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Kellermair L, Höfer C, Zeller MWG, Kubasta C, Bandke D, Weis S, Kellermair J, Forstner T, Helbok R, Vosko MR. Endothelial receptor proteins in acute venous thrombosis and delayed thrombus resolution in cerebral sinus vein thrombosis. J Neurol 2024:10.1007/s00415-024-12225-3. [PMID: 38578497 DOI: 10.1007/s00415-024-12225-3] [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: 12/14/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND PURPOSE Cerebral sinus venous thrombosis (CSVT) is a rare but life-threatening disease and its diagnosis remains challenging. Blood biomarkers, including D-Dimer are currently not recommended in guidelines. Soluble endothelial receptor proteins (sICAM-1, sPECAM-1 and sVCAM-1) have been shown to be promising diagnostic biomarkers in deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, we examined endothelial receptor proteins as potential biomarkers for detecting CSVT. METHODS In this bi-centre, prospective study, we quantified D-Dimer as well as sICAM-1, sPECAM-1 and sVCAM-1 in plasma of patients with clinically suspected CSVT managed in the neurological emergency department (ED) of a tertiary care hospital. All patients underwent cerebral magnetic resonance imaging (MRI) and were followed up after 3, 6 and 12 months to detect thrombus resolution. RESULTS Twenty-four out of 75 (32%) patients with clinically suspected CSVT presenting with headache to the ED were diagnosed with acute CSVT. These patients had a mean age of 45 ± 16 years and 78% were female. In patients with CSVT, mean baseline D-dimer (p < 0.001) and sPECAM-1 (p < 0.001) were significantly higher compared to patients without CSVT. The combination of D-Dimer and sPECAM-1 yielded the best ROC-AUC (0.994; < 0.001) with a negative predictive value of 95.7% and a positive predictive value of 95.5%. In addition, higher baseline sPECAM-1 levels (> 198 ng/ml) on admission were associated with delayed venous thrombus resolution at 3 months (AUC = 0.83). CONCLUSION sPECAM-1 in combination with D-Dimer should be used to improve the diagnostic accuracy of acute CSVT and sPECAM-1 may predict long-term outcome of CSVT. Confirmatory results are needed in other settings in order to show their value in the management concept of CSVT patients.
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Affiliation(s)
- Lukas Kellermair
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Christoph Höfer
- Department of Neurology, The Hospital of the Brothers of Saint John of God, Linz, Austria
| | - Matthias W G Zeller
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Christa Kubasta
- Department of Laboratory Medicine, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Dave Bandke
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Kepler University Hospital, Neuromed Campus, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Kepler University Hospital, Neuromed Campus, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Jörg Kellermair
- Medical Faculty, Johannes Kepler University, Linz, Austria
- Department of Cardiology, Kepler University Hospital, Med Campus III, Linz, Austria
| | - Thomas Forstner
- Department of Applied Systems Research and Statistics, Johannes Kepler University Linz, Linz, Austria
| | - Raimund Helbok
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria
| | - Milan R Vosko
- Department of Neurology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4021, Linz, Austria.
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Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente-Fernández L, de la Torre-Colmenero JD, Tejada Meza H, Vesperinas-Castro A, Sánchez-Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2024; 39:226-234. [PMID: 37442428 DOI: 10.1016/j.nrleng.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/22/2021] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P = .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain.
| | | | | | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, Spain
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | | | | | - L Llul
- Hospital Clínic, Barcelona, Spain
| | - J Egido
- Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, Spain
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Jiang H, Zhou C, Wei H, Wu Y, Zhou Y, Xiao X, Liu L, Li M, Duan J, Meng R, Ji X. Potential role of plasma branched-chain amino acids in the differential diagnosis of acute cerebral venous thrombosis. J Cereb Blood Flow Metab 2023; 43:1532-1543. [PMID: 37066688 PMCID: PMC10414010 DOI: 10.1177/0271678x231170037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023]
Abstract
Cerebral venous thrombosis (CVT) is a special and easily misdiagnosed or undiagnosed subtype of stroke. To identify specific biomarkers with a high predictive ability for the diagnosis of acute CVT, we performed metabolomic analysis in plasma samples from acute CVT patients and healthy controls and confirmed the results in validation cohorts. In the discovery stage, there were 343 differential metabolites, and the caffeine metabolism pathway and the biosynthesis pathway for the branched chain amino acids (BCAAs) valine, leucine, and isoleucine were two significant pathways between the CVT and healthy cohorts. The area under the curve (AUC) for metabolites associated with valine, leucine, and isoleucine biosynthesis was 0.934. In the validation stage, the BCAA concentrations demonstrated an AUC of 0.935 to differentiate patients with acute CVT from the control cohort. In addition, BCAAs combined with D-dimer levels were used to establish a diagnostic model for CVT, and the AUC was 0.951, showing good diagnostic efficacy of separating CVT patients from the control cohort. BCAAs as plasma biomarkers deserve to be further studied and even developed in clinical CVT management.
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Affiliation(s)
- Huimin Jiang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yan Wu
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yifan Zhou
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Xuechun Xiao
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Lu Liu
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Emergency, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ran Meng
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
- Neurology and Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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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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Kharel S, Shrestha S, Pant SR, Acharya S, Sharma A, Baniya S, Bhandari SS. High-Altitude Exposure and Cerebral Venous Thrombosis: An Updated Systematic Review. High Alt Med Biol 2023; 24:167-174. [PMID: 37615608 DOI: 10.1089/ham.2022.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Kharel, Sanjeev, Suraj Shrestha, Samriddha Raj Pant, Suman Acharya, Amit Sharma, Santosh Baniya, and Sanjeeb S. Bhandari. High-altitude exposure and cerebral venous thrombosis: an updated systematic review. High Alt Med Biol. 24:167-174, 2023. Background: High altitude (HA) may increase the risk of cerebral venous thrombosis (CVT). Differentiating it from other HA illnesses is crucial for prompt treatment and better outcomes. We aimed to summarize the clinical data, etiology, and risk factors of this poorly understood entity at an HA. Materials and Methods: A systematic literature search of various databases, including PubMed, Embase, and Google Scholar, was done using relevant keywords; cerebral venous thrombosis; HA, up to May 1, 2022. Results: A total of nine studies, including 75 cases of CVT at HA (3,000-8,848 m), with 66 males and 9 females, were included in this review. Headache and seizure were the most common clinical presentations. Smoking, drinking habits, and the use of oral contraceptive pills (OCP) were the most common risk factors for the development of CVT. Similarly, various underlying hypercoagulable states were also present among cases of CVT associated with HA exposure. Conclusion: Our review concludes that HA exposure can predispose individuals with risk factors such as preexisting hypercoagulable states, smoking, drinking habits, and use of OCP to an increased risk of CVT.
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Affiliation(s)
- Sanjeev Kharel
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - Samriddha Raj Pant
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - Suman Acharya
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Amit Sharma
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | | | - Sanjeeb S Bhandari
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
- Collaboration for Emergency Care, Kathmandu, Nepal
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Yu S, Feng W, Wang Y, Zhao M, Tu Y, Guo Z. Serum total bile acid levels assist in the prediction of acute intussusception with abdominal type Henoch-Schonlein purpura in children. Front Pediatr 2023; 11:1183470. [PMID: 37342527 PMCID: PMC10277492 DOI: 10.3389/fped.2023.1183470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
Background The severe acute abdomen associated with Henoch-Schonlein purpura (HSP) is an acute intussusception (AI). There is no reliable specific marker for AI with abdominal-type HSP. The serum total bile acid (TBA) level is a new prognostic marker associated with the severity of intestinal inflammation. The purpose of this study was to identify the prognostic value of serum TBA levels for the diagnosis of AI in children with abdominal-type HSP. Methods A retrospective study of 708 patients with abdominal-type HSP was conducted, with demographic data, clinical symptoms, hepatic function index, immune function markers, and clinical outcomes assessed. Patients were divided into two groups: HSP (613 patients) and HSP with AI (95 patients). The data were analysed using SPSS 22.0. Results Of the 708 patients, the serum TBA levels were higher in the HSP with AI group than in the HSP group (P < 0.05). Logistic regression analysis showed that vomiting (OR = 396.492, 95% CI = 14.93-10,529.67, P < 0.001), haematochezia (OR = 87.436, 95% CI = 5.944-1,286.214, P = 0.001), TBA (OR = 16.287, 95% CI = 4.83-54.922, P < 0.001), and D-dimer (OR = 5.987, 95% CI = 1.892-15.834, P = 0.003) were independent risk factors for abdominal-type HSP with AI. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off serum TBA value (sensitivity = 91.58%, specificity = 84.67%, AUC = 93.6524%) was >3 μmol/L for predicting AI in children with abdominal-type HSP. In this group of HSP patients with AI, a serum TBA level ≥6.98 μmol/L was significantly associated with an increased incidence of operative treatment (51.85% vs. 75.61%, P = 0.0181), intestinal necrosis (9.26% vs. 29.27%, P = 0.0117), and length of hospital stay [15.76 ± 5.31 vs. 10.98 ± 2.83 (days), P < 0.0001]. Conclusion In children with HSP and AI, the serum TBA level was significantly higher. A novel but promising haematological indicator, the serum TBA level, helps identify HSP with and without AI and predicts intestinal necrosis in HSP with AI.
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Affiliation(s)
- Sijie Yu
- Department of Nephrology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Feng
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Maoyuan Zhao
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yuying Tu
- Department of General Surgery, Jiangxi Hospital Affiliated to Children’s Hospital of Chongqing Medical University, Jiangxi, China
- Jiangxi Children’s Medical Center, Jiangxi Maternal and Child Health Hospital, Jiangxi, China
| | - Zhenhua Guo
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of General Surgery, Jiangxi Hospital Affiliated to Children’s Hospital of Chongqing Medical University, Jiangxi, China
- Jiangxi Children’s Medical Center, Jiangxi Maternal and Child Health Hospital, Jiangxi, China
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Yang Y, Cheng J, Peng Y, Luo Y, Zou D, Yang Y, Ma Y. Clinical features of patients with cerebral venous sinus thrombosis at plateau areas. Brain Behav 2023; 13:e2998. [PMID: 37095720 PMCID: PMC10275515 DOI: 10.1002/brb3.2998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Cerebral venous sinus thrombosis (CVST) is believed to be associated with high-altitude exposure and has worse clinical prognosis in plateau areas than in plain areas, although this needs to be further verified. This retrospective study aims to compare the clinical differences of patients with CVST in plateau and plain areas and further ascertain the role of high-altitude exposure in the etiology of aggravating predisposition toward CVST. METHODS Twenty-four symptomatic CVST patients occurring at plateau areas (altitude ≥ 4000 m), in corresponding with 24 CVST patients occurring at plain areas (altitude ≤ 1000 m), were recruited according to the inclusion and exclusion criteria from June 2020 to December 2021. The collected data and compared parameters include clinical features, neuroimaging findings, hematology profile, lipid profile, and coagulation profile within 24 h of hospital admission, as well as the treatment method and final outcome. RESULTS There were no obvious differences of demographic characteristics, including gender, age, height, and weight between patients with CVST in plateau and plain areas, as well as medical history, neuroimaging findings, treatment protocols, and clinical outcome (all p > .05). Compared to patients with CVST at plain areas, time before hospital admission was longer and heartbeat was slower in patients with CVST at plateau areas (all p < .05). More importantly, elevated red blood cells counts, hemoglobin level, and altered coagulation function were found in patients with CVST at plateau areas (all p < .05). CONCLUSION CVST patients in plateau areas presented with altered clinical characteristics, altered coagulation function, and aggravated predisposition toward venous thromboembolism compared with CVST patients in plain areas. Future prospective studies will be needed to further elucidate the influences of a high altitude on the pathogenesis of CVST.
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Affiliation(s)
- Yongxiang Yang
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Jingmin Cheng
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yuping Peng
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yan Luo
- Department of OncologyThe General Hospital of Western Theater CommandChengduChina
| | - Dongbo Zou
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
| | - Yongjian Yang
- Department of CardiologyThe General Hospital of Western Theater CommandChengduChina
| | - Yuan Ma
- Department of NeurosurgeryThe General Hospital of Western Theater CommandChengduChina
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Sun R, Huang F, Wu W, Yin G, Ding Q, Gu Z, Fan C, Song C, Liang M, Liu X, Bi X. Association of neutrophil to lymphocyte ratio and D-dimer with functional outcome in patients with cerebral venous sinus thrombosis. BMC Neurol 2023; 23:30. [PMID: 36658518 PMCID: PMC9850605 DOI: 10.1186/s12883-022-03030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Investigations on the risk factors for the prognosis of cerebral venous sinus thrombosis (CVST) are limited. This study aimed to explore whether specific inflammatory factors and coagulation indictors are associated with functional outcome in patients treated for CVST. METHODS This retrospective study included 137 patients admitted to our hospital between January 2010 and October 2021. The functional outcome was assessed with the modified Rankin Scale (mRS) score at discharge. Patients were divided into two groups, 102 patients with favorable outcomes (mRS 0-1) and 35 patients with poor outcomes (mRS 2-6). The clinical indexes were compared between two groups. Multivariable logistic regression was performed to identify the independent influencing factors for poor outcomes of CVST patients. The prognostic indicators were analyzed using the receiver operating characteristic (ROC) curve. RESULTS Compared with the favorable outcome group, the incidence of impaired consciousness and brain lesion, the levels of D-dimer, RDW, neutrophil count, neutrophil to lymphocyte ratio (NLR) and red blood cell distribution width to platelet ratio (%) on admission were significantly higher in the poor outcome group, while the level of lymphocyte count was significantly lower. After multivariable logistic regression analysis, baseline D-dimer level (odds ratio (OR), 1.180; 95% confidence interval (CI), 1.019-1.366, P = 0.027) and NLR (OR, 1.903; 95%CI, 1.232-2.938, P = 0.004) were significantly associated with unfavorable outcome at discharge. The ROC curve analysis showed that the areas under the curve of D-dimer, NLR and their combined detection for predicting worse outcome were 0.719, 0.707 and 0.786, respectively. CONCLUSIONS Elevated D-dimer level and NLR on admission were associated with an increased risk of poor functional outcome in patients with CVST.
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Affiliation(s)
- Rui Sun
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Feihong Huang
- Department of Neurology, Guilin People’s Hospital, Guilin, 541000 China
| | - Wen Wu
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Ge Yin
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Qichao Ding
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Zhengsheng Gu
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Cunxiu Fan
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Chenrui Song
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Meng Liang
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Xiaobei Liu
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
| | - Xiaoying Bi
- grid.73113.370000 0004 0369 1660Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433 China
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9
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Wauthier L, Favresse J, Hardy M, Douxfils J, Le Gal G, Roy P, van Es N, Ay C, ten Cate H, Lecompte T, Lippi G, Mullier F. D-dimer testing: A narrative review. Adv Clin Chem 2023. [DOI: 10.1016/bs.acc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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10
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Chen YC, Chang CW, Wu HC, Chen CM, Chang CH, Chang KH. Clinical Characteristics and Prognostic Factors of Non-Infectious Cerebral Venous Sinus Thrombosis. J Clin Med 2022; 11:jcm11206096. [PMID: 36294417 PMCID: PMC9605230 DOI: 10.3390/jcm11206096] [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: 09/01/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Non-infectious cerebral venous thrombosis (CVT) is an uncommon type of cerebrovascular disease that usually affects young patients. It occurs frequently in female patients, probably due to the association of sex-specific risk factors for coagulopathies. Currently, the prognostic factors of CVT remain unclear. We retrospectively reviewed the clinical characteristics among 260 CVT patients, including 147 females and 113 males. A favorable clinical outcome was defined by the scores of the modified Rankin Scale (mRS) ≤ 2 at hospital discharge, while a poor clinical outcome was defined by an mRS score of 3 to 6. A headache (28.5%) was the most frequent presentation. The most commonly affected sinus was the transverse-sigmoid sinus (59.6%). Most of the cases (78.5%) were treated with anticoagulants. One hundred and fifty-seven patients (60.4%) were discharged with favorable clinical outcomes. Consciousness disturbance (odds ratio: 5.01, p < 0.001) was associated with a poor clinical outcome. Patients with poor clinical outcomes demonstrated higher D-dimer levels on admission (4137.76 ± 3317.07 vs. 2476.74 ± 2330.87 ng/mL FEU, p = 0.029) and longer hospitalization days (31.81 ± 26.29 vs. 13.96 ± 8.82 days, p < 0.001) compared with favorable clinical outcomes. These findings provide important information of clinical characteristics and prognosis for CVT. Aggressive monitoring and treatment should be considered in CVT patients with poor prognostic factors.
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11
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Li Y, Zhang M, Xue M, Wei M, He J, Dong C. A case report of cerebral venous sinus thrombosis presenting with rapidly progressive dementia. Front Med (Lausanne) 2022; 9:985361. [PMID: 36091714 PMCID: PMC9452803 DOI: 10.3389/fmed.2022.985361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCerebral venous sinus thrombosis (CVST) is a rare but serious and treatable cause of neurologic symptoms. Due to the variable clinical presentation, CVST was often misdiagnosed. According to published case reports, common clinical manifestations of CVST include headache, focal neurological deficit, epilepsy, papilledema, etc. It is rare, nevertheless, to mention cases of rapidly progressive dementia (RPD).Case presentationWe reported a case of a 62-year-old retired male accountant, a Han Chinese from eastern China, who initially presented with slow response and memory decline. Until 2 months later, his memory declined and slow response deteriorated significantly, and he could not even complete simple tasks like brushing his teeth, washing his face, washing his feet, and dressing himself, and sometimes developed fecal incontinence. His neuropsychological test demonstrated severe cognitive decline. The cerebrospinal fluid (CSF) studies revealed markedly high opening pressure (260 mm of water), and coagulation tests indicated a mild elevation of D-Dimer of 1.19 mg/L. The magnetic resonance venography (MRV) showed thrombosis of the left transverse sinus, sigmoid sinus, and jugular venous bulb and was diagnosed as CVST. He switched from subcutaneous low molecular weight heparin (LMWH) and transitioned to oral anticoagulants at the time of discharge. The repeated CSF studies revealed normal opening pressure. After 5 days of anticoagulant treatment, his symptoms considerably improved, and a 1-month follow-up revealed that he had fully healed with no signs of recurrence.ConclusionThis case demonstrated the clinical heterogeneity of CVST, which should be taken into account for differential diagnosis of RPD. This case study also offered fresh data for the categorization of the clinical traits and the diagnosis of CVST.
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Affiliation(s)
- Yaqiang Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
- Department of Neurology, People’s Hospital of Lixin County, Bozhou, China
| | - Mei Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
- *Correspondence: Mei Zhang,
| | - Min Xue
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Ming Wei
- Department of Radiology, The First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Jiale He
- Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Chunhui Dong
- Department of Laboratory, The First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
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12
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An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis. Life (Basel) 2022; 12:life12050717. [PMID: 35629384 PMCID: PMC9145675 DOI: 10.3390/life12050717] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 01/05/2023] Open
Abstract
(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.
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13
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Pathak A, Singh VK, Kumar A, Mishra VN, Joshi D, Chaurasia RN. Predictive Value of Combination of D-dimer and Fibrinogen in Diagnosing Acute CVST. Ann Neurosci 2022; 28:156-161. [PMID: 35341225 PMCID: PMC8948324 DOI: 10.1177/09727531211063138] [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: 06/20/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke, and
the role of D-dimer and fibrinogen in early diagnosis of CVST has been
studied with varying results. The present study aims to study the role of
the combination of D-dimer and fibrinogen in early diagnosis of acute
CVST. Methods: Forty consecutive confirmed acute CVST cases admitted at a tertiary care
center were recruited for the study. D-dimer and fibrinogen were assessed by
a rapid semiquantitative latex agglutination assay. Results: Out of the 40 CVST patients, 21 (52.50%) were females. The mean age of the
patients was 37.58 years ± 19.17 years. Common clinical features were
headache (N = 38 [95%]), papilloedema (N =
15 [37.5%]), and seizures (N = 12 [30%]). Although the
sensitivity (75%) of the combination of D-dimer and fibrinogen assay was
lower than that of D-dimer or fibrinogen alone, the specificity and positive
predictive value (75% each) was higher. Conclusion: The combination of D-dimer and fibrinogen testing may aid in an early
diagnosis of acute CVST and in better management.
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Affiliation(s)
- Abhishek Pathak
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.,First authorship and equal contribution
| | - Varun Kumar Singh
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.,First authorship and equal contribution
| | - Anand Kumar
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vijaya Nath Mishra
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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14
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Yang X, Wu F, Liu Y, Duan J, Fisher M, Ji X, Meng R, Zhang H, Fan Z, Yang Q. Diagnostic performance of MR black-blood thrombus imaging for cerebral venous thrombosis in real-world clinical practice. Eur Radiol 2022; 32:2041-2049. [PMID: 34542696 DOI: 10.1007/s00330-021-08286-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/24/2021] [Accepted: 08/19/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES MR black-blood thrombus imaging (BTI) has been developed for the detection of cerebral venous thrombosis (CVT). Yet, there is a lack of real-world data to verifying its clinical performance. This study aims to evaluate the performance of BTI in diagnosing and staging CVT in a 5-year period. METHODS Patients suspected of CVT were enrolled between 2014 and 2019. Patients with or without BTI scans were classified into group A and group B, respectively. The prevalence of correct diagnosis of CVT and patients with evaluable clot age were compared. The diagnostic performance of BTI including sensitivity, specificity, and specific staging information was further analyzed. RESULTS Two hundred and twenty-one of the 308 patients suspected of CVT were eligible in the current study (114 in group A and 97 in group B), with 125 diagnosed by multidisciplinary teams to have CVTs (56 in group A, 69 in group B). The rate of correct diagnosis of CVT was higher in group A than that in group B (94.7% vs 60.8%, p < 0.001, x2 = 36.517) after adding BTI images. The percent of patients with evaluable staged segments between the two groups were 96.4% and 33.9%, respectively (x2 = 48.191, p < 0.001). BTI showed a sensitivity of 96.4% and 87.9% in the detection of CVT on per-patient and per-segment level, respectively. Up to 98.1% of all thrombosed segments could be staged by BTI and 59.6% of them were matched with clinical staging. CONCLUSIONS In the actual clinical practice, BTI improves diagnostic confidence and has an excellent performance in confirming and staging CVT. KEY POINTS • Black-blood thrombus imaging has good diagnostic performance in detecting cerebral venous thrombosis compared to traditional imaging methods with strong evidence in the actual clinical setting. • BTI helps clinicians to diagnose CVT with more accuracy and confidence, which can be served as a promising imaging examination. • BTI can also provide additional information of different thrombus ages objectively, the valuable reference for clinical strategy.
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Affiliation(s)
- Xiaoxu Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Fang Wu
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Yuehong Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Beijing, China
| | - Marc Fisher
- Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Beijing, China
| | - Huibo Zhang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China
| | - Zhaoyang Fan
- Radiology and Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti Nanlu, Chaoyang District, Beijing, 100020, China.
- Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China.
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China.
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15
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Khoujah D, Chang WTW. The emergency neurology literature 2020. Am J Emerg Med 2022; 54:1-7. [DOI: 10.1016/j.ajem.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022] Open
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16
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Ferro JM, de Sousa DA, Canhão P. Cerebral Venous Thrombosis. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Riva N, Attard LM, Vella K, Squizzato A, Gatt A, Calleja-Agius J. Diagnostic accuracy of D-dimer in patients at high-risk for splanchnic vein thrombosis: A systematic review and meta-analysis. Thromb Res 2021; 207:102-112. [PMID: 34600286 DOI: 10.1016/j.thromres.2021.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND D-dimer is included in the diagnostic algorithm for deep vein thrombosis and pulmonary embolism. However, its role in the diagnosis of splanchnic vein thrombosis (SVT) is still controversial. The aim of this study was to evaluate the diagnostic accuracy of D-dimer for SVT. METHODS We performed a systematic review of the literature with meta-analysis (PROSPERO protocol registration number: CRD42020184300). The electronic databases MEDLINE, EMBASE, and CENTRAL were searched from inception to March 2021 week 4. Studies which evaluated D-dimer accuracy for SVT in any category of patients were selected. The index test was any D-dimer assay; the reference standard was any radiological imaging. The QUADAS-2 checklist was used for the risk of bias assessment. A bivariate random-effects regression model was used to calculate summary estimates of sensitivity and specificity. RESULTS 12 studies (with a total of 1298 patients) evaluating the accuracy of D-dimer in patients at high risk of SVT (surgical patients, patients with liver cirrhosis or hepatocellular carcinoma) were included. None of the included studies was at low risk of bias. The weighted mean prevalence of SVT was 33.4% (95% CI, 22.5-45.2%, I2 = 94.8%). D-dimer accuracy was expressed by sensitivity 96% (95% CI, 72-100%); specificity 25% (95% CI, 5-67%); positive likelihood ratio 1.3 (95% CI, 0.9-1.9); negative likelihood ratio 0.16 (95% CI, 0.03-0.84); area under the ROC curve 0.80 (95% CI, 0.76-0.83). CONCLUSIONS D-dimer seems to have high sensitivity in the diagnosis of patients at high-risk for SVT. However, there is a strong need for more robust evidence on this topic.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Laura Maria Attard
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Kevin Vella
- Coagulation Medicine Laboratory, Department of Pathology, Mater Dei Hospital, Msida, Malta.
| | | | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; Coagulation Medicine Laboratory, Department of Pathology, Mater Dei Hospital, Msida, Malta.
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
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18
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Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente Fernández L, de la Torre Colmenero JD, Tejada Meza H, Vesperinas Castro A, Sánchez Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2021:S0213-4853(21)00116-X. [PMID: 34511275 DOI: 10.1016/j.nrl.2021.05.016] [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: 03/19/2021] [Revised: 04/29/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P=.03), focal deficits (P=.001), and encephalopathy (P <.001) showing a statistically significant association with poor prognosis (mRS> 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España.
| | | | - C Aguirre
- Hospital La Princesa, Madrid, España
| | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, España
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, España
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, España
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | | | | | - L Llul
- Hospital Clínic, Barcelona, España
| | - J Egido
- Hospital Clínico San Carlos, Madrid, España
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, España
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19
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Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Cerebral venous thrombosis: a practical guide. Pract Neurol 2021; 20:356-367. [PMID: 32958591 DOI: 10.1136/practneurol-2019-002415] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/04/2022]
Abstract
All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from 'conventional' stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although CVT can result in death or permanent disability, it generally has a favourable prognosis if diagnosed and treated early. Neurologists involved in stroke care therefore also need to be aware of the treatments for CVT (with varying degrees of supporting evidence): the mainstay is prompt anticoagulation but patients who deteriorate despite treatment can be considered for endovascular procedures (endovascular thrombolysis or thrombectomy) or neurosurgery (decompressive craniotomy). This review summarises current knowledge on the risk factors, diagnosis, treatment and prognosis of CVT in adults, and highlights some areas for future research.
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Affiliation(s)
- Leonardo Ulivi
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK
| | - Martina Squitieri
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK
| | - Hannah Cohen
- Haemostasis Research Unit, University College London, London, UK.,Haematology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Peter Cowley
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK.,Lysholm Department of Neuroradiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - David J Werring
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London WC1B 5EH, UK .,Lysholm Department of Neuroradiology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
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20
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Ciccone A. SARS-CoV-2 vaccine-induced cerebral venous thrombosis. Eur J Intern Med 2021; 89:19-21. [PMID: 34090750 PMCID: PMC8148433 DOI: 10.1016/j.ejim.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 12/13/2022]
Abstract
The nosological entity of the cerebral venous thrombosis caused by the SARS-CoV-2 vaccination differs from the common cerebral venous thrombosis in that it is due to immune thrombocytopenia triggered by vaccination. Cerebral venous thrombosis is one of several manifestations of this type of immune thrombocytopenia. Albeit many general aspects of management of cerebral venous thrombosis are similar, immune thrombocytopenia requires a specific therapeutic approach, which is not normally adopted for cerebral venous thrombosis due to other causes, therefore its early recognition is essential.
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Affiliation(s)
- Alfonso Ciccone
- Department of Neurology with neurosurgical activity and stroke unit, ASST di Mantova, Mantova, Italy.
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21
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Evaluating thunderclap headache. Curr Opin Neurol 2021; 34:356-362. [PMID: 33661161 DOI: 10.1097/wco.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). There has been no consensus guideline regarding the diagnostic workup. This review aims to provide an update on the evaluation of TCH. RECENT FINDINGS The most important update in the 2019 American College of Emergency Physicians guideline for evaluation of acute headache in the emergency department is that negative noncontrast brain computed tomography (CT) findings within 6 h from ictus essentially excludes SAH. Additionally, the updated guideline recommends that after a negative brain CT, CT angiogram is a reasonable alternative to lumbar puncture if clinical suspicion of an intracranial source of SAH is high. An important update of reversible vasoconstriction syndrome (RCVS), the second most common etiology of TCH, is the RCVS2 score development based on clinical and radiological features, providing high specificity and sensitivity for distinguishing RCVS from other intracranial arteriopathies. SUMMARY Although the evaluation of TCH is exhaustive, the potentially catastrophic consequence of a missed diagnosis of sentinel headache justifies the efforts. Awareness of the clinical features and application of diagnostic tools specific for different pathological conditions can facilitate the diagnostic workup.
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22
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Abstract
Cerebral venous thrombosis (CVT) is a rare form of deep venous thrombosis (DVT), yet a leading cause of stroke in young adults, with an incidence that seems to be increasing in recent years. Risk factors for CVT overlap with those of DVT in other locations, with the addition of local risk factors, such as infections, head trauma and neurosurgery. The clinical presentation is highly variable, hence the diagnosis of CVT may be delayed or overlooked. Early recognition and timely initiation of anticoagulant treatment are of essence, while decompressive surgery can be lifesaving for patients with impending transtentorial herniation. Concomitant intracranial hemorrhage is not a contraindication to anticoagulant treatment. Endovascular treatment may be suggested for selected patients who deteriorate despite anticoagulant treatment. In this review we will provide an extensive and contemporary discussion of the incidence, pathophysiology, risk factors, clinical presentation, neuroimaging and management of CVT, in accordance with recent guidelines. Additionally, we will summarize the latest data with regards to direct oral anticoagulants (DOACs) treatment in CVT.
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Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel - .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel - .,Department of Medicine and Surgery, University of Insubria, Varese, Italy -
| | - Samuela Pegoraro
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Bai C, Wang Z, Stone C, Zhou D, Ding J, Ding Y, Ji X, Meng R. Pathogenesis and Management in Cerebrovenous Outflow Disorders. Aging Dis 2021; 12:203-222. [PMID: 33532137 PMCID: PMC7801276 DOI: 10.14336/ad.2020.0404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/04/2020] [Indexed: 11/04/2022] Open
Abstract
In keeping with its status as one of the major causes of disability and mortality worldwide, brain damage induced by cerebral arterial disease has been the subject of several decades of scientific investigation, which has resulted in a vastly improved understanding of its pathogenesis. Brain injury mediated by venous etiologies, however, such as cerebral, jugular, and vertebral venous outflow disturbance, have been largely ignored by clinicians. Unfortunately, this inattention is not proportional to the severity of cerebral venous diseases, as the impact they exact on the quality of life of affected patients may be no less than that of arterial diseases. This is evident in disease sequelae such as cerebral venous thrombosis (CVT)-mediated visual impairment, epilepsy, and intracranial hypertension; and the long-term unbearable head noise, tinnitus, headache, dizziness, sleeping disorder, and even severe intracranial hypertension induced by non-thrombotic cerebral venous sinus (CVS) stenosis and/or internal jugular venous (IJV) stenosis. In addition, the vertebral venous system (VVS), a large volume, valveless vascular network that stretches from the brain to the pelvis, provides a conduit for diffuse transmission of tumors, infections, or emboli, with potentially devastating clinical consequences. Moreover, the lack of specific features and focal neurologic signs seen with arterial etiologies render cerebral venous disease prone to both to misdiagnoses and missed diagnoses. It is therefore imperative that awareness be raised, and that as comprehensive an understanding as possible of these issues be cultivated. In this review, we attempt to facilitate these goals by systematically summarizing recent advances in the diagnosis and treatment of these entities, including CVT, CVS stenosis, and IJV stenosis, with the aim of providing a valid, practical reference for clinicians.
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Affiliation(s)
- Chaobo Bai
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongao Wang
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Christopher Stone
- 4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Da Zhou
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Ding
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- 2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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24
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Raam R, Tabatabai RR. Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes, An Update. Emerg Med Clin North Am 2020; 39:67-85. [PMID: 33218663 DOI: 10.1016/j.emc.2020.09.004] [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] [Indexed: 10/23/2022]
Abstract
In the initial assessment of the headache patient, the emergency physician must consider several dangerous secondary causes of headache. A thorough history and physical examination, along with consideration of a comprehensive differential diagnosis may alert the emergency physician to the diagnosis of a secondary headache particularly when the history is accompanied by any of the following clinical features: sudden/severe onset, focal neurologic deficits, altered mental status, advanced age, active or recent pregnancy, coagulopathy, malignancy, fever, visual deficits, and/or loss of consciousness.
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Affiliation(s)
- Ryan Raam
- Keck School of Medicine of USC, LAC+USC Emergency Medicine Residency, 1200 North State Street #1011, Los Angeles, CA 90033, USA.
| | - Ramin R Tabatabai
- Keck School of Medicine of USC, LAC+USC Emergency Medicine Residency, 1200 North State Street #1011, Los Angeles, CA 90033, USA
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25
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Heldner MR, Zuurbier SM, Li B, Von Martial R, Meijers JCM, Zimmermann R, Volbers B, Jung S, El-Koussy M, Fischer U, Kohler HP, Schroeder V, Coutinho JM, Arnold M. Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels. Neurology 2020; 95:e898-e909. [PMID: 32576633 DOI: 10.1212/wnl.0000000000009998] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/30/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate prediction of cerebral venous thrombosis (CVT) by clinical variables and D-dimer levels. METHODS This prospective multicenter study included consecutive patients with clinically possible CVT. On admission, patients underwent clinical examination, blood sampling for D-dimers measuring (ELISA test), and magnetic resonance/CT venography. Predictive value of clinical variables and D-dimers for CVT was calculated. A clinical score to stratify patients into groups with low, moderate, or high CVT risk was established with multivariate logistic regression. RESULTS CVT was confirmed in 26.2% (94 of 359) of patients by neuroimaging. The optimal estimate of clinical probability was based on 6 variables: seizure(s) at presentation (4 points), known thrombophilia (4 points), oral contraception (2 points), duration of symptoms >6 days (2 points), worst headache ever (1 point), and focal neurologic deficit at presentation (1 point) (area under the curve [AUC] 0.889). We defined 0 to 2 points as low CVT probability (negative predictive value [NPV] 94.1%). Of the 186 (51.8%) patients who had a low probability score, 11 (5.9%) had CVT. The frequency of CVT was 28.3% (34 of 120) in patients with a moderate (3-5 points) and 92.5% (49 of 53) in patients with a high (6-12 points) probability score. All low CVT probability patients with CVT had D-dimers >500 μg/L. Predictive value of D-dimers for CVT for >675 μg/L (best cutoff) vs >500 μg/L was as follows: sensitivity 77.7%, specificity, 77%, NPV 90.7%, and accuracy 77.2% vs sensitivity 89.4%, specificity 66.4%, NPV 94.6%, and accuracy 72.4%, respectively. Adding the clinical score to D-dimers >500 μg/L resulted in the best CVT prediction score explored (at the cutoff ≥6 points: sensitivity 83%/specificity 86.8%/NPV 93.5%/accuracy 84.4%/AUC 0.937). CONCLUSION The proposed new clinical score in combination with D-dimers may be helpful for predicting CVT as a pretest score; none of the patients with CVT showed low clinical probability for CVT and D-dimers <500 μg/L. CLINICALTRIALSGOV IDENTIFIER NCT00924859.
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Affiliation(s)
- Mirjam R Heldner
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland.
| | - Susanna M Zuurbier
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Bojun Li
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Rascha Von Martial
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Joost C M Meijers
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Rebekka Zimmermann
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Bastian Volbers
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Simon Jung
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Marwan El-Koussy
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Urs Fischer
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Hans P Kohler
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Verena Schroeder
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Jonathan M Coutinho
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
| | - Marcel Arnold
- From the Department of Neurology (M.R.H., R.V.M., R.Z., B.V., S.J., U.F., M.A.), Inselspital, University Hospital and University of Bern, Switzerland; Department of Neurology (S.M.Z., J.M.C.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Experimental Vascular Medicine (J.C.M.M.), Amsterdam University Medical Centers, University of Amsterdam, and Department of Molecular and Cellular Hemostasis, Sanquin Research, Amsterdam, the Netherlands; and Institute of Diagnostic and Interventional Neuroradiology (M.E.-K.), Inselspital and Experimental Haemostasis Group (B.L., H.P.K., V.S.), Department for BioMedical Research, University of Bern, Switzerland
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Zhang X, Zhang X, Xu J, Huang T, Wu Y, Yang Y, Zhou H, Wu Y. Identification of and solution for false D-dimer results. J Clin Lab Anal 2020; 34:e23216. [PMID: 31967356 PMCID: PMC7307351 DOI: 10.1002/jcla.23216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Clinically, D-dimer (DD) levels are mainly used to exclude diseases such as deep venous thrombosis (DVT). In clinical testing, DD assays can be subjected to interference that may cause false results, which directly affect the clinical diagnosis. Our hypothesis was that the 95% confidence intervals (CIs) of the fibrin degradation product (FDP)/DD and fibrinogen (Fib)/DD ratios were used to identify these false results and corrected via multiple dilutions. METHODS In total, 16 776 samples were divided into three groups according to the DD levels detected by Sysmex CS5100 and CA7000: Group A, DD ≥ 2.0 μg/mL fibrinogen equivalent unit (FEU); group B, 0.5 < DD < 2.0 μg/mL FEU; and group C, DD ≤ 0.5 μg/mL FEU. The 95% CIs of the FDP/DD and Fib/DD ratios were calculated. Six abnormal DD results were found according to the 95% CIs. For verification, we performed multiple dilutions, compared the results with those of other instruments, and tested the addition of heterophilic blocking reagent (HBR). RESULTS The median and 95% CI of the FDP/DD ratio were 3.76 and 2.25-8.15 in group A, 5.63 and 2.86-10.58 in group B, 10.23 and 0.91-47.71 in groups C, respectively. For the Fib/DD ratio, the 95% CIs was 0.02-2.21 in group A, 0.68-8.15 in group B, and 3.82-55.27 in groups C. Six abnormal results were identified after multiple dilutions, by comparison with other detection systems, and after HBR addition. CONCLUSIONS The FDP/DD ratio is more reliable for identifying false results. If the FDP/DD ratio falls outside the 95% CI, it should be verified by different methods.
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Affiliation(s)
- Xian‐Yan Zhang
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
- Laboratory of Molecular CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
- Laboratory of Molecular Imagingthe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Xue‐Xuan Zhang
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Jia‐Long Xu
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Teng‐Yi Huang
- Department of Laboratory MedicineThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Ying Wu
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Ye‐Ru Yang
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Huan‐Bin Zhou
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Ying‐E Wu
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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Riva N, Ageno W. Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions. J Clin Med 2020; 9:E743. [PMID: 32164214 PMCID: PMC7141239 DOI: 10.3390/jcm9030743] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/03/2020] [Accepted: 03/08/2020] [Indexed: 02/07/2023] Open
Abstract
Cerebral vein thrombosis (CVT) and splanchnic vein thrombosis (SVT) are two manifestations of venous thromboembolism (VTE) at unusual sites. They have an incidence at least 25-50 times lower than usual site VTE, but represent true clinical challenges. Recent evidence on the epidemiology, risk factors, prognosis, and treatment of CVT and SVT has been published in the last two decades, thus contributing to a better understanding of these diseases. The improvement in imaging techniques and a higher degree of clinical suspicion may have led to the observed increased frequency, whereas a better knowledge of provoking mechanisms could have contributed to reducing the proportion of events classified as unprovoked or idiopathic (13%-21% of CVT, 15%-27% of SVT). Few small randomized clinical trials and a number of observational studies, although hampered by heterogeneous therapeutic approaches, shed light on the safety and effectiveness of anticoagulant therapy in these populations. However, there are still some grey areas that warrant future research. In this narrative review, we discuss recent advances and therapeutic challenges in CVT and SVT.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida MSD2080, Malta;
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida MSD2080, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
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Predictive value of D-dimer testing for the diagnosis of venous thrombosis in unusual locations: A systematic review. Thromb Res 2020; 189:5-12. [PMID: 32126379 DOI: 10.1016/j.thromres.2020.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The value of D-dimer testing for the diagnosis of thrombosis in unusual sites is not properly established and evidence is scarce. We performed a systematic review of the literature. METHODS The search was conducted in MEDLINE and Cochrane Library for papers published in the last 10 years including different presentations of thrombosis in unusual sites. Twenty-three articles were included, from January 1, 2008, to December 31, 2018, comprising 3378 patients with thrombosis in unusual sites (upper extremity deep vein thrombosis, cerebral vein thrombosis and splanchnic vein thrombosis). The Newcastle-Ottawa scale was used to assess the quality of the studies. RESULTS Two articles were related to upper extremity thrombosis, showing a high sensitivity and negative predictive value for D-dimer testing. Twelve articles concerned cerebral vein thrombosis, concluding that the timing of D-dimer testing was important, and that patients with a shorter duration of symptoms showed higher D-dimer levels. Sensitivity and specificity in these patients ranged from 58% to 97% and from 77% to 97.5%, respectively. Nine articles were related to splanchnic vein thrombosis. One described a population of patients with mesenteric venous thrombosis, and the rest included patients with portal vein thrombosis. The D-dimer testing methods and the proposed cut-off levels were remarkably different among the included studies. CONCLUSION D-dimer testing should not be currently recommended for the diagnosis of thrombosis in unusual sites as a first line diagnostic tool. The development of algorithms combining biomarkers such as D-dimer and clinical decision tools could improve the diagnosis.
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Louneva N, Maity A, Kennedy AR. Plasma D-Dimer Levels are Elevated in Radiation Oncology Patients. Radiat Res 2019; 193:46-53. [PMID: 31675265 DOI: 10.1667/rr15429.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
D-dimer plasma levels were evaluated to determine whether they are altered by radiation. D-dimer levels were measured in radiation oncology patients, who were diagnosed with prostate, breast or lung cancer, or leukemia, as well as in healthy subjects serving as controls. Blood samples from radiotherapy patients were taken at three different time points: pre-, on- and post-radiotherapy. For the patients, considered together, differences between the D-dimer levels at these three time points compared to controls were statistically significant. Compared to the pre-radiotherapy measurements, radiation exposure was associated with a significant increase in the D-dimer levels at the on- and post-radiotherapy time points. At the post-radiotherapy time point, D-dimer levels in the patients were not significantly reduced compared to the on-radiotherapy levels, indicating that the risk for developing disseminated intravascular coagulation (DIC) may be increased in some radiation oncology patients. Of particular concern are the post-radiotherapy results observed for the D-dimer levels in the leukemia patients, in which the average fold increase in the D-dimer levels was 5.43 (compared to the pre-radiotherapy levels). These results suggest that leukemia patients might benefit from frequent assessment of their D-dimer levels after their total-body irradiation-conditioning regimen to detect early signs of DIC development. It is hoped that the results described here will lead to heightened awareness in the radiation oncology community that the risk of DIC development is greatly increased in some of these patients.
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Affiliation(s)
- Natalia Louneva
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Maity
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann R Kennedy
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Summary. Thromboses of cerebral veins and/or sinuses (CVT) encompass a clinically rather heterogenous, relatively rare entity, which is nonetheless an important cause of stroke in the young. While until the mid of the last century the prognosis of CVT was thought to be poor or even fatal in the majority of cases, the advance and wider use of modern imaging technology since the early 1980s, together with the results of registries and population-based studies, revealed that CVT is more frequent and less life-threatening than previously assumed. However, because headache is frequently the only symptom, many oligosymptomatic cases might be overlooked. Both, CT- and MR-venography are suitable methods to confirm or rule out CVT, while the sensitivity of laboratory tests (D-dimer) alone is too low to rely on. Despite low evidence anticoagulation remains the treatment of choice during the acute phase and for secondary prevention.
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Yadegari S, Ghorbani A, Miri SR, Abdollahi M, Rostami M. Clinical features, risk factors, and outcome of cerebral venous thrombosis in Tehran, Iran. J Neurosci Rural Pract 2019; 7:554-558. [PMID: 27695236 PMCID: PMC5006468 DOI: 10.4103/0976-3147.185512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Despite increasing the use of magnetic resonance imaging (MRI), cerebral venous sinus thrombosis (CVST) has remained an under-diagnosed condition. In this study, characteristics and frequency of various risk factors of CVST patients in a tertiary referral hospital were closely assessed. Methods: Patients with an unequivocal diagnosis of CVST confirmed by MRI and magnetic resonance venography during 6 years of the study were included. All data from the onset of symptoms regarding clinical signs and symptoms, hospital admission, seasonal distribution, medical and drug history, thrombophilic profile, D-dimer, neuroimaging, cerebrospinal fluid findings, mortality, and outcome were collected and closely analyzed. Result: A total of 53 patients with female to male ratio of 3.07 and mean age of 33.7 years were included in the study. Headache and papilledema were the most frequent clinical features (44 and 36 patients, respectively). An underlying disease (diagnosed previously or after admission) was the most common identified risk factor for CVST in both females and males (21 patients). A total of 15 women used the oral contraceptive pill (OCP) where 12 of them had simultaneously other predisposing factors. Overall, 19 patients (36%) had more than one contributing factor. D-dimer had a sensitivity of 71.4% in CVST patients. The mortality of patients in this study was 3.7% (n = 2). Focal neurologic deficit and multicranial nerve palsy were associated with poor outcome which defined as death, recurrence, and massive intracranial hemorrhage due to anticoagulation (P = 0.050 and 0.004, respectively). Conclusion: Unlike most of the CVST studies in which OCP was the main factor; in this study, an underlying disease was the most identified cause. Considering the high probability of multiple risk factors in CVST that was shown by this study, appropriate work up should be noted to uncover them.
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Affiliation(s)
- Samira Yadegari
- Department of Neuro-ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Askar Ghorbani
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Roohollah Miri
- Department of Surgery, Institute of Cancer, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Research Center of Medical Students, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rostami
- Research Center of Medical Students, Tehran University of Medical Sciences, Tehran, Iran
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Favresse J, Lippi G, Roy PM, Chatelain B, Jacqmin H, Ten Cate H, Mullier F. D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications. Crit Rev Clin Lab Sci 2019; 55:548-577. [PMID: 30694079 DOI: 10.1080/10408363.2018.1529734] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
D-dimer is a soluble fibrin degradation product deriving from the plasmin-mediated degradation of cross-linked fibrin. D-dimer can hence be considered a biomarker of activation of coagulation and fibrinolysis, and it is routinely used for ruling out venous thromboembolism (VTE). D-dimer is increasingly used to assess the risk of VTE recurrence and to help define the optimal duration of anticoagulation treatment in patients with VTE, for diagnosing disseminated intravascular coagulation, and for screening medical patients at increased risk of VTE. This review is aimed at (1) revising the definition of D-dimer; (2) discussing preanalytical variables affecting the measurement of D-dimer; (3) reviewing and comparing assay performance and some postanalytical variables (e.g. different units and age-adjusted cutoffs); and (4) discussing the use of D-dimer measurement across different clinical settings.
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Affiliation(s)
- Julien Favresse
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Giuseppe Lippi
- b Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
| | - Pierre-Marie Roy
- c Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC , Université d'Angers , Angers , France
| | - Bernard Chatelain
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugues Jacqmin
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
| | - Hugo Ten Cate
- d Department of Internal Medicine, Cardiovascular Institute , Maastricht University Medical Center , Maastricht , the Netherlands
| | - François Mullier
- a CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory , Université Catholique de Louvain , Yvoir , Belgium
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Cao L, Wang J, Gao Y, Liang Y, Yan J, Zhang Y, Zhu M, Luo T, Chen J. Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report. BMC Neurol 2019; 19:133. [PMID: 31215399 PMCID: PMC6580543 DOI: 10.1186/s12883-019-1363-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background Heat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain. Case presentation We encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid–base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient’s level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved. Conclusions This case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.
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Affiliation(s)
- Lizhi Cao
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yaxuan Gao
- Norman Bethune Health Science Center of Jilin University, Changchun, 130000, Jilin, China
| | - Yumei Liang
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jinhua Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yunhai Zhang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Mingqin Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
| | - Tianfei Luo
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
| | - Jiafeng Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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Weimar C, Holzhauer S, Knoflach M, Koennecke HC, Masuhr F, Mono ML, Niederstadt T, Nowak-Göttl U, Schellong SM, Kurth T. [Cerebral venous and sinus thrombosis : S2k guidelines]. DER NERVENARZT 2019; 90:379-387. [PMID: 30758512 DOI: 10.1007/s00115-018-0654-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christian Weimar
- Neurologische Universitätsklinik, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Susanne Holzhauer
- Klinik für Pädiatrie mit Schwerpunkt Onkologie und Hämatologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - Michael Knoflach
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Florian Masuhr
- Abteilung für Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | | | - Thomas Niederstadt
- Institut für Klinische Radiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Ulrike Nowak-Göttl
- Institut für Klinische Chemie, Gerinnungszentrum UKSH (Campus Kiel und Lübeck), Kiel, Deutschland
| | | | - Tobias Kurth
- Institut für Public Health, Charité Universitätsmedizin, Berlin, Deutschland
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Xu T, Liang R. Cerebral Venous Thrombosis with Tumor-like Features: A Case Report and Review of the Literature. World Neurosurg 2019; 124:17-21. [PMID: 30610975 DOI: 10.1016/j.wneu.2018.12.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT), a rare cerebrovascular condition, is induced by blocked cerebral venous reflux, often presenting non-specific symptoms. Magnetic resonance imaging (MRI) of the brain may improve the often elusive diagnosis of CVT. However, the sensitivity, specificity and full spectrum of such MRI findings are poorly understood. CASE DESCRIPTION We report the case of a 53-year-old male patient with CVT. The patient complained of a severe headache in addition to an enhanced lesion on contrasted T1-weighted MR images, which was originally considered an angiogenic tumor. However, surgery and pathology confirmed the case to be CVT. Following surgery and administration of an anticoagulation agent, the patient's symptoms alleviated, and cranial MRI and CT 1 month after surgery showed no abnormalities. CONCLUSIONS We conclude that such cases may occur where CVT appears tumor-like on MRI, including mass effect and abnormal contrast enhancement. Therefore, for young and middle-aged adults with episodic and progressive headaches presenting such MRI findings, the possibility of CVT should always be considered. MRI combined with magnetic resonance venography should be used as the preferred strategy for early diagnosis of CVT.
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Affiliation(s)
- Tao Xu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Risheng Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
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Alshurafa S, Alfilfil W, Alshurafa A, Alhashim K. Cerebral venous sinus thrombosis in a young female misdiagnosed as migraine ending in a permanent vegetative state: a case report and review of the literature. J Med Case Rep 2018; 12:323. [PMID: 30343667 PMCID: PMC6196570 DOI: 10.1186/s13256-018-1846-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 09/10/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cerebral venous thrombosis refers to acute thrombosis or blood clots that can lead to strokes. This illness can be misdiagnosed as a migraine, resulting in a delay in management and catastrophic outcomes. We present a pitfall case that highlights the importance of careful history taking and physician awareness in diagnosing cerebral venous thrombosis. CASE PRESENTATION A recently married, previously healthy, young Arabic female presented to the emergency department three times with a complaint of throbbing frontal headache for the past 2 days with no neurological deficit. During her first two visits, she was seen by a junior general practitioner and was prescribed analgesics only as her migraine was precipitated by oral contraceptives and low hemoglobin. No imaging was requested during that visit. At the third visit, she underwent plain computed tomography of the head that was interpreted by an emergency consultant, who revealed the diagnosis despite limited resources. Unfortunately, the patient developed complications of the hydrocephalus, transtentorial brain herniation, and intraventricular hemorrhage that required multiple neurosurgical interventions and resulted in a permanent vegetative state. CONCLUSIONS Cerebral venous sinus thrombosis is an uncommon and tricky condition with unpredictable presentation and prognosis. A physician needs to have a high index of suspicion to diagnose it, especially when the patient presents with uncomplicated complaints. These simple complaints, such as headaches, usually lead to misdiagnosis and delay the appropriate diagnosis and management.
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Affiliation(s)
| | - Wadiah Alfilfil
- Prince Mohammed Bin Abdul-Aziz Hospital PMAH, Riyadh, Saudi Arabia
| | - Ayah Alshurafa
- Maternity and Children Hospital MCH, Dammam, Saudi Arabia
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Brain imaging in pregnant women with acute headache. J Neurol 2018; 265:1836-1843. [DOI: 10.1007/s00415-018-8924-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/30/2018] [Accepted: 06/02/2018] [Indexed: 12/19/2022]
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Smith E, Kumar V. BET 1: Does a normal D-dimer rule out cerebral venous sinus thrombosis (CVST)? Emerg Med J 2018; 35:396-397. [DOI: 10.1136/emermed-2018-207777.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Riva N, Dentali F, Donadini MP, Squizzato A, Ageno W. Risk of recurrence of unusual site venous thromboembolism. Hamostaseologie 2017; 33:225-31. [DOI: 10.5482/hamo-13-03-0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/29/2013] [Indexed: 02/06/2023] Open
Abstract
SummaryThe term unusual site venous thrombosis defines uncommon clinical manifestations of venous thromboembolism occurring in sites different from the lower limbs or the lungs, with peculiar pathophysiological features and clinical history. Information on long-term outcomes of unusual site thrombosis is generally scant, because most studies are small and usually retrospective.Recurrence rate of cerebral vein thrombosis is about 2/100 patient-years; the only identified predisposing factors have been male gender and personal history of thrombosis. Retinal vein occlusion showed a recurrence in the same eye of 2.5% and in the fellow eye of 11.9% within four years. Hypercholesterolemia, hypertriglyceridaemia and hyperhomocysteinaemia were significantly associated with recurrent events. Recurrence rates of splanchnic vein thrombosis are difficult to estimate given the heterogeneity of patient populations; higher recurrence rates are reported in the cirrhotic population (from 27% to 38.5%). Hormone therapy, myeloproliferative neoplasm or other prothrombotic states, and absence of anticoagulant therapy emerged as independent prognostic factors. Future studies should aim at better assessing the risk of recurrence in different patients subgroups and at identifying more accurate prognostic markers.
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Riva N, Ageno W. Approach to thrombosis at unusual sites: Splanchnic and cerebral vein thrombosis. Vasc Med 2017; 22:529-540. [PMID: 29202678 DOI: 10.1177/1358863x17734057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Splanchnic vein thrombosis (SVT) and cerebral vein thrombosis (CVT) are two manifestations of unusual site venous thromboembolism (VTE). SVT includes thrombosis in the portal, mesenteric or splenic veins, and the Budd-Chiari syndrome. CVT encompasses thrombosis of the dural venous sinuses and thrombosis of the cerebral veins. Unusual site VTE often represents a diagnostic and therapeutic challenge because of the heterogeneity in clinical presentation, the limited evidence available in the literature on the acute and long-term prognosis of these diseases, and the lack of large randomized controlled trials evaluating different treatment options. This narrative review describes the approach to patients with SVT or CVT by examining the diagnostic process, the assessment of potential risk factors and the appropriate anticoagulant treatment.
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Affiliation(s)
- Nicoletta Riva
- 1 Department of Pathology, University of Malta, Msida, Malta
| | - Walter Ageno
- 2 Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, di Minno M, Maino A, Martinelli I, Masuhr F, Aguiar de Sousa D, Stam J. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 2017; 24:1203-1213. [PMID: 28833980 DOI: 10.1111/ene.13381] [Citation(s) in RCA: 315] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/27/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We aimed to update the previous European Federation of Neurological Societies guidelines using a clearer and evidence-based methodology. METHOD We followed the Grading of Recommendations, Assessment, Development and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews and writing recommendations based on the quality of available scientific evidence. RESULTS We suggest using magnetic resonance or computed tomographic angiography for confirming the diagnosis of CVT and not routinely screening patients with CVT for thrombophilia or cancer. We recommend parenteral anticoagulation in acute CVT and decompressive surgery to prevent death due to brain herniation. We suggest preferentially using low-molecular-weight heparin in the acute phase and not direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that, in women who have suffered a previous CVT, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular-weight heparin should be considered throughout pregnancy and puerperium. CONCLUSIONS Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of CVT.
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Affiliation(s)
- J M Ferro
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, Lisboa.,Universidade de Lisboa, Lisboa, Portugal
| | - M-G Bousser
- Service de Neurologie, Hôpital Lariboisière, Paris, France
| | - P Canhão
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, Lisboa.,Universidade de Lisboa, Lisboa, Portugal
| | - J M Coutinho
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - I Crassard
- Service de Neurologie, Hôpital Lariboisière, Paris, France
| | - F Dentali
- Department of Clinical Medicine, Insubria University, Varese
| | - M di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, 'Federico II' University, Naples.,Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan
| | - A Maino
- A. Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - F Masuhr
- Department of Neurology, Bundeswehrkrankenhaus, Berlin, Germany
| | - D Aguiar de Sousa
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, Lisboa
| | - J Stam
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, di Minno M, Maino A, Martinelli I, Masuhr F, de Sousa DA, Stam J. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - Endorsed by the European Academy of Neurology. Eur Stroke J 2017; 2:195-221. [PMID: 31008314 DOI: 10.1177/2396987317719364] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/13/2017] [Indexed: 12/21/2022] Open
Abstract
The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer. We recommend parenteral anticoagulation in acute cerebral venous thrombosis and decompressive surgery to prevent death due to brain herniation. We suggest to use preferentially low-molecular weight heparin in the acute phase and not using direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations due to very poor quality of evidence concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that in women who suffered a previous cerebral venous thrombosis, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular weight heparin should be considered throughout pregnancy and puerperium. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of cerebral venous thrombosis.
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Affiliation(s)
- José M Ferro
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, Lisboa, Portugal.,Universidade de Lisboa, Lisboa, Portugal
| | | | - Patrícia Canhão
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, Lisboa, Portugal.,Universidade de Lisboa, Lisboa, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - Matteo di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, "Federico II" University, Naples, Italy.,Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Alberto Maino
- A. Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Florian Masuhr
- Department of Neurology, Bundeswehrkrankenhaus, Berlin, Germany
| | - Diana Aguiar de Sousa
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, Lisboa, Portugal.,Universidade de Lisboa, Lisboa, Portugal
| | - Jan Stam
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
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[Diagnostic and treatment standards for cerebral sinus venous thrombosis : Results of an online survey of German stroke units]. DER NERVENARZT 2017; 88:1159-1167. [PMID: 28695244 DOI: 10.1007/s00115-017-0377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this survey was to characterize the current diagnostic and therapeutic strategies for thrombosis of the cerebral sinus and veins (CVT) performed in German stroke units (SU). METHODS Between September 2015 and January 2016 all clinical heads of certified SUs in Germany were invited to participate in a standardized online survey. The survey concentrated on the basic characteristics of SUs, diagnostic and therapeutic procedures and was made anonymous if so desired. Frequencies were expressed as percentages and differences between regional stroke units (RSU) and supraregional (i. e. comprehensive) SUs (SRSU) were compared with the χ2-test or Fisher's test RESULTS: A total of 107 SU heads participated (response rate 42.8%) and 55.1% of these were RSUs. In 77.2% the diagnosis is made by magnetic resonance imaging angiography (MR-A, RSU 81.1% vs. SRSU 72.3%; p = 0.29). Of the SUs 79.1% determined d‑dimer if CVT is suspected (79.3% vs. 78.7%; p = 0.94) and 88.5% carried out screening for thrombophilia (89.5% vs. 87.2%; p = 0.72). Intravenous unfractionated heparin (67.2% vs. 70.2%; p = 0.74) or subcutaneous low molecular weight heparin (32.8% vs. 29.8%; p = 0.74) are first line therapy in all SUs. Invasive procedures, such as hypothermia (3.7% vs. 10.6%; p = 0.25), hemicraniectomy (26% vs. 63.9%; p = 0.0001), endovascular techniques (11.1% vs. 40.4%; p = 0.0007) and systemic thrombolysis (5.5% vs. 10.6%; p = 0.47) are performed more frequently in SRSUs. Of the SUs 18.5% already use new oral anticoagulants (10.7% vs. 27.7%; p = 0.027). Most of the SUs organize a follow-up visit (70.9% vs. 76.6%; p = 0.52) with a MRI (94.2% vs. 91.1%; p = 0.7) within the first 6 months. CONCLUSION The survey revealed substantial homogeneity between RSUs and SRSUs and standards are mostly in line with the guidelines. Non-established procedures, such as invasive therapeutic procedures and the administration of new oral anticoagulants were used significantly more often in SRSUs.
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Riva N, Ageno W. Clinical manifestations and imaging tools in the diagnosis of splanchnic and cerebral vein thromboses. Thromb Res 2017; 163:252-259. [PMID: 28673473 DOI: 10.1016/j.thromres.2017.06.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/14/2017] [Accepted: 06/25/2017] [Indexed: 12/19/2022]
Abstract
Splanchnic vein thrombosis (SVT) and cerebral vein thrombosis (CVT) are uncommon manifestation of venous thromboembolism (VTE), occurring less frequently than deep vein thrombosis of the lower extremities and pulmonary embolism. SVT encompasses portal vein thrombosis, mesenteric vein thrombosis, splenic vein thrombosis and the Budd-Chiari syndrome. It is therefore a heterogeneous disease, with differences in clinical manifestations according to the site of thrombosis. CVT includes thrombosis of the cortical or deep cerebral veins and thrombosis of the major dural venous sinuses. Clinical presentation is variable, with a wide spectrum of signs and symptoms that can mimic other cerebral diseases. There are no clinical algorithms or specific laboratory tests that can guide in the identification of SVT and CVT; therefore, the diagnosis relies exclusively on imaging tests. Conventional angiography once was the gold standard for the diagnosis of SVT and CVT, but it is rarely used nowadays. Abdominal ultrasound (US), computed tomography (CT) and magnetic resonance (MR) with angiography are currently used for the diagnosis of SVT; while cerebral CT and MR with angiography are currently used for the diagnosis of CVT. These imaging tests have different sensitivities/specificities and different advantages/disadvantages that should be kept into consideration when choosing the appropriate imaging test based on the suspected site of thrombosis. This narrative review summarizes the clinical and diagnostic approach to SVT and CVT.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, University of Malta, Msida, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Right Hand Weakness and Headache During Ascent to Mount Everest: A Case of Cerebral Venous Infarction. Neurologist 2017; 22:98-100. [PMID: 28471901 DOI: 10.1097/nrl.0000000000000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The increasing popularity of trekking in alpine regions has drawn attention to high altitude-associated health concerns. CASE REPORT Here, we report a case of cerebral venous infarction as a consequence of a hypercoagulable state induced by secondary polycythemia as an adaptation to high altitude. CONCLUSIONS When patients present focal neurological symptoms such as hemiparesis in addition to symptoms of acute mountain sickness or high-altitude cerebral edema such as headache, nausea, vomiting, and dizziness, cerebral venous infarction should be considered.
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Moisset X, Mawet J, Guegan-Massardier E, Bozzolo E, Gilard V, Tollard E, Feraud T, Noëlle B, Rondet C, Donnet A. French Guidelines For the Emergency Management of Headaches. Rev Neurol (Paris) 2016; 172:350-60. [PMID: 27377828 DOI: 10.1016/j.neurol.2016.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/08/2016] [Indexed: 01/03/2023]
Affiliation(s)
- X Moisset
- Inserm U-1107, NeuroDol, Clermont Université, Université d'Auvergne, 49, boulevard François-Mitterrand, 63000 Clermont-Ferrand, France; CHU Gabriel Montpied, Service de Neurologie, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.
| | - J Mawet
- Centre d'urgences céphalées, département de Neurologie, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris AP-HP, Université Paris Denis Diderot et DHU NeuroVasc Sorbonne Paris-Cité, Paris, France
| | - E Guegan-Massardier
- Service de neurologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - E Bozzolo
- Service de neurologie, Pôle des Neurosciences Cliniques, CHU de Nice, Nice, France
| | - V Gilard
- Service de neurochirurgie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - E Tollard
- Service de neuroradiologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - T Feraud
- Service d'accueil des urgences, hôpital Timone, boulevard Jean-Moulin, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Noëlle
- Cabinet privé, 35, allée de Champrond, 38330 Saint-Ismier, France
| | - C Rondet
- Faculté de médecine, Service de médecine générale, Université Pierre-et-Marie-Curie Paris 06, Paris, France
| | - A Donnet
- Inserm U-1107, NeuroDol, Clermont Université, Université d'Auvergne, 49, boulevard François-Mitterrand, 63000 Clermont-Ferrand, France; Centre d'évaluation et de traitement de la douleur, hôpital Timone, boulevard Jean-Moulin, 264, rue Saint-Pierre, 13385 Marseille, France
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Agrawal K, Burger K, Rothrock JF. Cerebral Sinus Thrombosis. Headache 2016; 56:1380-9. [DOI: 10.1111/head.12873] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kunal Agrawal
- Department of Neurology; University of California, San Diego; San Diego CA USA
| | - Kathy Burger
- Department of Neurology; School of Medicine, George Washington University; Washington DC USA
| | - John F. Rothrock
- Department of Neurology; School of Medicine, George Washington University; Washington DC USA
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