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Uluduz D, Midi I, Duman T, Yayla V, Karahan AY, Afsar N, Goksu EO, Mengulluoglu N, Aytac E, Sungur MA, Yesilot N, Ince B, Yalin OO, Oruc S, Senol MG, Yilmaz A, Gokce M, Demirci S, Kusbeci OY, Uzuner G, Caglayan HZB, Acikgoz M, Kurucu H, Ozdag F, Baybas S, Ekmekci H, Cabala M, Yaman M, Yürekli VA, Tekeli H, Genc H, Utku U, Sahin S, Tokuc FEU, Uzuner N, Bektas H, Kablan Y, Goksel BK, Milanlioglu A, Orken DN, Aluclu U, Colakoglu S, Tufekci A, Bakar M, Nazliel B, Tascilar N, Goksan B, Kozak HH, Demir S, Mısırli CH, Kucukoglu H, Cinar N, Domac FM, Ozturk S, Gunes T. Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study. Seizure 2020; 78:113-117. [PMID: 32353818 DOI: 10.1016/j.seizure.2020.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). METHOD VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. RESULTS The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. CONCLUSIONS In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.
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Affiliation(s)
- Derya Uluduz
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ipek Midi
- Department of Neurology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Taskin Duman
- Department of Neurology, Mustafa Kemal University, School of Medicine, Hatay, Turkey.
| | - Vildan Yayla
- Clinic of Neurology, Saglik Bilimleri University, Bakirkoy Sadi Konuk Research and Training, Hospital, Istanbul, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Usak University, School of Medicine, Usak, Turkey
| | - Nazire Afsar
- Department of Neurology, Acıbadem Mehmet Aydinlar University, Istanbul, Turkey
| | - Eylem Ozaydin Goksu
- Clinic of Neurology, Antalya Research and Training Hospital, Antalya, Turkey
| | | | - Emrah Aytac
- Department of Neurology, Firat University, School of Medicine, Elazig, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, Duzce University, School of Medicine, Duzce, Turkey
| | - Nilufer Yesilot
- Department of Neurology, Istanbul University, School of Medicine, Istanbul, Turkey
| | - Birsen Ince
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Osman Ozgur Yalin
- Clinic of Neurology, Saglik Bilimleri University, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Serdar Oruc
- Department of Neurology, Kocatepe University, School of Medicine, Afyon, Turkey
| | - Mehmet Guney Senol
- Clinic of Neurology, Sisli Hamidiye Research and Training Hospital, Istanbul, Turkey; Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
| | - Arda Yilmaz
- Department of Neurology, Mersin University, School of Medicine, Mersin, Turkey
| | - Mustafa Gokce
- Department of Neurology, Sütçü İmam University, School of Medicine, Kahramanmaraş, Turkey
| | - Seden Demirci
- Department of Neurology, Aspendos Anatolian Hospital, Antalya, Turkey; Department of Neurology, Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | | | - Gulnur Uzuner
- Department of Neurology, Osmangazi University, School of Medicine, Eskisehir, Turkey
| | | | - Mustafa Acikgoz
- Department of Neurology, Bülent Ecevit University, School of Medicine, Zonguldak, Turkey
| | - Hatice Kurucu
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fatih Ozdag
- Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
| | - Sevim Baybas
- Clinic of Neurology, Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey
| | - Hakan Ekmekci
- Department of Neurology, Selçuk University, School of Medicine, Konya, Turkey
| | - Murat Cabala
- Clinic of Neurology, Saglik Bilimleri University, Bakirkoy Sadi Konuk Research and Training, Hospital, Istanbul, Turkey
| | - Mehmet Yaman
- Department of Neurology, Kocatepe University, School of Medicine, Afyon, Turkey
| | - Vedat Ali Yürekli
- Department of Neurology, Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Hakan Tekeli
- Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey; Clinic of Neurology, Sancaktepe Research and Training Hospital, Istanbul, Turkey
| | - Hamit Genc
- Department of Neurology, Mersin University, School of Medicine, Mersin, Turkey
| | - Uygar Utku
- Department of Neurology, Sütçü İmam University, School of Medicine, Kahramanmaraş, Turkey
| | - Sevki Sahin
- Department of Neurology, Maltepe University, School of Medicine, Istanbul, Turkey
| | | | - Nevzat Uzuner
- Department of Neurology, Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Hesna Bektas
- Clinic of Neurology, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Yuksel Kablan
- Department of Neurology, Inonu University, School of Medicine, Malatya, Turkey
| | | | - Aysel Milanlioglu
- Department of Neurology, Yüzüncü Yıl University, School of Medicine, Van, Turkey
| | | | - Ufuk Aluclu
- Department of Neurology, Dicle University, School of Medicine, Diyarbakir, Turkey
| | - Sena Colakoglu
- Department of Neurology, Mustafa Kemal University, School of Medicine, Hatay, Turkey
| | - Ahmet Tufekci
- Department of Neurology, Recep Tayyip Erdoğan University, School of Medicine, Rize, Turkey
| | - Mustafa Bakar
- Department of Neurology, Uludağ University, School of Medicine, Bursa, Turkey
| | - Bijen Nazliel
- Department of Neurology, Gazi University, School of Medicine, Ankara, Turkey
| | - Nida Tascilar
- Department of Neurology, Bülent Ecevit University, School of Medicine, Zonguldak, Turkey; Department of Neurology, Medipol University, Istanbul, Turkey
| | - Baki Goksan
- Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Hasan Huseyin Kozak
- Department of Neurology, Necmettin Erbakan University, School of Medicine, Konya, Turkey
| | - Serkan Demir
- Clinic of Neurology, Saglik Bilimleri University, II. Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey; Clinic of Neurology, Sancaktepe Research and Training Hospital, Istanbul, Turkey
| | - Cemile Handan Mısırli
- Clinic of Neurology, Saglik Bilimleri University, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - Hayriye Kucukoglu
- Clinic of Neurology, Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey
| | - Nilgun Cinar
- Department of Neurology, Maltepe University, School of Medicine, Istanbul, Turkey
| | - Fusun Mayda Domac
- Clinic of Neurology, Erenkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Istanbul, Turkey
| | - Serefnur Ozturk
- Department of Neurology, Selçuk University, School of Medicine, Konya, Turkey
| | - Taskin Gunes
- Clinic of Neurology, Saglik Bilimleri University, Istanbul Research and Training Hospital, Istanbul, Turkey
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Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH). BACKGROUND HDH has been recognized for many years, but the pathophysiology of this condition is not known. High arterial blood pressure, decreased serum osmolality, sodium washout, and high blood urea nitrogen level are reported risk factors for HDH. Low serum magnesium (Mg) level is known to cause some types of headache, including migraine (menstrual migraine in particular), tension-type headaches, and cluster and posttraumatic headaches. Low Mg has also been reported in HDH patients. METHODS A total of 250 hemodialysis (HD) patients were questioned about problems with headache. Of these, 75 were diagnosed with HDH according to the revised International Headache Society criteria for 2003. Eighty age- and sex-matched HD patients without HDH were selected as a control group. For each HDH and control subject, arterial diastolic and systolic blood pressure, body weight, and serum levels of sodium, blood urea nitrogen, creatinine, and Mg were measured before and after one HD session. Urea reduction rate and ultrafiltration were determined. Serum levels of phosphorus, calcium, albumin, and parathormone were measured only before the session. Findings in the HDH and control group were statistically compared. RESULTS As noted, 75 (30%) of the total 250 HD patients surveyed were diagnosed with HDH. The mean headache duration in this group was 5.17 +/- 5 hours. Vertex location, bilateral headache, dull nature, and moderate severity were the most prevalent features of HDH. There were no statistically significant differences between the HDH and control groups with respect to causes of end-stage renal disease. There were no significant differences between the HDH and control groups with respect to predialysis values for blood urea nitrogen, body weight, and arterial blood pressure (P > .05), and the same was true for comparisons of the postdialysis values for these parameters. The mean predialysis sodium level in the HDH group was higher than in the control group (P= .003). Both the mean predialysis and mean postdialysis Mg levels in the HDH group were significantly lower than the corresponding levels in the control group (P= .05 and P= .02, respectively). CONCLUSIONS The results suggest that low blood Mg level and high blood sodium level may be risk factors for HDH. Magnesium supplementation may help patients with HDH whose serum Mg levels are found to be low.
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Affiliation(s)
- Basak Karakurum Goksel
- Department of Neurology, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey
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