Journal Article•
Early diagnosis and treatment of cerebral venous sinus thrombosis
TL;DR: The clinical manifestations of CVST are non-specific, therefore, in patients with suspicious CVST, both MRI and MRV should be done in time, and DSA in case of need, and anticoagulation and thrombolysis therapy should be given at once.
Abstract: Objective To explore the early diagnosis and treatment of cerebral venous sinus thrombosis(CVST).Methods A retrospective analysis was done in 12 patients with CVST hospitalized in 2005-2008,the items analyzed included the patients' age,clinical manifestations,laboratory data,images,therapy and prognosis.Results The onset of CVST was mostly acute or sub-acute,9 patients manifested as nonspecific headache in the early stage,in which,five were misdiagnosed.Increase of CSF pressure was found in all patients.MRI and MRV were performed on eight patients,and CVST was confirmed in six patients(75%).DSA was done in seven patients and all were confirmed as having CVST(100%).Anticoagulation therapy with heparin was given to seven patients with two recovered,four improved and one died.Interventional treatment was given to five patients with four recovered and one improved.Conclusion The clinical manifestations of CVST are non-specific,therefore,in patients with suspicious CVST,both MRI and MRV should be done in time,and DSA in case of need.When the diagnosis of CVST is confirmed,anticoagulation and thrombolysis therapy should be given at once.Interventional therapy might be the one of the most effective treatments for patients with CVST.
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01 Dec 2017
TL;DR: In Chinese Han patients, compared with patients without seizures, patients with seizures afterCVST had a worse outcome, and risk factors such as male gender, paresis, parenchymal lesion and superior sagittal sinus thrombosis were independently associated with seizure onset after CVST.
Abstract: Background and purpose Clinical features of epileptic seizures after cerebral venous sinus thrombosis (CVST) among Chinese patients are not known, and it is still controversial whether seizures would affect the outcome of CVST. Methods In a Chinese hospital-based study of consecutive patients with CVST between 2003 and 2015, we described the clinical features of seizures and determined the predictors of seizure onset using multivariable logistic regression analysis. We also compared the in-hospital case-fatality and short-term functional outcome (modified Rankin Scale (mRS) at discharge) in patients with versus without seizures using ordinal regression analysis. Results Among 151 patients with CVST, 52 (34.4%) presented seizures, of which 42 (80.8%) were generalised seizures. Male gender (OR 6.32, 95% CI 2.06 to 19.35, p=0.001), motor deficits (OR 4.89, 95% CI 1.52 to 15.68, p=0.008), intracerebral haemorrhage (OR 3.93, 95% CI 1.16 to 13.26, p=0.027), cerebral infarction (OR 3.78, 95% CI 1.15 to 12.36, p=0.029) and superior sagittal sinus thrombosis (OR 3.38, 95% CI 91.16 to 9.86, p=0.026) were independent predictors for seizures. The overall in-hospital case-fatality rate was 2.0% (3/151), and 21 (13.9%) had mRS >2 at discharge. Compared with patients without seizures, patients with seizures were more likely to have a worse outcome (p=0.02) at discharge, independent of age, gender, clinical presentation, clot burden and presence of parenchymal lesions. Conclusions In Chinese Han patients, compared with patients without seizures, patients with seizures after CVST had a worse outcome. Risk factors such as male gender, paresis, parenchymal lesion and superior sagittal sinus thrombosis were independently associated with seizure onset after CVST. Generalised seizure was the main form of seizures after CVST, which was obviously different to seizures after strokes of arterial origin.
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TL;DR: Reasons for absent overt hypercoagulability within this study population may be the small patient sample, long time since the event, and avoidance of acquired risk factors like oral contraception, particularly in patients with idiopathic CVST.
Abstract: Cerebral venous sinus thrombosis (CVST) is a relatively rare, but potentially lethal condition. In approximately 15% of the patients, the cause of CVST remains unclear. Conventional clotting tests such as prothrombin time and activated partial thromboplastin time are not sensitive enough to detect prothrombotic conditions nor mild haemostatic abnormalities. The calibrated automated thrombogram (CAT) is a physiological function test that might be able to detect minor aberrations in haemostasis. Therefore, we aimed to detect the presence of a prothrombotic state in patients who endured idiopathic CVST with the CAT assay. Five adult patients with an idiopathic, radiologically proven CVST that had been admitted during the past 3 years were included in this study. The control group consisted of five age/gender matched healthy volunteers. Exclusion criteria were known haematological disorders, malignancy (current/past) or hormonal and anticoagulant therapy recipients. We obtained venous blood samples from all participants following cessation of anticoagulation. Using the CAT assay, we determined lag time, normalized endogenous thrombin potential (ETP), ETP reduction and normalized peak height. In addition, prothrombin concentrations were determined. We found no significant differences in lag time (4.7 min [4.5–4.9] vs 5.3 min [3.7–5.7], p = 0.691), normalized ETP (142% [124–148] vs 124% [88–138], p = 0.222), ETP reduction (29% [26–35] vs 28% [24–58], p > 0.999), and normalized peak height (155% [153–175] vs 137 [94–154], p = 0.056) between patients and their age/gender matched controls. In addition, prothrombin concentrations did not significantly differ between patients and controls (120% [105–132] vs 127% [87–139], p > 0.999). Reasons for absent overt hypercoagulability within this study population may be the small patient sample, long time since the event (e.g. 3 years) and avoidance of acquired risk factors like oral contraception. Given the fact that CVST is a serious condition with a more than negligible risk of venous thrombosis event recurrence, exclusion of clinically relevant hypercoagulability remains a challenging topic to further study at the acute and later time points, particularly in patients with idiopathic CVST.