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Leitinger M, Broggi S, Spendel M, Kalss G, Petrović I, Krainz H, Rossini F, Höfler J, Toma A, Kuchukhidze G, Mauritz M, Poppert K, Crespo‐Pimentel B, Bosque‐Varela P, Pleyers A, Ganger P, Kotzot D, Lessel D, Griessenauer CJ, Trinka E. Multiple intracerebral hematomas during SEEG recording and intradural hemorrhage after spinal tap: A case report prompting more research on collagen IV gene mutation and oral nicotine consumption as risk factors. Epilepsia Open 2025; 10:329-335. [PMID: 39579033 PMCID: PMC11803267 DOI: 10.1002/epi4.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 10/31/2024] [Accepted: 11/04/2024] [Indexed: 11/25/2024] Open
Abstract
Intracerebral hemorrhages (ICH) during implantation of stereo-EEG electrodes are rare. The impact of tobacco-free nicotine consumption on periprocedural bleeding is uncertain. We present a 20+ year-old man with drug-resistant epilepsy who underwent stereo-EEG with 17 depth electrodes. Within a few days after insertion, the patient developed multiple ICHs in the electrode trajectories and an intradural hemorrhage after a diagnostic spinal tap. We performed the investigation of the clotting system and whole-exome sequencing (WES). WES identified a heterozygous mutation c.4698G>T, p.(Trp1566Cys) in COL4A2 (NM_001846.4) encoding a collagen type-IV alpha-2 chain inherited from his seemingly healthy mother. As COL4A2 mutations had been identified in four adult patients with ICH we postulated that the identified variant presents a potential risk factor. Notably, mutations encoding other collagens have been linked to cerebral hemorrhages (COL4A1) and increased propensity to trigger ICH upon smoking (COL1A2). Our patient consumed at least 24 oral nicotine pouches (containing 11 mg nicotine each) per day. We consider the patient's COL4A2 mutation in combination with his substantial nicotine consumption as likely predisposition to multiple ICHs precipitated by stereo-EEG. Patients with nicotine consumption and any collagen mutation may have a substantially higher risk for hemorrhagic complications in SEEG and other neurosurgical procedures. PLAIN LANGUAGE SUMMARY: A young man with drug-resistant epilepsy experienced multiple intracerebral hemorrhages after implantation of SEEG electrodes for presurgical evaluation and concomitantly a intradural hemorrhage after a lumbar spinal tap. A collagen IV mutation of unclear significance and heavy use of oral nicotine pouches were the only potential risk factors identified. As collagen mutations were previously described risk factors and smoking in particular worsens the bleeding risk in collagen mutations, further research is warranted to prevent hemorrhages in neurosurgical procedures. Nicotine consumption in any form is a preventable risk factor.
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Affiliation(s)
- Markus Leitinger
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Serena Broggi
- Neurology and Stroke UnitASST Sette Laghi HospitalVareseItaly
| | - Mathias Spendel
- Department of Neurosurgery, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Gudrun Kalss
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Ivan Petrović
- Faculty of MedicineUniversity of Novi SadNovi SadSerbia
| | - Herbert Krainz
- Department of Neurosurgery, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Fabio Rossini
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Julia Höfler
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Andreea Toma
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Giorgi Kuchukhidze
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Matthias Mauritz
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Kai‐Nicolas Poppert
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Bernardo Crespo‐Pimentel
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Pilar Bosque‐Varela
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Anna Pleyers
- Department of Human Genetics, Landeskrankenhaus University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Patricia Ganger
- Department of Human Genetics, Landeskrankenhaus University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Dieter Kotzot
- Department of Human Genetics, Landeskrankenhaus University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Davor Lessel
- Department of Human Genetics, Landeskrankenhaus University HospitalParacelsus Medical UniversitySalzburgAustria
- Institute of Human GeneticsUniversity of RegensburgRegensburgGermany
- Institute of Clinical Human GeneticsUniversity Hospital RegensburgRegensburgGermany
| | - Christoph J. Griessenauer
- Department of Neurosurgery, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
| | - Eugen Trinka
- Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, European Reference Network EpiCARE, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University HospitalParacelsus Medical UniversitySalzburgAustria
- Medical Informatics, and TechnologyInstitute of Public Health, Medical Decision Making and Health Technology Assessment, University for Health SciencesHall in TyrolAustria
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Saleem Z, Liaquat S, Syed M, Abbas Z, Amir A, Shahbaz NN. Prevalence of the Usage of Smokeless Tobacco in Patients Presenting With Stroke in a Tertiary Care Hospital. Cureus 2022; 14:e21060. [PMID: 35155023 PMCID: PMC8825677 DOI: 10.7759/cureus.21060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background Stroke is one of the leading causes of disability, long-term morbidity, and mortality. The key modifiable risk factors for stroke are largely driven by demographic changes and various social adaptations. Smokeless tobacco consumption is high in developing countries with less awareness of its potential health risks. Aim This study was designed to determine the prevalence of usage of smokeless tobacco in patients presenting with stroke in a tertiary care hospital in Karachi. Methods This is a cross-sectional study conducted at the Department of Neurology of Dr. Ruth K. M. Pfau Civil Hospital in Karachi. A total of 192 patients were enrolled during the study period of six months, from September 2018 to March 2019. All consenting patients were recruited who presented with stroke and fulfilled the inclusion criteria. All patients were assessed by a trained neurologist. Results A total of 192 patients with stroke were included. There were 146 (76%) males and 46 (24%) females with a mean age of 53 ± 6.1 years. The highest percentage (39%) of cases was illiterate. A majority (64%) of patients presented belonged to a lower socioeconomic background. Out of 192 stroke patients, 131 (68.2%) consumed smokeless tobacco. Conclusion The frequency of smokeless tobacco consumption was found to be high in stroke patients who require the attention of the physician on modifiable risk factors.
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Affiliation(s)
- Zainab Saleem
- Neurology, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Sumayyah Liaquat
- Neurology, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Mohsina Syed
- Neurology, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Zaira Abbas
- Stroke Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, GBR
| | - Amani Amir
- Internal Medicine, Hussain Lakhani Hospital, Karachi, PAK
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Baishya B, Satpathy A, Nayak R, Mohanty R. Oral hygiene status, oral hygiene practices and periodontal health of brick kiln workers of Odisha. J Indian Soc Periodontol 2019; 23:163-167. [PMID: 30983789 PMCID: PMC6434730 DOI: 10.4103/jisp.jisp_383_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim and Objective: The aim of this study was to assess the oral hygiene status, oral hygiene practices, and periodontal health among brick kiln workers of Odisha. Materials and Methods: Four hundred and eight subjects (300 males and 108 females) between the ages of 22 and 65 years with mean age of 33.44 ± 2.34 years working in various brick kilns in the district of Khordha, Odisha, participated in the survey. Data were collected through personal interview and clinical examinations. Results: Overall prevalence of periodontal diseases among brick kiln workers was 86.27%. There was a statistically significant difference in the distribution of Community periodontal index (CPI) (P < 0.001) and loss of attachment score scores (P < 0.001). Periodontal disease was significantly associated with age, oral hygiene status, practices, and tissues abuse habits. Most of the workers were males (59%), in the age group of 30–40 years (40.69%), having only a primary level of education (75.98%) and were married (80.88%). Majority of the workers brushed their teeth once daily (78.9%) with toothbrush (51.5%) and used toothpaste (41.2%). Most of them were found to be consuming paan or gutkha as compared to cigarette or beedi smoking. Among the subjects with a CPI >2, higher prevalence of periodontal disease was seen in subjects older than 50 years of age (86.7%), those brushing once daily only (75.2%), brushing with finger (82.8%), with higher frequency and duration of consumption of tobacco and alcohol, and having a poor oral hygiene (85.5%). Conclusion: The survey among brick kiln workers revealed that the oral hygiene status was poor, they had ill-informed oral hygiene practices and most of them were suffering from periodontal disease.
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Affiliation(s)
- Banashree Baishya
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Anurag Satpathy
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Rashmita Nayak
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Rinkee Mohanty
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
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