1
|
Khatami SS, Revheim ME, Høilund-Carlsen PF, Alavi A, Ghorbani Shirkouhi S, Andalib S. Central nervous system manifestations following vaccination against COVID-19. Brain Behav Immun Health 2024; 38:100788. [PMID: 38818372 PMCID: PMC11137405 DOI: 10.1016/j.bbih.2024.100788] [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: 09/10/2023] [Revised: 03/03/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccination has become the most effective countermeasure in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, vaccination is associated with side effects. This narrative review focuses on central nervous system (CNS) manifestations following COVID-19 vaccination and provides a summary of the potential underlying mechanisms and methods of diagnosis and management of the vaccination-related CNS manifestations. Headache, myalgia, optic neuritis, seizure, multiple sclerosis, acute disseminated encephalomyelitis and encephalitis, delirium, acute transverse myelitis, and stroke have been reported after COVID-19 vaccination. Constant headache and myalgia are common manifestations that may necessitate further clinical investigation for stroke. To limit consequences, it is imperative to follow standard treatment protocols for each neurological disorder following COVID-19 vaccination. Immunosuppressive medication can be helpful in the treatment of seizures following vaccination since the immune response is involved in their etiology. Clinicians should be aware of the manifestations after COVID-19 vaccination to respond promptly and effectively. Clinical guidelines for the management of CNS manifestations following COVID-19 vaccination are in high demand and would be useful in each new SARS-CoV-2 variant pandemic.
Collapse
Affiliation(s)
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | | | - Sasan Andalib
- Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
2
|
Ryu HU, Kim HJ, Shin BS, Kang HG. Clinical approaches for poststroke seizure: a review. Front Neurol 2024; 15:1337960. [PMID: 38660095 PMCID: PMC11039895 DOI: 10.3389/fneur.2024.1337960] [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: 11/13/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Poststroke seizure is a potential complication of stroke, which is the most frequent acute symptomatic seizure in adults. Patients with stroke may present with an abnormal or aggressive behavior accompanied by altered mental status and symptoms, such as hemiparesis, dysarthria, and sensory deficits. Although stroke manifestations that mimic seizures are rare, diagnosing poststroke seizures can be challenging when accompanied with negative postictal symptoms. Differential diagnoses of poststroke seizures include movement disorders, syncope, and functional (nonepileptic) seizures, which may present with symptoms similar to seizures. Furthermore, it is important to determine whether poststroke seizures occur early or late. Seizures occurring within and after 7 d of stroke onset were classified as early and late seizures, respectively. Early seizures have the same clinical course as acute symptomatic seizures; they rarely recur or require long-term antiseizure medication. Conversely, late seizures are associated with a risk of recurrence similar to that of unprovoked seizures in a patient with a focal lesion, thereby requiring long-term administration of antiseizure medication. After diagnosis, concerns regarding treatment strategies, treatment duration, and administration of primary and secondary prophylaxis often arise. Antiseizure medication decisions for the initiation of short-term primary and long-term secondary seizure prophylaxis should be considered for patients with stroke. Antiseizure drugs such as lamotrigine, carbamazepine, lacosamide, levetiracetam, phenytoin, and valproate may be administered. Poststroke seizures should be diagnosed systematically through history with differential diagnosis; in addition, classifying them as early or late seizures can help to determine treatment strategies.
Collapse
Affiliation(s)
- Han Uk Ryu
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hong Jin Kim
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| |
Collapse
|
3
|
Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, Kam W, Kirkham FC, McNair ND, Singhal AB, Thijs V, Yang VXD. Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association. Stroke 2024; 55:e77-e90. [PMID: 38284265 DOI: 10.1161/str.0000000000000456] [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: 01/30/2024]
Abstract
Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.
Collapse
|
4
|
Ranjan R, Ken-Dror G, Sharma P. Pathophysiology, diagnosis and management of cerebral venous thrombosis: A comprehensive review. Medicine (Baltimore) 2023; 102:e36366. [PMID: 38050259 PMCID: PMC10695550 DOI: 10.1097/md.0000000000036366] [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: 10/11/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
Cerebral venous thrombosis is a rare cause of stroke in young mostly female adults which is frequently overlooked due to its variable clinical and radiological presentation. This review summarizes current knowledge on it risk factors, management and outcome in adults and highlights areas for future research. Females are 3 times more commonly affected and are significantly younger than males. The presenting symptoms can range from headache to loss of consciousness. However, the often-nebulous nature of symptoms can make the diagnosis challenging. Magnetic resonance imaging with venography is often the diagnostic imaging of choice. While unfractionated or low molecular-weight heparin is the mainstay of treatment, endovascular intervention with thrombolysis or thrombectomy and decompressive craniectomy may be required depending on clinical status. Nevertheless, approximately 80% of patients have a good recovery but mortality rates of -5% to 10% are not uncommon. Diagnosing cerebral venous thrombosis can be challenging but with vigilance and expert care patients have the best chance of a good clinical outcome.
Collapse
Affiliation(s)
- Redoy Ranjan
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
| | - Gie Ken-Dror
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
- Department of Clinical Neurology, Imperial College London Healthcare NHS Trust, London, United Kingdom
| |
Collapse
|
5
|
Shi Y, Chen K, Sui Y, Huang C. Posttraumatic delayed cerebral venous thrombosis with thrombocytopenia leading to multiple delayed intracranial hemorrhage. Asian J Surg 2023; 46:5619-5620. [PMID: 37599130 DOI: 10.1016/j.asjsur.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Yu Shi
- Department of Neurosurgery, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China
| | - Kai Chen
- Department of Neurosurgery, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China
| | - Yihang Sui
- Department of Neurology, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China
| | - Changren Huang
- Department of Neurosurgery, The Affliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou 646000, Sichuan, China; Neurosurgical Clinical Research Center of Sichuan Province Luzhou, China; Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Laboratory of Neurological Diseases and Brain Functions, The Affliated Hospital of Southwest Medical University, Luzhou, China.
| |
Collapse
|
6
|
Biggi M, Contento M, Magliani M, Giovannelli G, Barilaro A, Bessi V, Lombardo I, Massacesi L, Rosati E. Alice in wonderland syndrome "through the looking-glass" in a rare presentation of non-convulsive status epilepticus in cerebral venous sinus thrombosis and COVID-19. Cortex 2023; 167:218-222. [PMID: 37572532 DOI: 10.1016/j.cortex.2023.06.020] [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: 12/20/2022] [Revised: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 08/14/2023]
Abstract
Alice in Wonderland Syndrome (AIWS) is a rare perceptual disorder, rarely associated with epileptic etiology. We report the case of a 23-year-old man with subacute onset of right peri-orbital headache and visual misperceptions consistent with AIWS Type B, who underwent laboratory tests, brain CT with venography, ophthalmic examination, and neurological assessment that turned out to be normal except for visuospatial difficulties and constructional apraxia. A nasopharyngeal SARS-CoV2 swab taken as screening protocol was positive. The EEG performed because of the persistence of AIWS showed a focal right temporo-occipital non-convulsive status epilepticus; a slow resolution of clinical and EEG alterations was achieved with anti-seizure medications. Brain MRI showed right cortical temporo-occipital signal abnormalities consistent with peri-ictal changes and post-contrast T1 revealed a superior sagittal sinus thrombosis, thus anticoagulant therapy was initiated. AIWS is associated with temporo-parieto-occipital carrefour abnormalities, where visual and somatosensory inputs are integrated to generate the representation of body schema. In this patient, AIWS is caused by temporo-occipital status epilepticus without anatomical and electroencephalographic involvement of the parietal region, consistent with the absence of somatosensory symptoms of the syndrome. Status epilepticus can be the presenting symptom of cerebral venous sinus thrombosis (CVST) which, in this case, is possibly due to the hypercoagulable state associated with COVID-19.
Collapse
Affiliation(s)
- M Biggi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - M Contento
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology, Pordenone Hospital, Pordenone, Italy
| | - M Magliani
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - G Giovannelli
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - A Barilaro
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - V Bessi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - I Lombardo
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
| | - L Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - E Rosati
- Department of Neurology 2, Careggi University Hospital, Florence, Italy.
| |
Collapse
|
7
|
Proaño JS, Martinez PA, Sendi P, Totapally BR. Characteristics and Outcomes of Children with Cerebral Sinus Venous Thrombosis. Neurocrit Care 2023; 39:331-338. [PMID: 37438549 DOI: 10.1007/s12028-023-01765-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/19/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Cerebral sinus venous thrombosis (CSVT) is an uncommon condition in children with potentially serious outcomes. Large epidemiological studies in children with CSVT are few. The objective of this study is to evaluate the epidemiology and in-hospital outcomes of hospitalized children with CSVT in the United States. METHODS We performed a retrospective cross-sectional analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database for the combined years 2016 and 2019. The database was queried using the diagnoses for intracranial and intraspinal phlebitis and thrombophlebitis, nonpyogenic thrombosis of the intracranial venous system, and cerebral infarction due to cerebral venous thrombosis. Sample weighting was employed to produce national estimates. RESULTS Of 12,165,621 discharges, 3202 had CSVT (in-hospital prevalence 26.3 per 100,000 discharges). Male patients accounted for 57% of CSVT discharges. The median age was 8 years (interquartile range 1-16), with a U-shaped distribution with peaks in patients younger than 4 years and patients aged between 18 and 20 years. A total of 19.3% of children with CSVT had either hemorrhagic or ischemic stroke. Patients with stroke were more likely to require mechanical ventilation (odds ratio [OR] 2.7; 95% confidence interval [CI] 2.1-3.3; p < 0.001) and have higher mortality (OR 2.3; 95% CI 1.6-3.4; p < 0.001). Mechanical ventilation was necessary for 25.2% of patients with CSVT, of whom the majority were neonates and young children. The need for mechanical ventilation was associated with increased mortality (OR 16.6; 95% CI 9.9-27.9; p < 0.001). The overall mortality rate for CSVT was 4.1%, and 16.5% of patients with CSVT were discharged with home health care or to a skilled nursing facility. CONCLUSIONS CSVT, which has a U-shaped age distribution, is an uncommon condition in children. Stroke is common in children with CSVT, and it is associated with an increased need for mechanical ventilation and increased mortality. The need for mechanical ventilation is more common in infants, and it is associated with increased mortality across all age groups.
Collapse
Affiliation(s)
- Juan Sebastian Proaño
- Marshall University Joan C Edwards School of Medicine, 1600 Medical Center Drive, Huntington, WV, 25705, USA.
| | - Paul A Martinez
- Department of Pediatric Critical Care, Nicklaus Children's Hospital, Miami, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Prithvi Sendi
- Department of Pediatric Critical Care, Nicklaus Children's Hospital, Miami, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Balagangadhar R Totapally
- Department of Pediatric Critical Care, Nicklaus Children's Hospital, Miami, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| |
Collapse
|
8
|
Herzig-Nichtweiß J, Salih F, Berning S, Malter MP, Pelz JO, Lochner P, Wittstock M, Günther A, Alonso A, Fuhrer H, Schönenberger S, Petersen M, Kohle F, Müller A, Gawlitza A, Gubarev W, Holtkamp M, Vorderwülbecke BJ. Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study. Ann Intensive Care 2023; 13:85. [PMID: 37712992 PMCID: PMC10504169 DOI: 10.1186/s13613-023-01183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Acute symptomatic epileptic seizures are frequently seen in neurocritical care. To prevent subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is lacking. This study aimed at prospectively assessing the risk of unprovoked seizure relapse with respect to the use of antiseizure medications. It was hypothesized that after a first acute symptomatic seizure of structural etiology, the cumulative 12-month risk of unprovoked seizure relapse is ≤ 25%. METHODS Inclusion criteria were age ≥ 18 and acute symptomatic first-ever epileptic seizure; patients with status epilepticus were excluded. Using telephone and mail interviews, participants were followed for 12 months after the acute symptomatic first seizure. Primary endpoint was the occurrence and timing of a first unprovoked seizure relapse. In addition, neuro-intensivists in Germany were interviewed about their antiseizure treatment strategies through an anonymous online survey. RESULTS Eleven of 122 participants with structural etiology had an unprovoked seizure relapse, resulting in a cumulative 12-month risk of 10.7% (95%CI, 4.7%-16.7%). None of 19 participants with a non-structural etiology had a subsequent unprovoked seizure. Compared to structural etiology alone, combined infectious and structural etiology was independently associated with unprovoked seizure relapse (OR 11.1; 95%CI, 1.8-69.7). Median duration of antiseizure treatment was 3.4 months (IQR 0-9.3). Seven out of 11 participants had their unprovoked seizure relapse while taking antiseizure medication; longer treatment durations were not associated with decreased risk of unprovoked seizure relapse. Following the non-representative online survey, most neuro-intensivists consider 3 months or less of antiseizure medication to be adequate. CONCLUSIONS Even in case of structural etiology, acute symptomatic seizures bear a low risk of subsequent unprovoked seizures. There is still no evidence favoring long-term treatments with antiseizure medications. Hence, individual constellations with an increased risk of unprovoked seizure relapse should be identified, such as central nervous system infections causing structural brain damage. However, in the absence of high-risk features, antiseizure medications should be discontinued early to avoid overtreatment.
Collapse
Affiliation(s)
- Julia Herzig-Nichtweiß
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Farid Salih
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Sascha Berning
- Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - Michael P Malter
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Johann O Pelz
- Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany
| | - Matthias Wittstock
- Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Albrecht Günther
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Angelika Alonso
- Department of Neurology, Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany
| | - Hannah Fuhrer
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | - Silvia Schönenberger
- Department of Neurology, Medical Faculty Heidelberg, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | | | - Felix Kohle
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Annekatrin Müller
- Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany
| | - Alexander Gawlitza
- Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany
| | - Waldemar Gubarev
- Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany
| | - Bernd J Vorderwülbecke
- Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany.
| |
Collapse
|
9
|
Galeano-Valle F, Oblitas CM, González-San-Narciso C, Esteban-San-Narciso B, Lafuente-Gómez G, Demelo-Rodríguez P. Cerebral venous thrombosis in adults: a case series of 35 patients from a tertiary hospital. Rev Clin Esp 2023:S2254-8874(23)00075-9. [PMID: 37343816 DOI: 10.1016/j.rceng.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To describe the baseline characteristics, clinical presentation, imaging tests and outcomes and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). PATIENTS AND METHODS Retrospective, single-center, observational study that included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed through electronic medical records. RESULTS A total of 35 patients were included and the median age at diagnosis was 50.3 (+/- 17.8) years, the majority being women (74.4%). Almost 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1%; among them, 75% were low molecular weight heparins. The compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) within the first two weeks occurred in 28.6% (10 patients). During the mean follow-up of 3.3 years, 14.3% died (among them, only one patient´s death was caused by CVT), one patient had major bleeding and no patient presented recurrence of CVT. CONCLUSIONS In our cohort, CVT affected more frequently young women with at least one risk factor for the development of CVT. The presence of edema on CT and corticosteroid treatment were associated with poor short-term prognosis. A good long-term prognosis was observed in terms of mortality, recurrence, and bleeding.
Collapse
Affiliation(s)
- Francisco Galeano-Valle
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Crhistian-Mario Oblitas
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Candela González-San-Narciso
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Gemma Lafuente-Gómez
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
10
|
Karlin AR, Kumar NK, Vossough A, Abend NS, Ichord RN, Beslow LA. Pediatric Cerebral Sinovenous Thrombosis and Risk for Epilepsy. Pediatr Neurol 2023; 146:85-94. [PMID: 37453223 DOI: 10.1016/j.pediatrneurol.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Cerebral sinovenous thrombosis (CSVT) is a rare form of pediatric stroke with significant morbidity. We determined cumulative incidence and predictors of acute seizures, remote seizures, and epilepsy after pediatric CSVT. METHODS Retrospective analysis of 131 neonates and children with neuroimaging-confirmed CSVT enrolled between 2008 and 2020 from a single-center prospective consecutive cohort. Acute seizures occurred within 7 days of CSVT. Remote seizures occurred >7 days after CSVT. Epilepsy was defined as 2 or more remote seizures at least 24 hours apart. Survival methods determined the incidence of and risk factors for remote seizures and epilepsy. RESULTS Acute seizures occurred in 14/33 neonates (42%) and 19/98 children (19%). Among children, hemorrhage predicted acute seizures (OR 6.6, 95% CI 1.9 to 22.4, P = 0.003). Remote seizures occurred in six neonates; five developed epilepsy. Remote seizures occurred in 14 children; 10 developed epilepsy. In neonates, 1- and 3-year epilepsy-free survival were 86% (95% CI 62% to 95%) and 66% (95% CI 32% to 87%). One- and 3-year epilepsy-free survival in children were 88% (95% CI 76% to 92%) and 84% (95% CI 59% to 86%). In multivariable analysis for children, acute seizures predicted epilepsy (HR 3.8, 95% CI 1.1-13.3, P = 0.039). In both cohorts, Pediatric Stroke Outcome Measure scores at last follow-up were worse in those with epilepsy compared to those without. CONCLUSIONS Acute seizures occurred in approximately one quarter of our cohort and are an epilepsy risk factor in children with CSVT. Neonates and children with epilepsy had worse outcomes than those without.
Collapse
Affiliation(s)
- Alexis R Karlin
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nankee K Kumar
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas S Abend
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca N Ichord
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A Beslow
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
11
|
Hurford R, Siripurapu R, Emsley HCA, Lovett J, Werring D, Punter MNM. Uncommon causes of ischaemic stroke: how to approach the diagnosis. Pract Neurol 2023; 23:35-45. [PMID: 35863878 DOI: 10.1136/pn-2022-003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 02/02/2023]
Abstract
Stroke is a common neurological emergency and although most cases are associated with traditional vascular risk factors leading to cerebral ischaemia by well-recognised pathophysiological mechanisms, around 4% of ischaemic strokes are due to rare conditions. These are important to recognise due to their different management, which is often specific and effective, and due to their different prognosis from otherwise cryptogenic ischaemic strokes. We outline a practical approach to identifying uncommon causes of ischaemic stroke by highlighting diagnostic 'red flags' and propose a structured approach to investigating them.
Collapse
Affiliation(s)
- Robert Hurford
- Neurology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rekha Siripurapu
- Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Hedley C A Emsley
- Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Joanna Lovett
- Neurology Department, Wessex Neurological Centre, Southampton, UK
| | - David Werring
- Stroke Research Group, UCL institute of neurology, London, UK
| | - Martin Nicholas Michael Punter
- Department of Medicine, University of Otago, Wellington, New Zealand .,Department of Neurology, Wellington Regional Hospital, Newtown, New Zealand
| |
Collapse
|
12
|
Pleșa FC, Jijie A, Toma GS, Ranetti AE, Manole AM, Rotaru R, Caloianu I, Anghel D, Dulămea OA. Challenges in Cerebral Venous Thrombosis Management-Case Reports and Short Literature Review. Life (Basel) 2023; 13:life13020334. [PMID: 36836691 PMCID: PMC9964720 DOI: 10.3390/life13020334] [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: 11/25/2022] [Revised: 01/07/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare type of stroke, with a complex clinical presentation that can make it a diagnostic challenge for the swift initiation of anticoagulation. When a hemorrhagic transformation is added, therapeutic management becomes even more complex. We describe a series of four cases, aged between 23 and 37 years old, with cerebral venous thrombosis. They were admitted to our clinic between 2014 and 2022. All cases presented significant challenges in either diagnostic, therapeutic or etiologic evaluation, at different stages of the disease. Late complications such as epilepsy or depression and other behavioral disorders represent long-term sequelae for the patient. Therefore, through its late complications, CVT is not only an acute disease but a chronic disorder with long-term follow-up requirements. The first case of the series is of a postpartum woman with focal neurological deficit caused by CVT with hemorrhagic transformation that presented multiple thrombotic complications and severe depression. The second case is of a man with extensive cerebral thrombosis who developed bilateral papillary edema under therapeutic anticoagulation treatment. The third case is of a woman with bilateral cavernous sinus thrombosis who later developed depressive disorder and focal seizures. The fourth case is of a pregnant woman in the first trimester presenting with a steep decline in consciousness level secondary to deep cerebral vein thrombosis requiring intensive care and subsequently developing a memory disorder. For a long period of time, due to being underdiagnosed, few things were known about CVT. Nowadays, we have all the tools to diagnose, treat, and follow up cases of CVT.
Collapse
Affiliation(s)
- Florentina Cristina Pleșa
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
- Department of Preclinical Disciplines, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Alina Jijie
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
| | - Gabriela Simona Toma
- Department of Radiology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Aurelian Emilian Ranetti
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
- Department of Endocrinology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania
- Correspondence:
| | - Aida Mihaela Manole
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
| | - Ruxandra Rotaru
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
| | - Ionuț Caloianu
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
| | - Daniela Anghel
- Department of Medico-Surgical and Prophylactic Disciplines, Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
- Department of Internal Medicine, Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Octaviana Adriana Dulămea
- Neurology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Neurology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| |
Collapse
|
13
|
Predicting Factors for Seizures after Cerebral Venous Thrombosis: A Retrospective Single Center Cohort Study. Life (Basel) 2022; 13:life13010111. [PMID: 36676061 PMCID: PMC9865306 DOI: 10.3390/life13010111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Seizures are a common complication of cerebral venous thrombosis. In this study, we intended to define clinical and neuroradiological factors associated with early and late seizures and predictors for seizure recurrence. Methods: The database of our high-volume tertiary stroke center was screened for patients diagnosed with cerebral venous thrombosis between April 2006 and July 2021. Demographics, clinical, imaging, and instrumental data were collected. Results: Out of a total of 80 patients, 30 had seizures, either within the first week after onset (22 patients) or after (8 patients). Speech impairment and intracerebral bleeding were statistically associated with seizures in univariate analysis, but in a logistic regression model, only brain damage with hemorrhagic infarct and/or presence of brain hematoma [OR 6.051; 95% CI 1.881−19.468] (p = 0.003) were predicting factors for seizures. Late seizures were significantly more frequent in younger age [OR 0.864; 95% CI 0.763−0.978] (p = 0.020). Early seizures resulted as protective factors for recurrence; an altered state of consciousness at baseline and late seizures resulted as predictive factors for relapses (0.0% vs. 81.0%, p = 0.005, and 100.0% vs. 19.0%, p < 0.005, respectively). Conclusions: Our study confirms brain bleeding as the strongest risk factor for seizures after cerebral venous thrombosis. Recurrence is unusual after early seizures, while the presence of late seizures seems to raise the risk of recurrence.
Collapse
|
14
|
Zhou Y, Jiang H, Wei H, Liu L, Zhou C, Ji X. Venous stroke–a stroke subtype that should not be ignored. Front Neurol 2022; 13:1019671. [PMID: 36277910 PMCID: PMC9582250 DOI: 10.3389/fneur.2022.1019671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Based on the etiology, stroke can be classified into ischemic or hemorrhagic subtypes, which ranks second among the leading causes of death. Stroke is caused not only by arterial thrombosis but also by cerebral venous thrombosis. Arterial stroke is currently the main subtype of stroke, and research on this type has gradually improved. Venous thrombosis, the particular type, accounts for 0.5–1% of all strokes. Due to the lack of a full understanding of venous thrombosis, as well as its diverse clinical manifestations and neuroimaging features, there are often delays in admission for it, and it is easy to misdiagnose. The purpose of this study was to review the pathophysiology mechanisms and clinical features of arterial and venous thrombosis and to provide guidance for further research on the pathophysiological mechanism, clinical diagnosis, and treatment of venous thrombosis. This review summarizes the pathophysiological mechanisms, etiology, epidemiology, symptomatology, diagnosis, and treatment heterogeneity of venous thrombosis and compares it with arterial stroke. The aim is to provide a reference for a comprehensive understanding of venous thrombosis and a scientific understanding of various pathophysiological mechanisms and clinical features related to venous thrombosis, which will contribute to understanding the pathogenesis of intravenous stroke and provide insight into diagnosis, treatment, and prevention.
Collapse
Affiliation(s)
- Yifan Zhou
- 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, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Jiang
- 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, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Huimin Wei
- School of Engineering Medicine, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Lu Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Zhou
- 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, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Chen Zhou
| | - Xunming Ji
- 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, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xunming Ji
| |
Collapse
|
15
|
Xiao L, Ji X, Zhao H, Luo Y, Hu S, Zhao T, Hu Z, Duan J. A novel severe cerebral venous thrombosis rat model based on semi-ligation combined with ferric chloride and thrombin. CNS Neurosci Ther 2022; 28:2129-2140. [PMID: 36000206 PMCID: PMC9627376 DOI: 10.1111/cns.13950] [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: 06/02/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
AIMS An applicable cerebral venous sinus thrombosis (CVST) model is imperative for exploring its pathophysiology. We established a novel severe CVST model using semi-ligation, ferric chloride, and thrombin. METHODS A total of 138 male Sprague-Dawley rats were randomly divided into semi-ligation (n = 75) and non-semi-ligation (n = 63) groups. A sham group (n = 46) was also included. We compared short-term and long-term neurological and cognitive dysfunction, mortality rates, thrombus load, venous infarction volume, the blood-brain barrier permeability, brain water content, and microglia activation among the three groups. RESULTS Thrombi involving multiple venous sinuses appeared in all semi-ligation rats within 2 days postoperatively. Compared with the non-semi-ligation group, short-term and long-term neurological dysfunction were more severe (p < 0.05), and thrombus weight, venous infarction volumes, and microglia activation were more significant (p < 0.05) in the semi-ligation group. Further, the cognitive function of the semi-ligation group significantly decreased (p < 0.05) on postoperative day 21. Cumulative mortality rates between the semi-ligation and non-semi-ligation groups did not differ significantly. CONCLUSION Semi-ligation combined with ferric chloride and thrombin can produce a severe CVST model with multiple venous sinus involvement, which is suitable for short- and long-term neurological and cognitive dysfunction assessment.
Collapse
Affiliation(s)
- Lipo Xiao
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina,Department of NeurologyThe People's Hospital of QingxianCangzhouChina
| | - Xunming Ji
- Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Haiping Zhao
- Cerebrovascular Diseases Research Institute and Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yumin Luo
- Cerebrovascular Diseases Research Institute and Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Shuyuan Hu
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Tingyu Zhao
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Zeliang Hu
- Department of Pathology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jiangang Duan
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| |
Collapse
|
16
|
Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081105. [PMID: 35892907 PMCID: PMC9332165 DOI: 10.3390/life12081105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 12/05/2022]
Abstract
Cerebral venous thrombosis (CVT) is a rare type of stroke that may cause an intracranial hypertension syndrome as well as focal neurological deficits due to venous infarcts. MRI with venography is the method of choice for diagnosis, and treatment with anticoagulants should be promptly started. CVT incidence has increased in COVID-19-infected patients due to a hypercoagulability state and endothelial inflammation. CVT following COVID-19 vaccination could be related to vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare but severe complication that should be promptly identified because of its high mortality rate. Platelet count, D-dimer and PF4 antibodies should be dosed. Treatment with non-heparin anticoagulants and immunoglobulin could improve recuperation. Development of headache associated with seizures, impaired consciousness or focal signs should raise immediate suspicion of CVT. In patients who received a COVID-19 adenovirus-vector vaccine presenting thromboembolic events, VITT should be suspected and rapidly treated. Nevertheless, vaccination benefits clearly outweigh risks and should be continued.
Collapse
|
17
|
Woock M, Martinez-Majander N, Seiffge DJ, Selvik HA, Nordanstig A, Redfors P, Lindgren E, Sanchez van Kammen M, Rentzos A, Coutinho JM, Doyle K, Naess H, Putaala J, Jood K, Tatlisumak T. Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach. Ther Adv Neurol Disord 2022; 15:17562864221106362. [PMID: 35785404 PMCID: PMC9243376 DOI: 10.1177/17562864221106362] [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: 02/04/2022] [Accepted: 05/24/2022] [Indexed: 12/03/2022] Open
Abstract
The association between stroke and cancer is well-established. Because of an aging population and longer survival rates, the frequency of synchronous stroke and cancer will become even more common. Different pathophysiologic mechanisms have been proposed how cancer or cancer treatment directly or via coagulation disturbances can mediate stroke. Increased serum levels of D-dimer, fibrin degradation products, and CRP are more often seen in stroke with concomitant cancer, and the clot retrieved during thrombectomy has a more fibrin- and platelet-rich constitution compared with that of atherosclerotic etiology. Multiple infarctions are more common in patients with active cancer compared with those without a cancer diagnosis. New MRI techniques may help in detecting typical patterns seen in the presence of a concomitant cancer. In ischemic stroke patients, a newly published cancer probability score can help clinicians in their decision-making when to suspect an underlying malignancy in a stroke patient and to start cancer-screening studies. Treating stroke patients with synchronous cancer can be a delicate matter. Limited evidence suggests that administration of intravenous thrombolysis appears safe in non-axial intracranial and non-metastatic cancer patients. Endovascular thrombectomy is probably rather safe in these patients, but probably futile in most patients placed on palliative care due to their advanced disease. In this topical review, we discuss the epidemiology, pathophysiology, and prognosis of ischemic and hemorrhagic strokes as well as cerebral venous thrombosis and concomitant cancer. We further summarize the current evidence on acute management and secondary preventive therapy.
Collapse
Affiliation(s)
- Malin Woock
- Department of Neurology, Sahlgrenska University Hospital, Blå stråket 7, 413 46 Gothenburg, Sweden
| | | | - David J Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mayte Sanchez van Kammen
- Department of Neurology, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Alexandros Rentzos
- Department of Radiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Doyle
- Department of Physiology, Centre for Research in Medical Devices (CÚRAM), National University of Ireland, Galway, Galway, Ireland
| | - Halvor Naess
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
18
|
Heckelmann J, Dafotakis M, Schulz JB. [Cerebral venous sinus thrombosis : An overview of causes, diagnostics and treatment]. DER NERVENARZT 2022; 93:413-421. [PMID: 35412038 PMCID: PMC9004207 DOI: 10.1007/s00115-022-01283-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Die Sinus‑/Hirnvenenthrombose ist eine teils fulminant verlaufende, jedoch mit einer Inzidenz von 1,32 Fällen pro 100.000 Personenjahre eher seltene neurologische Diagnose. Nichtsdestotrotz ist die Erkrankung für etwa 0,5–1 % aller Schlaganfälle verantwortlich. Die neurologische Untersuchung zeigt oft ein unspezifisches Bild, gerade bei jüngeren Patientinnen mit akut bis subakut aufgetretenen, lageabhängigen Kopfschmerzen sollte diese Differenzialdiagnose jedoch unbedingt bedacht werden. Im Rahmen dieses Artikels erfolgt die Präsentation der häufigsten Ursachen, einschließlich eines Exkurses zur vakzininduzierten immunthrombotischen Thrombozytopenie (VITT), und es werden Empfehlungen zur klinischen, laborchemischen und bildgebenden Diagnostik gegeben. Zudem werden relevante Komplikationen, mit besonderem Augenmerk auf epileptische Anfälle im Rahmen der Krankheitsentität und die leitliniengemäße Akuttherapie und Sekundärprophylaxe dargestellt.
Collapse
Affiliation(s)
- Jan Heckelmann
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Manuel Dafotakis
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Jörg B Schulz
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| |
Collapse
|
19
|
Gorman JB, Field TS. ACTION-CVT: Are the Findings ACTIONable? Stroke 2022; 53:739-741. [PMID: 35143324 DOI: 10.1161/strokeaha.122.038564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Johnathon B Gorman
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Canada
| |
Collapse
|
20
|
Abstract
Purpose of Review Cerebral venous thrombosis (CVT) is a rare cause of stroke that most commonly affects younger women. Here, we review new literature relevant to the management and prognosis of individuals with CVT and ongoing areas of uncertainty. Recent Findings Direct-acting oral anticoagulants (DOACs) are being increasingly integrated into routine care but are not yet recommended by guidelines. Recent randomized clinical trials and available case series offer reassuring safety data. Routine use of endovascular therapy is not associated with improved outcomes. The relationship between recanalization and prognosis is uncertain. Summary The evidence base for management of CVT continues to improve. Ongoing areas of uncertainty include duration of therapy and whether certain subgroups of patients may benefit from neurointervention or personalized approaches to antithrombotic strategy. The state of knowledge will continue to benefit from large collaborative international efforts, and integration of patient partnerships to identify research priorities.
Collapse
|
21
|
Fang Y, Song G, Lin J, Ye X, Huang S. Predicting the occurrence of early seizures after cerebral venous thrombosis using a comprehensive nomogram. Epilepsy Res 2021; 178:106820. [PMID: 34844093 DOI: 10.1016/j.eplepsyres.2021.106820] [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: 04/10/2021] [Revised: 10/30/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seizure is a common clinical manifestation of cerebral venous thrombosis (CVT). The mortality rate of patients with CVT with seizure is three times higher than that of patients without seizure. The aim of this study was to develop a nomogram to predict the individual probability of acute seizure events in patients with CVT. METHOD This was a single-center, retrospective cohort study. We analyzed and compared demographic variables, epidemiological risk factors, clinical presentation, laboratory results and imaging data in a cohort of 142 patients who were diagnosed with CVT in our hospital from January 2013 to December 2018. A nomogram was constructed to predict the risk of early seizure (ES) in these patients according to the multivariable logistic regression analysis results. The concordance index, GiViTi calibration belt and decision curve analysis (DCA) were used to assess nomogram performance. RESULTS Forty-three (30.28%) patients experienced seizure within 2 weeks after a CVT diagnosis. Multivariate analysis identified focal neurologic deficit, Glasgow Coma Scale (GCS) scores ≤ 8 on admission, hemorrhagic lesions, superior sagittal sinus thrombosis (SSST) and frontal lobe lesions as independent predictive factors for ES occurrence after CVT. A nomogram was generated based on these predictive factors with the concordance index reaching 0.82, indicating that the clinical tool was well calibrated. DCA showed that the model was useful with a threshold probability in the range of 0-77%. CONCLUSIONS We developed the first nomogram that could predict the risk of ES in CVT patients. This effective and convenient tool has shown promising clinical benefit and will assist clinicians in making treatment decisions.
Collapse
Affiliation(s)
- Yongkang Fang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Guini Song
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jiahe Lin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiaodong Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| |
Collapse
|
22
|
Lindgren E, Rentzos A, Hiltunen S, Serrano F, Heldner MR, Zuurbier SM, Silvis SM, Mansour M, Allingham W, Punter MNM, Giarola BF, Wells J, Sánchez van Kammen M, Piechowiak EI, Chiota-McCollum N, Garcia-Esperon C, Cognard C, Kleinig T, Ghiasian M, Coutinho JM, Arnold M, Arauz A, Putaala J, Jood K, Tatlisumak T. Dural arteriovenous fistulas in cerebral venous thrombosis: Data from the International Cerebral Venous Thrombosis Consortium. Eur J Neurol 2021; 29:761-770. [PMID: 34811840 DOI: 10.1111/ene.15192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE To explore the prevalence, risk factors, time correlation, characteristics and clinical outcome of dural arteriovenous fistulas (dAVFs) in a cerebral venous thrombosis (CVT) population. METHODS We included patients from the International CVT Consortium registries. Diagnosis of dAVF was confirmed centrally. We assessed the prevalence and risk factors for dAVF among consecutive CVT patients and investigated its impact on clinical outcome using logistic regression analysis. We defined poor outcome as modified Rankin Scale score 3-6 at last follow-up. RESULTS dAVF was confirmed in 29/1218 (2.4%) consecutive CVT patients. The median (interquartile range [IQR]) follow-up time was 8 (5-23) months. Patients with dAVF were older (median [IQR] 53 [44-61] vs. 41 [29-53] years; p < 0.001), more frequently male (69% vs. 33%; p < 0.001), more often had chronic clinical CVT onset (>30 days: 39% vs. 7%; p < 0.001) and sigmoid sinus thrombosis (86% vs. 51%; p < 0.001), and less frequently had parenchymal lesions (31% vs. 55%; p = 0.013) at baseline imaging. Clinical outcome at last follow-up did not differ between patients with and without dAVF. Additionally, five patients were confirmed with dAVF from non-consecutive CVT cohorts. Among all patients with CVT and dAVF, 17/34 (50%) had multiple fistulas and 23/34 (68%) had cortical venous drainage. Of 34 patients with dAVF with 36 separate CVT events, 3/36 fistulas (8%) were diagnosed prior to, 20/36 (56%) simultaneously and 13/36 after (36%, median 115 [IQR 38-337] days) diagnosis of CVT. CONCLUSIONS Dural arteriovenous fistulas occur in at least 2% of CVT patients and are associated with chronic CVT onset, older age and male sex. Most CVT-related dAVFs are detected simultaneously or subsequently to diagnosis of CVT.
Collapse
Affiliation(s)
- Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexandros Rentzos
- Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital, Gothenburg, Västra Götaland County, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Fabiola Serrano
- National Institute of Neurology, Neurosurgery Manuel Velasco Suarez, Mexico-City, Mexico
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Susanna M Zuurbier
- Department of Neurology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - Suzanne M Silvis
- Department of Neurology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - Maryam Mansour
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - William Allingham
- The Balfour Hospital, National Health Service Orkney, Kirkwall, Orkney, UK
| | - Martin N M Punter
- Department of Neurology, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Blake F Giarola
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Jeremy Wells
- Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Eike I Piechowiak
- Inselspital, University Institute for Diagnostic and Interventional Neuroradiology, Bern, Switzerland
| | - Nicole Chiota-McCollum
- Department of Neurology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Carlos Garcia-Esperon
- John Hunter Hospital, University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Timothy Kleinig
- Department of Neurology, South Australian Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antonio Arauz
- National Institute of Neurology, Neurosurgery Manuel Velasco Suarez, Mexico-City, Mexico
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | |
Collapse
|
23
|
Sánchez van Kammen M, Aguiar de Sousa D, Poli S, Cordonnier C, Heldner MR, van de Munckhof A, Krzywicka K, van Haaps T, Ciccone A, Middeldorp S, Levi MM, Kremer Hovinga JA, Silvis S, Hiltunen S, Mansour M, Arauz A, Barboza MA, Field TS, Tsivgoulis G, Nagel S, Lindgren E, Tatlisumak T, Jood K, Putaala J, Ferro JM, Arnold M, Coutinho JM, Sharma AR, Elkady A, Negro A, Günther A, Gutschalk A, Schönenberger S, Buture A, Murphy S, Paiva Nunes A, Tiede A, Puthuppallil Philip A, Mengel A, Medina A, Hellström Vogel Å, Tawa A, Aujayeb A, Casolla B, Buck B, Zanferrari C, Garcia-Esperon C, Vayne C, Legault C, Pfrepper C, Tracol C, Soriano C, Guisado-Alonso D, Bougon D, Zimatore DS, Michalski D, Blacquiere D, Johansson E, Cuadrado-Godia E, De Maistre E, Carrera E, Vuillier F, Bonneville F, Giammello F, Bode FJ, Zimmerman J, d'Onofrio F, Grillo F, Cotton F, Caparros F, Puy L, Maier F, Gulli G, Frisullo G, Polkinghorne G, Franchineau G, Cangür H, Katzberg H, Sibon I, Baharoglu I, Brar J, Payen JF, Burrow J, Fernandes J, Schouten J, Althaus K, Garambois K, Derex L, Humbertjean L, Lebrato Hernandez L, Kellermair L, Morin Martin M, Petruzzellis M, Cotelli M, Dubois MC, Carvalho M, Wittstock M, Miranda M, Skjelland M, Bandettini di Poggio M, Scholz MJ, Raposo N, Kahnis R, Kruyt N, Huet O, Sharma P, Candelaresi P, Reiner P, Vieira R, Acampora R, Kern R, Leker R, Coutts S, Bal S, Sharma SS, Susen S, Cox T, Geeraerts T, Gattringer T, Bartsch T, Kleinig TJ, Dizonno V, Arslan Y. Characteristics and Outcomes of Patients With Cerebral Venous Sinus Thrombosis in SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. JAMA Neurol 2021; 78:1314-1323. [PMID: 34581763 DOI: 10.1001/jamaneurol.2021.3619] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). Objective To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. Design, Setting, and Participants This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. Exposures Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. Main Outcomes and Measures Clinical characteristics and mortality rate. Results Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. Conclusions and Relevance In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.
Collapse
Affiliation(s)
- Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal
| | - Sven Poli
- Department of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany.,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Charlotte Cordonnier
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs van Haaps
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel M Levi
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzanne Silvis
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maryam Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Antonio Arauz
- National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr R.A. Calderón Guardia, San José, Costa Rica
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Georgios Tsivgoulis
- Second Department of Neurology in National, Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jose M Ferro
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Lisbon, Portugal
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Aarti R Sharma
- Imperial College London School of Medicine, Imperial College London, London, United Kingdom
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Alberto Negro
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Gutschalk
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Alina Buture
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland.,UCD School of Medicine, University College Dublin, Dublin, Ireland.,School of Medicine, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ana Paiva Nunes
- Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Andreas Tiede
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany
| | - Antonio Medina
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Audrey Tawa
- Department of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
| | - Barbara Casolla
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom.,Stroke Unit, Hôpital Pasteur 2, URRIS - UR2CA, Unité de Recherche Clinique Cote d'Azur, Cote d'Azur University, Nice, France
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy
| | | | - Caroline Vayne
- Department of Hematology and Hemostasis, Tours University Hospital, Tours, France
| | - Catherine Legault
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christian Pfrepper
- Division of Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | | | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain
| | | | - David Bougon
- Department of Critical Care, Annecy Genevois Hospital, Annecy, France
| | | | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Dylan Blacquiere
- Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Elias Johansson
- Department Clinical Science, Wallenberg Center for Molecular Medicine, Umeå University, Umeå, Sweden
| | | | | | - Emmanuel Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Fabrice Bonneville
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | - Julian Zimmerman
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Francois Cotton
- Department of Radiology, Lyon University Hospital, Lyon, France
| | - François Caparros
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Laurent Puy
- Department of Neurosciences and Cognition, Lille University Hospital, Lille, France
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany
| | - Giosue Gulli
- Department of Medicine, Ashford and St Peters Hospital NHS Foundation Trust, Surrey, United Kingdom
| | - Giovanni Frisullo
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Guillaume Franchineau
- Department of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France
| | - Hakan Cangür
- Department of Neurology, Hospital of the City of Wolfsburg, Wolfsburg, Germany
| | - Hans Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Igor Sibon
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - Irem Baharoglu
- Department of Neurology, Haga Hospital, The Hague, the Netherlands
| | - Jaskiran Brar
- Department of Neurology, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | | | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Australia
| | - João Fernandes
- Department of Neurology, Norra Älvsborgs Länssjukhus, Trollhattan, Sweden
| | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
| | | | - Katia Garambois
- Stroke Unit, University Hospital of Grenoble, Grenoble, France
| | - Laurent Derex
- Department of Neurology, Hospices Civils de Lyon, Lyon, France
| | | | | | - Lukas Kellermair
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Maria Cotelli
- Department of Neurology, ASL Vallecamonica-Sebino, Breno, Italy
| | - Marie-Cécile Dubois
- Department of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - Marta Carvalho
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Moritz J Scholz
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Robert Kahnis
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Nyika Kruyt
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Olivier Huet
- UFR de Bio-médecine, Hospital de la Cavale Blanche, CHRU de Brest, Brest, France
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, London, United Kingdom
| | - Paolo Candelaresi
- Department of Neurology and Stroke, Cardarelli Hospital, Naples, Italy
| | - Peggy Reiner
- Department of Neurology, Lariboisière Hospital, Paris, France
| | - Ricardo Vieira
- Department of Hematology, Universidade Federal do Cariri, Juazeiro do Norte, Brazil
| | | | - Rolf Kern
- Department of Neurology, Kempten Hospital, Kempten, Germany
| | - Ronen Leker
- Department of Neurology, Hadassah University Medical Center, Jerusalem, Israel
| | - Shelagh Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simerpreet Bal
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Shyam S Sharma
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Sophie Susen
- Department of Hematology and Transfusion, Lille University Hospital, Lille, France
| | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, Toulouse University Hospital, Toulouse, France
| | | | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Vanessa Dizonno
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Yildiz Arslan
- Neurology Clinic, Medicana İzmir International Hospital, Izmir, Turkey
| |
Collapse
|
24
|
Patel ND, Desai N, S Sandhu MR, Patel SD, Tunguturi A, Mahuwala ZK. Burden of acute symptomatic seizures in cerebral venous sinus thrombosis: A nationwide United States analysis. Clin Neurol Neurosurg 2021; 209:106943. [PMID: 34563864 DOI: 10.1016/j.clineuro.2021.106943] [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: 05/31/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Acute symptomatic seizures (ASS) are seen in one-third of cerebral venous sinus thrombosis (CVT) cases either as the presenting symptom or shortly after diagnosis in the acute phase. The goal of our study was to assess the trends in recognition of ASS in CVT over the years and to determine factors predictive of ASS in the patients with CVT for early identification of candidates who would benefit from anti-seizure medications (ASM). MATERIALS AND METHODS The Nationwide Inpatient Sample (NIS) database was accessed to identify adult inpatient admissions with a primary or secondary diagnosis of CVT. Comorbidities, complications, risk factors, and procedures pertaining to these hospitalizations were compared between CVT patients with and without ASS. RESULTS A total of 53,710 CVT-related hospitalizations were identified, of which 18.1% of patients had a burden of ASS at presentation or subsequently during hospitalization. CVT patients with ASS had a longer average duration of hospitalization and higher overall morbidity and mortality. CONCLUSIONS Our study showed ~one in five patients (18.1%) with CVT had ASS. ASS patients had higher odds of mortality and disability at discharge, requiring post-discharge rehabilitation care. It is crucial to identify risk factors of ASS in the CVT population to avoid future preventable revisit related to seizures. Additional research is required for risk stratification of patients with CVT for primary and secondary seizure prophylaxis and determining the appropriate choice and duration of ASM in these patients.
Collapse
Affiliation(s)
- Neel D Patel
- Master in Public Health, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Ninad Desai
- St. Vincent's Medical Center, Hartford Healthcare, CT, USA
| | | | | | | | | |
Collapse
|
25
|
Wu X, Ya J, Zhou D, Ding Y, Ji X, Meng R. Nonthrombotic internal jugular venous stenosis may facilitate cerebral venous thrombosis. CNS Neurosci Ther 2021; 27:1396-1408. [PMID: 34397153 PMCID: PMC8504525 DOI: 10.1111/cns.13719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To explore the effect of nonthrombotic internal jugular venous stenosis (IJVS) exerted on cerebral venous thrombosis (CVT). METHODS Patients with imaging confirmed CVT were enrolled into this real-world case-control study consecutively from January 2018 through April 2021, and were divided into CVT and IJVS-CVT groups, according to whether or not with non-thrombotic IJVS. Chi-square and logistic regression models were utilized for between-group comparison of thrombotic factors. RESULTS A total of 199 eligible patients entered into final analysis, including 92 cases of CVT and 107 cases of IJVS-CVT. Chi-square revealed that thrombophilic conditions were found in majority of CVT, while only minority in the IJVS-CVT group (83.7% vs. 20.6%, p < 0.001). Multivariate logistic regression indicated that most identified thrombophilia were negatively related to IJVS-CVT (all p < 0.05), including oral contraceptive use (β = -1.38), hyperhomocysteinemia (β = -1.58), hematology (β = -2.05), protein C/S deficiency (β = -2.28), connective tissue disease (β = -1.18) and infection (β = -2.77). All recruited patients underwent standard anticoagulation, 10 cases in IJVS-CVT group also received jugular angioplasty for IJVS correction. Most participants obtained alleviations during 1-year follow-up. However, both clinical and imaging outcomes in IJVS-CVT group were not as good as those in CVT group (both p < 0.05). Moreover, 8 cases with CVT and 7 cases with IJVS-CVT were rehospitalized for CVT recurrences and underwent customized treatment. CONCLUSION Nonthrombotic IJVS may be one of the risk factors of CVT. Anticoagulation might need to be suggested for IJVS patients.
Collapse
Affiliation(s)
- Xiaoqin Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingyuan Ya
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
26
|
Petrović J, Švabić T, Zidverc-Trajković J, Stanarčević P, Jovanović D, Mijajlović M. Cerebral venous thrombosis: a retrospective unicentric analysis of clinical and neuroimaging characteristics. Neurol Sci 2021; 43:1839-1847. [PMID: 34347215 DOI: 10.1007/s10072-021-05514-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/18/2021] [Indexed: 01/30/2023]
Abstract
Thrombosis of dural sinuses and/or cerebral veins (CVT) is an uncommon form of stroke, usually affecting young individuals. It has a variable clinical presentation ranging from mild cases presenting only headaches, to severe cases featuring encephalopathy, coma or status epilepticus. A retrospective cross-sectional study of patients treated in the outpatient department and in-hospital during the period from 2014 to 2020 at the Neurology Clinic-University Clinical Centre of Serbia was conducted. Forty-nine patients (24 men; 25 women) were included in the study. Twenty-three patients (46.9%) suffered a subacute form of CVT (48 h-4 weeks), 19 (38.8%) presented with an acute form (< 48 h) and 7 (14.3%) with a chronic form (> 4 weeks). Around 75% of patients reported headaches during disease course. Focal neurological deficit (FND) was observed in 27 (55.1%) patients. Patients who did not report headaches (22.4%) presented with more severe symptoms (seizures and coma). More than 70% of patients had no radiologically evident brain parenchymal lesion. The most frequent locations of CVT were transverse sinus (79.6%), sigmoid sinus (44.9%) and superior sagittal sinus (36.7%). Thrombosis of more than one sinus/vein occurred in 33 (67.3%) patients. Hereditary thrombophilia was observed in 9 (18.4%) patients, 11 (22.4%) patients had some type of infection and 20% of women reported OCT usage. As much as 25% of cases remained without evident risk factors. The most common symptom in our cohort was acute unilateral throbbing headache of high intensity, while patients without headaches had more severe symptoms.
Collapse
Affiliation(s)
- Jovan Petrović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Švabić
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jasna Zidverc-Trajković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Dejana Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milija Mijajlović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia.
| |
Collapse
|
27
|
Sánchez van Kammen M, Heldner MR, Brodard J, Scutelnic A, Silvis S, Schroeder V, Kremer Hovinga JA, Middeldorp S, Levi M, Hiltunen S, Lindgren E, Mansour M, Arauz A, Barboza MA, Zuurbier SM, Aguiar de Sousa D, Ferro JM, Fischer U, Field TS, Jood K, Tatlisumak T, Putaala J, Arnold M, Coutinho JM. Frequency of Thrombocytopenia and Platelet Factor 4/Heparin Antibodies in Patients With Cerebral Venous Sinus Thrombosis Prior to the COVID-19 Pandemic. JAMA 2021; 326:332-338. [PMID: 34213527 PMCID: PMC8317004 DOI: 10.1001/jama.2021.9889] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022]
Abstract
Importance Cases of cerebral venous sinus thrombosis in combination with thrombocytopenia have recently been reported within 4 to 28 days of vaccination with the ChAdOx1 nCov-19 (AstraZeneca/Oxford) and Ad.26.COV2.S (Janssen/Johnson & Johnson) COVID-19 vaccines. An immune-mediated response associated with platelet factor 4/heparin antibodies has been proposed as the underlying pathomechanism. Objective To determine the frequencies of admission thrombocytopenia, heparin-induced thrombocytopenia, and presence of platelet factor 4/heparin antibodies in patients diagnosed with cerebral venous sinus thrombosis prior to the COVID-19 pandemic. Design, Setting, and Participants This was a descriptive analysis of a retrospective sample of consecutive patients diagnosed with cerebral venous sinus thrombosis between January 1987 and March 2018 from 7 hospitals participating in the International Cerebral Venous Sinus Thrombosis Consortium from Finland, the Netherlands, Switzerland, Sweden, Mexico, Iran, and Costa Rica. Of 952 patients, 865 with available baseline platelet count were included. In a subset of 93 patients, frozen plasma samples collected during a previous study between September 2009 and February 2016 were analyzed for the presence of platelet factor 4/heparin antibodies. Exposures Diagnosis of cerebral venous sinus thrombosis. Main Outcomes and Measures Frequencies of admission thrombocytopenia (platelet count <150 ×103/μL), heparin-induced thrombocytopenia (as diagnosed by the treating physician), and platelet factor 4/heparin IgG antibodies (optical density >0.4, in a subset of patients with previously collected plasma samples). Results Of 865 patients (median age, 40 years [interquartile range, 29-53 years], 70% women), 73 (8.4%; 95% CI, 6.8%-10.5%) had thrombocytopenia, which was mild (100-149 ×103/μL) in 52 (6.0%), moderate (50-99 ×103/μL) in 17 (2.0%), and severe (<50 ×103/μL) in 4 (0.5%). Heparin-induced thrombocytopenia with platelet factor 4/heparin antibodies was diagnosed in a single patient (0.1%; 95% CI, <0.1%-0.7%). Of the convenience sample of 93 patients with cerebral venous sinus thrombosis included in the laboratory analysis, 8 (9%) had thrombocytopenia, and none (95% CI, 0%-4%) had platelet factor 4/heparin antibodies. Conclusions and Relevance In patients with cerebral venous sinus thrombosis prior to the COVID-19 pandemic, baseline thrombocytopenia was uncommon, and heparin-induced thrombocytopenia and platelet factor 4/heparin antibodies were rare. These findings may inform investigations of the possible association between the ChAdOx1 nCoV-19 and Ad26.COV2.S COVID-19 vaccines and cerebral venous sinus thrombosis with thrombocytopenia.
Collapse
Affiliation(s)
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Justine Brodard
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzanne Silvis
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Verena Schroeder
- Experimental Haemostasis Group, Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | - Johanna A. Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Saskia Middeldorp
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel Levi
- National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, United Kingdom
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Maryam Mansour
- Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | - Antonio Arauz
- National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico-City, Mexico
| | - Miguel A. Barboza
- Neurosciences Department, Hospital Dr R.A. Calderón Guardia, CCSS, San José, Costa Rica
| | - Susanna M. Zuurbier
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisbon, Portugal
| | - Jose M. Ferro
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisbon, Portugal
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thalia S. Field
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
28
|
Krzywicka K, Heldner MR, Sánchez van Kammen M, van Haaps T, Hiltunen S, Silvis SM, Levi M, Kremer Hovinga JA, Jood K, Lindgren E, Tatlisumak T, Putaala J, Aguiar de Sousa D, Middeldorp S, Arnold M, Coutinho JM, Ferro JM. Post-SARS-CoV-2-vaccination cerebral venous sinus thrombosis: an analysis of cases notified to the European Medicines Agency. Eur J Neurol 2021; 28:3656-3662. [PMID: 34293217 PMCID: PMC8444640 DOI: 10.1111/ene.15029] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis (CVST) has been described after vaccination against SARS-CoV-2. The clinical characteristics of 213 post-vaccination CVST cases notified to the European Medicines Agency are reported. METHODS Data on adverse drug reactions after SARS-CoV-2 vaccination notified until 8 April 2021 under the Medical Dictionary for Regulatory Activities Term 'Central nervous system vascular disorders' were obtained from the EudraVigilance database. Post-vaccination CVST was compared with 100 European patients with CVST from before the COVID-19 pandemic derived from the International CVST Consortium. RESULTS In all, 213 CVST cases were identified: 187 after AstraZeneca/Oxford (ChAdOx1 nCov-19) vaccination and 26 after a messenger RNA (mRNA) vaccination (25 with Pfizer/BioNTech, BNT162b2, and one with Moderna, mRNA-1273). Thrombocytopenia was reported in 107/187 CVST cases (57%, 95% confidence interval [CI] 50%-64%) in the ChAdOx1 nCov-19 group, in none in the mRNA vaccine group (0%, 95% CI 0%-13%) and in 7/100 (7%, 95% CI 3%-14%) in the pre-COVID-19 group. In the ChAdOx1 nCov-19 group, 39 (21%) reported COVID-19 polymerase chain reaction tests were performed within 30 days of CVST symptom onset, and all were negative. Of the 117 patients with a reported outcome in the ChAdOx1 nCov-19 group, 44 (38%, 95% CI 29%-47%) had died, compared to 2/10 (20%, 95% CI 6%-51%) in the mRNA vaccine group and 3/100 (3%, 95% CI 1%-8%) in the pre-COVID-19 group. Mortality amongst patients with thrombocytopenia in the ChAdOx1 nCov-19 group was 49% (95% CI 39%-60%). CONCLUSIONS Cerebral venous sinus thrombosis occurring after ChAdOx1 nCov-19 vaccination has a clinical profile distinct from CVST unrelated to vaccination. Only CVST after ChAdOx1 nCov-19 vaccination was associated with thrombocytopenia.
Collapse
Affiliation(s)
- Katarzyna Krzywicka
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thijs van Haaps
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Suzanne M Silvis
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,National Institute for Health Research, University College London Hospitals (UCLH), Biomedical Research Centre, London, UK
| | - Johanna A Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisbon, Portugal
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - José M Ferro
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
29
|
Affiliation(s)
- Allan H Ropper
- From the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Joshua P Klein
- From the Department of Neurology, Brigham and Women's Hospital, Boston
| |
Collapse
|
30
|
Acute Symptomatic Seizures in Cerebral Venous Thrombosis. Neurology 2021; 96:639. [PMID: 33277421 DOI: 10.1212/wnl.0000000000011322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
31
|
Abstract
Thrombosis of the cerebral veins and sinuses (CVT) is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects children and young adults, especially women. In this review, we will summarize recent advances on the knowledge of patients with CVT.
Collapse
Affiliation(s)
- Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria - CHULN, University of Lisbon, Lisbon, Portugal.,Faculdade de Medicina, Universidade de, Lisboa, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal
| |
Collapse
|
32
|
Bentley P, Sharma P. Distinguishing early from late seizures after cerebral venous thrombosis: Cinderepilepsy. Neurology 2020; 95:513-514. [PMID: 32759204 DOI: 10.1212/wnl.0000000000010579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Paul Bentley
- From the Department of Brain Sciences (P.B.), Imperial College London, Charing Cross Hospital; Institute of Cardiovascular Research (P.S.), Royal Holloway University of London (ICR2UL); and Department of Clinical Neuroscience (P.S.), Imperial College Healthcare NHS Trust, London UK
| | - Pankaj Sharma
- From the Department of Brain Sciences (P.B.), Imperial College London, Charing Cross Hospital; Institute of Cardiovascular Research (P.S.), Royal Holloway University of London (ICR2UL); and Department of Clinical Neuroscience (P.S.), Imperial College Healthcare NHS Trust, London UK.
| |
Collapse
|
33
|
Sánchez van Kammen M, Lindgren E, Silvis SM, Hiltunen S, Heldner MR, Serrano F, Zelano J, Zuurbier SM, Mansour M, Aguiar de Sousa D, Canhão P, Al-Asady S, Ekizoglu E, Redfors P, Yesilot N, Ghiasian M, Barboza MA, Arnao V, Aridon P, Punter MN, Ferro JM, Arauz A, Tatlisumak T, Arnold M, Putaala J, Jood K, Coutinho JM. Late seizures in cerebral venous thrombosis. Neurology 2020; 95:e1716-e1723. [DOI: 10.1212/wnl.0000000000010576] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/25/2020] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo examine the incidence, characteristics, treatment, and predictors of late seizures (LS) after cerebral venous thrombosis (CVT), we described these features in a registry of 1,127 patients with CVT.MethodsWe included consecutive adult patients from an international consortium of 12 hospital-based CVT registries. We excluded patients with a history of epilepsy or with <8 days of follow-up. We defined LS as seizures occurring >7 days after diagnosis of CVT. We used multivariable Cox regression to identify predictors of LS.ResultsWe included 1,127 patients with CVT. During a median follow-up of 2.0 years (interquartile range [IQR] 1.0–6.3), 123 patients (11%) experienced ≥1 LS (incidence rate for first LS 30 per 1,000 person-years, 95% confidence interval [CI] 25–35). Median time to first LS was 5 months (IQR 1–16 months). Baseline predictors of LS included status epilepticus in the acute phase (hazard ratio [HR] 7.0, 95% CI 3.9–12.6), decompressive hemicraniectomy (HR 4.2, 95% CI 2.4–7.3), acute seizure(s) without status epilepticus (HR 4.1, 95% CI 2.5–6.5), subdural hematoma (HR 2.3, 95% CI 1.1–4.9), and intracerebral hemorrhage (HR 1.9, 95% CI 1.1–3.1). Eighty-five patients (70% of patients with LS) experienced a recurrent seizure during follow-up, despite the fact that 94% received antiepileptic drug treatment after the first LS.ConclusionDuring a median follow-up of 2 years, ≈1 in 10 patients with CVT had LS. Patients with baseline intracranial bleeding, patients with acute symptomatic seizures, and those who underwent decompressive hemicraniectomy were at increased risk of developing LS. The high recurrence risk of LS justifies epilepsy diagnosis after a first LS.
Collapse
|