological symptoms despite negative results on serial non-contrast cranial CT scans.
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Paediatric otogenic cerebral venous sinus thrombosis: a multidisciplinary approach. The Journal of Laryngology & Otology 2021; 136:3-7. [PMID: 34698003 DOI: 10.1017/s0022215121003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paediatric otogenic cerebral venous sinus thrombosis is a rare, heterogeneous and life-threatening condition, with possible otological, neurological and ophthalmological sequelae. Its course and outcomes can be widely variable. The publications available often consider individual aspects of paediatric otogenic cerebral venous sinus thrombosis management. The condition itself and the nature of the currently available guidance can lead to uncertainties when holistically managing patients with paediatric otogenic cerebral venous sinus thrombosis. OBJECTIVES Clear recommendations for the comprehensive assessment and management of paediatric otogenic cerebral venous sinus thrombosis are presented, along with the literature review upon which they are based. Its clinical and radiological assessment are discussed. CONCLUSION A multidisciplinary approach to assessment and management is recommended, inclusive of infectious diseases, ENT surgery, neurology, ophthalmology and haematology. On balance, anticoagulation is recommended for three months. Follow-up imaging is not recommended in the absence of clinical concern. Follow up by ENT surgery, neurology and ophthalmology departments is recommended.
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18
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Vasseneix C, Najjar RP, Xu X, Tang Z, Loo JL, Singhal S, Tow S, Milea L, Ting DSW, Liu Y, Wong TY, Newman NJ, Biousse V, Milea D. Accuracy of a Deep Learning System for Classification of Papilledema Severity on Ocular Fundus Photographs. Neurology 2021; 97:e369-e377. [PMID: 34011570 DOI: 10.1212/wnl.0000000000012226] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the performance of a deep learning system (DLS) in classifying the severity of papilledema associated with increased intracranial pressure on standard retinal fundus photographs. METHODS A DLS was trained to automatically classify papilledema severity in 965 patients (2,103 mydriatic fundus photographs), representing a multiethnic cohort of patients with confirmed elevated intracranial pressure. Training was performed on 1,052 photographs with mild/moderate papilledema (MP) and 1,051 photographs with severe papilledema (SP) classified by a panel of experts. The performance of the DLS and that of 3 independent neuro-ophthalmologists were tested in 111 patients (214 photographs, 92 with MP and 122 with SP) by calculating the area under the receiver operating characteristics curve (AUC), accuracy, sensitivity, and specificity. Kappa agreement scores between the DLS and each of the 3 graders and among the 3 graders were calculated. RESULTS The DLS successfully discriminated between photographs of MP and SP, with an AUC of 0.93 (95% confidence interval [CI] 0.89-0.96) and an accuracy, sensitivity, and specificity of 87.9%, 91.8%, and 86.2%, respectively. This performance was comparable with that of the 3 neuro-ophthalmologists (84.1%, 91.8%, and 73.9%, p = 0.19, p = 1, p = 0.09, respectively). Misclassification by the DLS was mainly observed for moderate papilledema (Frisén grade 3). Agreement scores between the DLS and the neuro-ophthalmologists' evaluation was 0.62 (95% CI 0.57-0.68), whereas the intergrader agreement among the 3 neuro-ophthalmologists was 0.54 (95% CI 0.47-0.62). CONCLUSIONS Our DLS accurately classified the severity of papilledema on an independent set of mydriatic fundus photographs, achieving a comparable performance with that of independent neuro-ophthalmologists. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that a DLS using mydriatic retinal fundus photographs accurately classified the severity of papilledema associated in patients with a diagnosis of increased intracranial pressure.
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Affiliation(s)
- Caroline Vasseneix
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Raymond P Najjar
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Xinxing Xu
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Zhiqun Tang
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Jing Liang Loo
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Shweta Singhal
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Sharon Tow
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Leonard Milea
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark.
| | - Daniel Shu Wei Ting
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Yong Liu
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Tien Y Wong
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Nancy J Newman
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Valerie Biousse
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark
| | - Dan Milea
- From the Singapore Eye Research Institute (C.V., R.P.N., Z.T., J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); Duke-NUS Medical School (R.P.N., J.L.L., S.S., S.T., T.Y.W., D.M.); Institute of High Performance Computing (X.X., Y.L.), Agency for Science, Technology and Research (A*STAR); Singapore National Eye Centre (J.L.L., S.S., S.T., D.S.W.T., T.Y.W., D.M.); University of Berkeley (L.M.), CA; Departments of Ophthalmology and Neurology (N.J.N., V.B.), Emory University School of Medicine, Atlanta, GA; and Copenhagen University Hospital (D.M.), Denmark.
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Çetin İD, Eraslan C, Şimşek E, Kanmaz S, Serin HM, Karapınar DY, Yılmaz SK, Aktan G, Tekgül H, Gökben S. Cerebral sinovenous thrombosis in children: A single-center experience. Turk Arch Pediatr 2021; 56:236-244. [PMID: 34104915 DOI: 10.5152/turkarchpediatr.2021.20073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/23/2020] [Indexed: 02/02/2023]
Abstract
Objective The study aimed to evaluate the patients with a diagnosis of cerebral sinovenous thrombosis in terms of clinical findings, etiology and underlying risk factors, imaging findings, treatment, and prognosis in the long term. Materials and Methods Medical records of 19 patients whose ages ranged between 0 days and 17 years with clinical and radiological cerebral sinovenous thrombosis in Ege University Department of Child Neurology were retrospectively evaluated. Results Nine of nineteen cases were female (47.3%). The median age was 84 months (0-201 months). The most common complaint at the presentation was headache (n=12) and the most common physical examination finding was papilledema (n=11). In etiology, otitis/mastoiditis in three cases, iron deficiency anemia in three cases, sinusitis in two cases, catheter use in four cases, Behçet's disease in three cases were determined. The most common observed genetic factors causing thrombosis was methylenetetrahydrofolate reductase mutation. The transverse sinus (68.4%) is the sinus where thrombosis is most frequently observed. As a result of an average follow-up of 12 months (2-72 months), hemiparesis (n=3/19, 15.7%) and epilepsy (n=5/19, 26.3%) were recorded as sequelae findings, and no mortality was observed. Conclusion In cases presenting with headache, evaluation of papilledema on funduscopic examination should not be skipped. Neurological imaging should be performed in the change of consciousness of poor feeding infants and children with infections in the head and neck area or underlying chronic diseases. When cerebral sinovenous thrombosis is detected, anticoagulant therapy should be started immediately.
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Affiliation(s)
- İpek Dokurel Çetin
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Cenk Eraslan
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Erdem Şimşek
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Seda Kanmaz
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Hepsen Mine Serin
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Yılmaz Karapınar
- Department of Child Health and Diseases, Department of Pediatric Hematology and Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sanem Keskin Yılmaz
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Gül Aktan
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Hasan Tekgül
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Sarenur Gökben
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
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