Clinical features, risk factors, and outcome of cerebral venous thrombosis in Tehran, Iran.
01 Oct 2016-Journal of Neurosciences in Rural Practice (J Neurosci Rural Pract)-Vol. 7, Iss: 4, pp 554-558
TL;DR: Compared to most of the CVST studies in which OCP was the main factor, an underlying disease was the most identified cause and appropriate work up should be noted to uncover them.
Abstract: Introduction: Despite increasing the use of magnetic resonance imaging (MRI), cerebral venous sinus thrombosis (CVST) has remained an under-diagnosed condition. In this study, characteristics and frequency of various risk factors of CVST patients in a tertiary referral hospital were closely assessed. Methods: Patients with an unequivocal diagnosis of CVST confirmed by MRI and magnetic resonance venography during 6 years of the study were included. All data from the onset of symptoms regarding clinical signs and symptoms, hospital admission, seasonal distribution, medical and drug history, thrombophilic profile, D-dimer, neuroimaging, cerebrospinal fluid findings, mortality, and outcome were collected and closely analyzed. Result: A total of 53 patients with female to male ratio of 3.07 and mean age of 33.7 years were included in the study. Headache and papilledema were the most frequent clinical features (44 and 36 patients, respectively). An underlying disease (diagnosed previously or after admission) was the most common identified risk factor for CVST in both females and males (21 patients). A total of 15 women used the oral contraceptive pill (OCP) where 12 of them had simultaneously other predisposing factors. Overall, 19 patients (36%) had more than one contributing factor. D-dimer had a sensitivity of 71.4% in CVST patients. The mortality of patients in this study was 3.7% ( n = 2). Focal neurologic deficit and multicranial nerve palsy were associated with poor outcome which defined as death, recurrence, and massive intracranial hemorrhage due to anticoagulation ( P = 0.050 and 0.004, respectively). Conclusion: Unlike most of the CVST studies in which OCP was the main factor; in this study, an underlying disease was the most identified cause. Considering the high probability of multiple risk factors in CVST that was shown by this study, appropriate work up should be noted to uncover them.
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TL;DR: D-dimer testing should not be currently recommended for the diagnosis of thrombosis in unusual sites as a first line diagnostic tool, but the development of algorithms combining biomarkers such as D- dimer and clinical decision tools could improve the diagnosis.
17 citations
TL;DR: Puerperium appears to be the main etiological factor and headache as the most common system for CVST in study population in KashmirNorth India.
Abstract: 1 Department of Neurology, Sheri-Kashmir Institute of Medical Sciences-Srinagar 2 Department of Clinical Biochemistry, SheiKashmir Institute of Medical Sciences Srinagar-India * Corresponding Author Dr Sheikh Nawaz Ahmad Department of Neurology, SKIMS, SrinagarIndia Email: drnawaz855@gmail.com, Ph: +91-9906737223 Abstract Background: Cerebral venous sinus thrombosis (CVST) has a variable clinical presentation making early diagnosis difficult. A number of prothrombotic states have been implicated in causation of CVST, but results are mixed. Aims: The study was aimed to find out the clinical, etiological and prognostic factors of CVST in KashmirNorth India. Materials and Methods: The study was carried out in a tertiary care hospital where all patients of CVST admitted between 1st August 2014 and 31 st July, 2016 were included in the study. The enrolled patients were studied for their demographic profile and a 2-5ml blood sample was collected from the subjects as well. Patients were followed up for minimum period of 6 months and outcome was assessed on the basis of morbidity and mortality. Results: A total of 36 patients of CVST were included in the study. The mean age of the patients was 35.5years with highest representation (38.89%) among 31-40years age group. Headache was present in 94.4%. 30 patients (83.3%) were alive at the end of follow-up and 6 patients died (16.6%). Among various etiological factors purperium has a maximum representation (33.33%). Out of 32 female patients in the study group, 16 (44.44%) female patients had puerperium and 06 (16.66%) had oral contraceptive as a risk factor. Unconscious with purposive movements was observed in 27.78 % of the subjects. Out of 39 patients who survived, 31 cases (79.4%) had no disability symptoms, 5 patients had mild disability (13%) and 3 patients had moderate disability at six months of follow-up. Conclusion: Purperium appears to be the main etiological factor and headache as the most common system for CVST in study population.
2 citations
Cites background from "Clinical features, risk factors, an..."
...OCPs have long been attributed to development of CVST (4) ....
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...trauma, cancers and medications like oral contraceptives (OCPs) are some influencing conditions (3-6) ....
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01 Jan 2019
TL;DR: Cerebral venous sinus thrombosis is an uncommon diagnosis affecting as many as 15.7 patients per million people per year and there is a predisposing hypercoagulable state or less commonly an underlying cause such as trauma or infection.
Abstract: Cerebral venous sinus thrombosis (CVST) is an uncommon diagnosis affecting as many as 15.7 patients per million people per year. It affects females more common than males with a ratio of 3:1, and in the majority of cases, there is a predisposing hypercoagulable state or less commonly an underlying cause such as trauma or infection.
1 citations
TL;DR: Favorable outcome was found in most of the patients at hospital discharge, Nonetheless, complications can occur during the hospital course which might require surgical intervention.
Abstract: Introduction: Cerebral venous sinus thrombosis (CVST) is a potentially serious neurological condition. Yet, non-specific clinical and radiological features of cerebral venous sinus thrombosis, making it delay in the diagnosis and subsequent management. This study aims to find the hospital course and outcome of patients.
Methods: A descriptive cross-sectional study was done in patients with diagnosis of cerebral venous sinus thrombosis confirmed by computed tomography or by magnetic resonance imaging with magnetic resonance venography. Demography, clinical features, hospital course and outcome at hospital discharge were recorded and analysed.
Results: A total of nine patients included in the study. Mean age of patient was 33.22 ± 9.24 years with male to female ratio of 1:2. Headache was the most common presenting symptom found in eight patients. GCS at admission of all of the patients were 15 except for 2 patients. Surgical intervention was required in two patients. Good outcome with mRS score of 0 was found in eight patients at hospital discharge. No mortality was observed in this study.
Conclusions: Favorable outcome was found in most of the patients at hospital discharge. Nonetheless, complications can occur during the hospital course which might require surgical intervention.
TL;DR: Deep cerebral venous sinus thrombosis occurs in HIV patient with normal CD4 count, and a patient who developed CVT while on reverse transcriptase inhibitors for the last four years is reported.
Abstract: Deep cerebral venous sinus thrombosis occurs in HIV patient with normal CD4 count. We report a patient who developed CVT while on reverse transcriptase inhibitors for the last four years, with low protein S level.
References
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TL;DR: A subgroup of clinically identifiable CVT patients is at increased risk of bad outcome and may benefit from more aggressive therapeutic interventions, to be studied in randomized clinical trials.
Abstract: Background and Purpose— The natural history and long-term prognosis of cerebral vein and dural sinus thrombosis (CVT) have not been examined previously by adequately powered prospective studies. Methods— We performed a multinational (21 countries), multicenter (89 centers), prospective observational study. Patients were followed up at 6 months and yearly thereafter. Primary outcome was death or dependence as assessed by modified Rankin Scale (mRS) score >2 at the end of follow-up. Results— From May 1998 to May 2001, 624 adult patients with CVT were registered. At the end of follow-up (median 16 months), 356 patients (57.1%) had no symptom or signs (mRS=0), 137 (22%) had minor residual symptoms (mRS=1), and 47 (7.5%) had mild impairments (mRS=2). Eighteen (2.9%) were moderately impaired (mRS=3), 14 (2.2%) were severely handicapped (mRS=4 or 5), and 52 (8.3%) had died. Multivariate predictors of death or dependence were age >37 years (hazard ratio [HR]=2.0), male sex (HR=1.6), coma (HR=2.7), mental status disorder (HR=2.0), hemorrhage on admission CT scan (HR=1.9), thrombosis of the deep cerebral venous system (HR=2.9), central nervous system infection (HR=3.3), and cancer (HR=2.9). Fourteen patients (2.2%) had a recurrent sinus thrombosis, 27 (4.3%) had other thrombotic events, and 66 (10.6%) had seizures. Conclusions— The prognosis of CVT is better than reported previously. A subgroup (13%) of clinically identifiable CVT patients is at increased risk of bad outcome. These high-risk patients may benefit from more aggressive therapeutic interventions, to be studied in randomized clinical trials.
1,903 citations
TL;DR: In this paper, the authors described the clinical presentations of the disorder such as those that occur after a head injury or lumbar puncture, and suggested anticoagulation, thrombolysis, and measures to control intracranial hypertension.
Abstract: Thrombosis of the cerebral veins and sinuses affects mainly young adults and children This potentially disabling or fatal condition is usually not diagnosed until a week after the onset of symptoms This review article describes the clinical presentations of the disorder such as those that occur after a head injury or lumbar puncture Therapeutic options include anticoagulation, thrombolysis, and measures to control intracranial hypertension
1,217 citations
Journal Article•
TL;DR: Hemostatic disorders are the leading causes of cerebral venous thrombosis, in particular, constitutional thromBophilia often associated with one or several promoting factors such as use of oral contraception, which explains the incidence peak among young women.
Abstract: Cerebral venous thrombosis represents less than 1 % of all strokes, usually affecting young women, probably because of hormonal factors. The most common symptom is headache, with or without focal neurological findings such as deficits or seizures. Brain MRI is the gold standard for diagnosis. Anticoagulation should be initiated as soon as possible, followed by vitamin K antagonists, for at least 3 months. Predisposing causes and risk factors for cerebral venous thrombosis are multiple. Prognosis is good and recurrence rate is low.
397 citations
"Clinical features, risk factors, an..." refers background in this paper
...[1] Despite an increasing use of magnetic resonance imaging (MRI), CVST has remained an under‐diagnosed condition.[2,3] Although generally considered a disease with good outcome in developed countries, in under developed, and low‐income countries during the hospitalization mortality rate may be up to 14%[4,5] which could be due to delay in diagnosis....
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TL;DR: This study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients.
Abstract: Background and Purpose— Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men. Methods— We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenter prospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis. Results— Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l P=0.01), which was entirely due to a better outcome in female patients with gender-specifi...
319 citations
Additional excerpts
...This study showed that multiple risk factors could be present in CVST. Underlying disease was the most common predisposing factor in our patients and CVST was the first presentation in some of the diseases....
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...Therefore, the effect of OCP may be enforced in the presence of other factors in developing of CVST....
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...[15] These factors were not seen in this and other studies as underlying cause in CVST.[16] Although further studies with emphasize on the underlying condition between CVST and DVT/PTE patients should be performed....
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...[15] These factors were not seen in this and other studies as underlying cause in CVST.[16] Although further studies The presence of multiple risk factors at the same time in patients with CVST was less considered before....
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...The importance of multiple risk factors in CVST was further discovered regarding the observation of patients over the different month of the year where it showed higher number of patients in warm months of the year which could be due to the role of dehydration in developing of CVST. Sensitivity of D‑dimer was 71.4%, and false negative results were detected in 28.5% of patients....
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TL;DR: A hypercoagulable state and especially thromboses are emerging as clinical issues in HIV-infected patients and further studies are in order to more clearly delineate the pathophysiologic mechanism(s).
Abstract: Human immunodeficiency virus infection is an illness with protean manifestations including hematological abnormalities. Thromboembolic complications in HIV-infected patients have been described. Recent literature describes an incidence ranging from 0.26% to 7.6%; higher incidence is seen in patients with active opportunistic infections or malignancy, and in patients with the acquired immunodeficiency syndrome. A variety of potential mechanisms have been proposed to account for the observed hypercoagulability in HIV-infected patients. These include the presence of antiphospholipid-anticardiolipin antibodies, decreased activities of natural anticoagulants (especially protein S), and increased platelet activation. Recent epidemiological studies emphasize the increased incidence of thromboembolic events including myocardial infarction in the HIV-infected population after the introduction of highly active antiretroviral therapy. The use of protease inhibitors in particular is implicated. A hypercoagulable state and especially thromboses are emerging as clinical issues in HIV-infected patients. Further studies are in order to more clearly delineate the pathophysiologic mechanism(s) of thromboses in HIV-infected patients.
117 citations
"Clinical features, risk factors, an..." refers background in this paper
...The other reason might be the effect of infection in the induction of hypercoagulable state[19,20] which may explain CVST in the patient with hepatitis B and the patient with a history of bacterial meningitis 1 month before thrombosis....
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