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Akinshina S, Bitsadze V, Khizroeva J, Tretyakova M, Grigoreva K, Gashimova N, Vorobev A, Zubenko V, Makatsariya N, Valikhanova L, Kapanadze D, Zainulina M, Solopova A, Mashkova T, Yagubova F, Tsibizova V, Gris JC, Elalamy I, Gerotziafas G, Makatsariya A. Cerebral vein thrombosis: management tactics with a focus on pregnancy, the use of hormone therapy and assisted reproductive technologies. J Matern Fetal Neonatal Med 2025; 38:2447349. [PMID: 39757006 DOI: 10.1080/14767058.2024.2447349] [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: 10/20/2024] [Revised: 12/08/2024] [Accepted: 12/16/2024] [Indexed: 01/07/2025]
Abstract
Purpose: Cerebral vein thrombosis is a rare, life-threatening condition that has now become more commonly diagnosed due to advancements in imaging techniques. Our purpose is to improve understanding of pathogenesis, diagnosis and pregnancy and IVF management in patients with a history of cerebral thrombosis. Materials and methods: We present an overview of the modern tactics of anticoagulant therapy for cerebral thrombosis with a focus on pregnancy, the use of hormone therapy, and assisted reproductive technologies. Results: The most common risk factors for cerebral vein thrombosis are pregnancy, the postpartum period, and the use of oral contraceptives, which explains the high incidence of this pathology in women. The development of cerebral thrombosis is a vivid example of the interaction and synergetic effects of persistent factors that cause an increased risk of thrombotic complications, which include thrombophilia and acquired risk factors. Despite the possible risks, pregnancy after previously suffered cerebral thrombosis is not contraindicated provided adequate anticoagulant therapy. Conclusions: The most common provoking factors for the development of cerebral thrombosis in women are pregnancy and the use of estrogen-containing drugs. The issue of thromboprophylaxis during pregnancy, when using ART methods and the possibility of using hormonal therapy after cerebral vein thrombosis requires further study.
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Affiliation(s)
- Svetlana Akinshina
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Viktoria Bitsadze
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Jamilya Khizroeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Maria Tretyakova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Kristina Grigoreva
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nilufar Gashimova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexander Vorobev
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladislav Zubenko
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Stavropol Regional Clinical Perinatal Center, Stavropol, Russia
| | - Nataliya Makatsariya
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Lala Valikhanova
- Department of General Medicine, I.M.Sechenov First State Moscow Medical University Baku branch, Huseyn Javid, Baku, Yasamal, Azerbaijan
| | | | - Marina Zainulina
- Snegirev Maternity Hospital No 6, Saint Petersburg, Russia
- Department of Obstetrics, Gynecology and Reproductive Medicine, Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation, Saint Petersburg, Russia
| | - Alina Solopova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Academician Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Health Ministry of Russian Federation, Moscow, Russia
| | - Tamara Mashkova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Fidan Yagubova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Valentina Tsibizova
- The PREIS School (International and European School of Perinatal, Neonatal and Reproductive Medicine), Firenze, Italy
| | - Jean-Christophe Gris
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Pharmaceutical and Biological Sciences, Montpellier University, Montpellier, France
| | - Ismail Elalamy
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Obstetrics, Gynecology and Perinatal Medicine, Sorbonne University, Paris, France
- Hospital Tenon, Paris, France
| | - Grigoris Gerotziafas
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Sorbonne University, INSERM UMR_S_938, Saint-Antoine Research Center (CRSA), Team "Cancer Biology and Therapeutics", Group "Cancer - Angiogenesis - Thrombosis", University Institute of Cancerology (UIC), Paris, France
- Thrombosis Center, Tenon - Saint Antoine University Hospital, Hôpitaux Universitaires Est Parisien, Assitance Publique Hôpitaix de Paris (AP-HP), Paris, France
| | - Alexander Makatsariya
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Polavarapu A, Bhushan A, Duarte-Celada W, Windisch T, Bhushan B. Enoxaparin Failure in Patient With Cerebral Venous Sinus Thrombosis and Prothrombin G20210A Mutation: Case Report. Neurologist 2025; 30:175-181. [PMID: 39505562 PMCID: PMC12045334 DOI: 10.1097/nrl.0000000000000591] [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] [Indexed: 11/08/2024]
Abstract
INTRODUCTION Cerebral venous sinus thrombosis (CVST) is a rare, serious, and complex cerebrovascular disease. The prothrombin G20210A mutation is the second most common inherited thrombophilia and is considered to be one of the etiologies of CVST. The optimal heparinoid medication for treatment remains a topic of debate. CASE REPORT This case report describes a young woman with CVST who did not respond to low-molecular-weight heparin (LMWH). The patient was initially treated with LMWH; however, her symptoms and clot burden in the sagittal sinus worsened, and coagulation studies showed no evidence of therapeutic anticoagulation despite good compliance. Unfractionated heparin was then initiated, and the patient's symptoms improved dramatically within 24 hours, along with the recanalization of the cerebral venous sinuses. Genetic testing revealed a heterozygous mutation in the prothrombin gene (G20210A). This mutation is a known risk factor for CVST. However, it is unclear why the patient did not respond to LMWH but responded appropriately to unfractionated heparin. CONCLUSION This case report highlights the potential for LMWH resistance in patients with CVST and prothrombin gene mutations. These findings also emphasize the importance of close monitoring of coagulation parameters and clinical response in patients with CVST receiving LMWH.
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Affiliation(s)
| | | | - Walter Duarte-Celada
- Department of Neurology, University Medical Center, Texas Tech University Health Sciences Center
- Departments of Neurology, Covenant Medical Center
| | - Thomas Windisch
- Department of Interventional Radiology, Covenant Medical Center
| | - Bharat Bhushan
- Hospitalist Program, Department of Family and Community Medicine, University Medical Centre, Texas Tech University Health Sciences Center, Lubbock, TX
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Zhang X, Fu Y, Wang H, Zhu X, Yu Y, Jiang J, Cao P, Qian X, Shen C, Zhai X. Magnetic Resonance Screening for Cerebral Venous Sinus Thrombosis during Treatment with Pegaspargase. Semin Thromb Hemost 2025. [PMID: 40280165 DOI: 10.1055/a-2575-7359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2025]
Abstract
In children with leukemia, cerebral venous sinus thrombosis (CVST) has a significant incidence and mortality rate, which may interfere with the chemotherapy process and lead to long-term neurological complications. However, large studies and population-based data on CVST in children are scarce. This study aims to characterize pediatric CVST associated with pegaspargase (PEG-ASP) and evaluate the significance of magnetic resonance venography (MRV) screening following induction remission in acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). We present a retrospective cohort of a total of 27 children with CSVT and ALL/LBL. The study covers a 4-year period for MRV screening following induction remission and an 8-year comparison period, involving 716 children treated at the Department of Hematology, Children's Hospital of Fudan University. The detection rate of CVST significantly increased after MRV screening (8.4% vs. 1.6%, p < 0.01). Over half (58%) of the CVST cases were asymptomatic. Male (84% vs. 52%, p = 0.008), immune subtype of T (37% vs. 10%, p = 0.001) and higher initial platelet counts (196.25 ± 140.67 vs. 112.49 ± 115.62, p = 0.02) patients were more likely to develop CVST. The common symptoms were headache (56%), seizures (31%), vomiting (13%), lethargy (13%), coma (6%), hallucinations (6%), and schizophrenia (6%). Symptomatic patients had a higher likelihood of transverse sinus involvement (75% vs. 9%, p = 0.006). Asymptomatic patients had shorter treatment durations (25.5 ± 16.7 weeks vs. 51.6 ± 25.8 weeks, p = 0.02) and fewer long-term complications (50% vs. 0%, p = 0.02). Thromboelastographic amplitude values at 30 minutes after maximum amplitude were significantly higher in symptomatic patients (49.4 ± 13.2 vs. 35.1 ± 8.3, p = 0.01). This study highlights a significant incidence of PEG-ASP-related CVST in children, with MRV screening revealing a notably higher detection rate than previously reported. Most cases were asymptomatic, which demonstrated better prognoses, emphasizing the importance of MRV for early CVST diagnosis after induction remission in ALL/LBL.
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Affiliation(s)
- Xiao Zhang
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yang Fu
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Hongsheng Wang
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xiaohua Zhu
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yi Yu
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Junye Jiang
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Ping Cao
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xiaowen Qian
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Chen Shen
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xiaowen Zhai
- Department of Hematology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, People's Republic of China
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Simaan N, Molad J, Hallevi H, Metanis I, Mendel R, Barnea R, Auriel E, Naftali J, Eliahou R, Aladdin S, Orion D, Peretz S, Leker RR, Honig A. Predictors of acute symptomatic seizure in cerebral venous thrombosis patients-a multicenter cohort study. Ther Adv Neurol Disord 2025; 18:17562864251330864. [PMID: 40291759 PMCID: PMC12033526 DOI: 10.1177/17562864251330864] [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: 11/18/2024] [Accepted: 03/11/2025] [Indexed: 04/30/2025] Open
Abstract
Background Acute symptomatic seizures (ASYS) is a common presentation in cerebral sinus venous thrombosis (CSVT) patients. Objectives We aimed to characterize CSVT patients experiencing ASYS within 7 days from presentation. Additionaly, we aimed to find predictors for ASYS within CSVT patients. Methods Prospective CSVT databases from six academic centers (January 2010-December 2023) were retrospectively analyzed. Clinical outcomes at the 90-day follow-up included seizure occurrence and the modified-Rankin-Scale (mRS). Results From 529 included patients (mean age 42.4 ± 18.6 years, 64.3% females), 106 (20%) had ASYS. ASYS patients were more often males (47.2% vs 20.1%, <0.001), and presented more often with focal neurological deficits (50% vs 22%, p < 0.001) but less often with papilledema (13.2% vs 29.3%, p < 0.001). On multivariate analysis cortical-vein thrombosis (odds ratio (OR) 4.17, p < 0.001), intracerebral hemorrhage (ICH; OR 3.06, p = 0.002), any superior-sagittal-sinus (SSS) thrombosis (OR 2.49, p = 0.006), predicted ASYS. Conversely, presentation with papilledema (OR 0.39, p = 0.03) negatively predicted ASYS. ASYS patients had lower rates of 90-day-mRS-0-1 (51.9% vs 83.9%, p < 0.001). Patients who experienced seizures between the second and seventh day (n = 58) had similar baseline characteristics to those with seizures only on the day of presentation (n = 48) but were less likely to achieve a good functional outcome by day 90 (42.6% vs 58.9%, p < 0.05) and had a lower rate of complete recanalization on follow-up venous imaging (25.5% vs 57.5%, p = 0.02). Status-epilepticus in comparison to non-ASYS patients achieved lower rates of 90-day-mRS-0-1 (11% vs 84%, p < 0.001) and higher 90-day-mortality (44% vs 5.6%, p < 0.001). In a multivariate analysis ASYS was a negative predictor for 90-day-mRS-0-1 (OR 3.3, 95% confidence interval 1.43-7.5, p = 0.005). Conclusion CSVT patients experiencing ASYS, and to a greater degree patients with either status epilepticus or ASYS between second and seventh day achieved less often 90-day-mRS-0-1. Possibly, they epitomize a different course of disease that may require a more suitable treatment strategy.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed, Israel
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jeremy Molad
- Department of Neurology and Stroke, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hen Hallevi
- Department of Neurology and Stroke, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Issa Metanis
- Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rom Mendel
- Department of Neurology, Assuta Medical Center, Ashdod, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| | - Eitan Auriel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| | - Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| | - Ruth Eliahou
- Department of Radiology, Rabin Medical Center, Petah Tikva, Israel
| | - Shorooq Aladdin
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - David Orion
- Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Shlomi Peretz
- Department of Neurology, Shamir Medical Center, Zerifin, Israel
| | - Ronen R. Leker
- Department of Neurology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Asaf Honig
- Department of Neurology, Soroka Medical Center, Ben Gurion Avenue, Be’er Sheva 84101, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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5
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Bian HT, Wang X, Liu GY, Zhou C, Meng R, Liu L, Duan JG, Yan F, Li CH, Li M, Hui W, Zhang XX, Zhao D, Li YP, Fang Q, Kang DZ, Zeng HL, Liang ZJ, Shi ZH, Yue W, Sun QJ, Chen GS, Song JL, Yan ZR, Ji QH, Wang KJ, Tong LS, Hu X, Cao WF, Yan W, Gao RJ, Li Q, Wang JY, Liu Y, Wang BJ, Wang XH, Yao ST, Lang Y, Li HP, Anderson CS, Ji XM. Endovascular treatment for cerebral venous thrombosis: a multicenter study in China. Mil Med Res 2025; 12:16. [PMID: 40200369 PMCID: PMC11978133 DOI: 10.1186/s40779-025-00605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 03/19/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Endovascular treatment (EVT) is gaining popularity for the management of severe forms of cerebral venous thrombosis (CVT), but the evidence supporting its efficacy and safety is limited. METHODS This multicenter study included patients with CVT admitted to 104 hospitals in 31 provinces/cities in China between January 2018 and June 2022. Propensity score weighting models were used to adjust baseline confounding variables to determine the association of EVT on the primary outcome of good functional status, defined as score 0 - 1 on the modified Rankin Scale after hospital discharge. RESULTS Of 3063 patients identified through hospital records searches, 2774 adults [age (42 ± 15.8) years, female 50.3%] fulfilled eligibility criteria and agreed to be included, of whom 449 (16.2%) received EVT and 2325 (83.8%) received standard care. There was no significant difference between the EVT group and the standard care group in terms of the possibility of good functional recovery [weighted risk ratio = 1.00, 95% confidence interval (CI) 0.96 - 1.03]. Similarly, there was no difference in the likelihood of death at hospital discharge (weighted risk ratio = 1.91, 95% CI 0.91 - 3.68). In subgroup analysis, the possibility of good functional recovery was lower in patients with intracerebral hemorrhage (weighted risk ratio = 0.88, 95% CI 0.79 - 0.98; P for interaction = 0.01) and seizures (weighted risk ratio = 0.86, 95% CI 0.76 - 0.95; P for interaction = 0.03). CONCLUSION In this large nationwide study, EVT was not associated with improved functional outcomes compared to standard care in patients with CVT.
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Affiliation(s)
- He-Tao Bian
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, 2000, Australia
| | - Gui-You Liu
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Lan Liu
- School of Statistics, University of Minnesota at Twin Cities, Minneapolis, MN, 55455, USA
| | - Jian-Gang Duan
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Chuan-Hui Li
- Department of Neurology and Stroke Center, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Min Li
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Wen Hui
- Department of Science and Technology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xu-Xiang Zhang
- Department of Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Dong Zhao
- Department of Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100013, China
| | - Ya-Peng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450002, China
| | - Qi Fang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - De-Zhi Kang
- Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Hong-Liang Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Zhi-Jian Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Xining, 530021, China
| | - Zheng-Hao Shi
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Qin-Jian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Gui-Sheng Chen
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, 750001, China
| | - Jian-Long Song
- Department of Neurology, the First Affiliated Hospital of USTC, Hefei, 230001, China
| | - Zhong-Rui Yan
- Department of Neurology, Jining First People's Hospital, Jining, 272113, Shandong, China
| | - Qiu-Hong Ji
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Kai-Jie Wang
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063099, Hebei, China
| | - Lu-Sha Tong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiao Hu
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Wen-Feng Cao
- Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, 330006, China
| | - Wei Yan
- Department of Neurology, the First People's Hospital of Kashi, Kashi, 84000, Xinjiang, China
| | - Rui-Jiang Gao
- Department of Neurology, Inner Mongolia People's Hospital, Hohhot, 010010, China
| | - Qi Li
- Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Jian-Yi Wang
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yi Liu
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Bao-Jun Wang
- Department of Neurology, Baotou Central Hospital Inner Mongolia, Baotou, 014040, Inner Mongolia Autonomous Region, China
| | - Xiao-Hua Wang
- Department of Neurology, Qujing No. 1 Hospital, Qujing, 655000, Yunnan, China
| | - Sheng-Tao Yao
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563099, Guizhou, China
| | - Ye Lang
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, 257100, Shandong, China
| | - Hai-Peng Li
- Department of Neurology, the First People's Hospital of Chenzhou, Chenzhou, 424300, Hunan, China
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, 2000, Australia
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Xun-Ming Ji
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China.
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6
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Morais MB, Aguiar de Sousa D. Pathophysiology and Management of Cerebral Venous Thrombosis. Hamostaseologie 2025. [PMID: 40199511 DOI: 10.1055/a-2518-9103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2025] Open
Abstract
Cerebral venous thrombosis (CVT) is a less common type of stroke that can occur across all age groups but predominantly affects children and young adults. Diagnosis is often challenging due to the nonspecific and variable clinical presentation. The disease course is heterogeneous, with CVT-related parenchymal lesions developing in approximately 50 to 60% of cases. Despite some advancements, significant gaps persist in understanding the pathophysiology of CVT, including the mechanisms underlying brain injury. Anticoagulation is the cornerstone of CVT treatment, but strategies targeting secondary mechanisms of parenchymal damage are still lacking. Here, the current state of the field is briefly reviewed, with the aim to introduce a wide audience (neuroscientists and clinicians alike) to the disease and inform clinical practice and future research.
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Affiliation(s)
- Mariana B Morais
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Lopes Lab Unit, Gulbenkian Institute for Molecular Medicine, Lisbon, Portugal
| | - Diana Aguiar de Sousa
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Lopes Lab Unit, Gulbenkian Institute for Molecular Medicine, Lisbon, Portugal
- Neurosciences Department, Stroke Center, Centro Hospitalar Universitário Lisboa Central - ULS São José, Lisbon, Portugal
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7
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Lupu CI, Vlad RM. Sagittal sinus thrombosis - rare complication of nephrotic syndrome in a young child. Arch Clin Cases 2025; 12:54-58. [PMID: 40135192 PMCID: PMC11934352 DOI: 10.22551/2025.46.1201.10313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025] Open
Abstract
The nephrotic syndrome (NS) is caused by increased glomerular permeability. We report a case of NS in a 3-year-old girl, complicated with central nervous system venous thrombosis. Physical examination revealed anasarca (edema, pleurisy, and ascites), intensely foaming urine. The lab tests showed severe, non-selective proteinuria, marked hypoproteinemia, dyslipidemia; also associated with abnormal thyroid panel due to urinary binding protein loss. Once the diagnosis was established and pathogen-specific treatment was started, the clinical and paraclinical evolution were favorable. A prolonged right body seizure was the onset symptom of cerebral venous infarction due to sagittal sinus thrombosis. Short- and long-term outcomes of the thrombosis can be severe, so anticoagulant therapy was promptly initiated.
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Affiliation(s)
- Catalin Ionut Lupu
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Children's Hospital, Bucharest, Romania
| | - Raluca Maria Vlad
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Children's Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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8
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Hejdenberg O, Hånell A, Lewén A, Enblad P, Svedung Wettervik T. Individualized, Autoregulatory-guided Intracranial Pressure and Cerebral Perfusion Pressure Targets in Severe Cerebral Venous Thrombosis: Preliminary Findings. J Neurosurg Anesthesiol 2025:00008506-990000000-00153. [PMID: 40128641 DOI: 10.1097/ana.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 02/27/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND Severe cerebral venous thrombosis (CVT) patients often require neurointensive care with multimodal monitoring. However, optimal treatment targets for intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral autoregulation remain unclear. This study investigated the relationships between ICP, CPP, and autoregulation indices (PRx, optimal CPP [CPPopt]) with clinical outcomes in severe CVT. METHODS This observational study included 15 patients with severe CVT with ICP-monitoring, treated in the neurointensive care (NIC) unit, Uppsala. The percentage of eligible monitoring time (EMT) outside certain thresholds was calculated for ICP, PRx, CPP, and ΔCPPopt (CPP-CPPopt) and analysed in relation to outcome (Glasgow Outcome at Discharge Scale [GODS]). Outcome heatmaps were generated to visualize transitions from better to worse outcomes for single variables and 2 variables (ICP, CPP, or ΔCPPopt in combination with PRx). RESULTS Median %EMT for ICP>20 mm Hg and CPP<60 mm Hg was <5%. Higher %EMT for ICP>20 mm Hg (r=-0.60, P=0.02) correlated with worse outcome (lower GODS). The median %EMT of impaired cerebral pressure autoregulation was 34%. Outcome heatmaps indicated transitions toward worse outcome when PRx exceeded zero and ΔCPPopt became negative, but these correlations were not significant. Higher PRx reduced the safe ICP and CPP range, in 2-variable heatmaps. CONCLUSIONS A higher %EMT of ICP>20 mm Hg was unfavorable in severe CVT. Impaired cerebral autoregulation with high PRx was frequent and may reduce the safe ICP/CPP range. Larger, multi-centre studies are needed to validate these findings in this rare condition.
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Affiliation(s)
- Olle Hejdenberg
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Sweden
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Kashani M, Brown M, Domecq Graces JP. Acute Intracerebral Hemorrhage Associated with Extensive Venous Thrombosis Due to Spontaneous Heparin-Induced Thrombocytopenia After Total Knee Replacement: A Case Report. Hematol Rep 2025; 17:12. [PMID: 40126221 PMCID: PMC11932193 DOI: 10.3390/hematolrep17020012] [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: 01/07/2025] [Revised: 02/24/2025] [Accepted: 03/03/2025] [Indexed: 03/25/2025] Open
Abstract
INTRODUCTION Heparin-induced thrombocytopenia (HIT) is an autoimmune life-threatening prothrombotic syndrome associated with low platelet count after heparin exposure. Spontaneous heparin-induced thrombocytopenia (S-HIT) is an even less frequent variant of HIT, with only a handful of reports available in the literature, where unexplained thrombocytopenia and/or thrombosis without recent heparin exposure occurs in the setting of positive anti-PF4 antibodies. CASE PRESENTATION We report a case of S-HIT associated with pulmonary artery embolism, left internal jugular vein, and cerebral vein sinus thrombosis complicated with ipsilateral acute intracerebral hemorrhage. DISCUSSION It is important to highlight that in patients with otherwise unexplained thrombocytopenia and prior exposure to an inflammatory process, S-HIT should be on the differential. CONCLUSIONS Recognition and avoidance of heparin exposure is the most important aspect of S-HIT, as the management is otherwise similar to HIT.
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Affiliation(s)
- Mehdi Kashani
- Department of Nephrology, Hypertension, and Critical Care Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA (J.P.D.G.)
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10
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Zhang M, Jiang F, Wen Q, Chen Y, Zhang Z, Zhang M, Zhong J. Sliding balloon-assisted thrombectomy combined with aspiration and intrasinus urokinase thrombolysis for the treatment of hemorrhagic cerebral venous sinus thrombosis: experience of 10 patients. Front Neurol 2025; 16:1519308. [PMID: 40125396 PMCID: PMC11925791 DOI: 10.3389/fneur.2025.1519308] [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: 10/29/2024] [Accepted: 02/25/2025] [Indexed: 03/25/2025] Open
Abstract
Background Cerebral venous sinus thrombosis (CVST) is an unusual cause of stroke. Currently, standard anticoagulant therapy does not have satisfactory efficacy for treating some cases of hemorrhagic CVST. Therefore, we explored the efficacy and safety of the combination of sliding balloon-assisted thrombectomy with aspiration and intrasinus urokinase thrombolysis for the treatment of CVST patients with intracranial hemorrhage (ICH). Methods We retrospectively analyzed the clinical, imaging and follow-up data of 10 CVST patients with ICH who underwent sliding balloon-assisted thrombectomy combined with aspiration and intrasinus thrombolysis with urokinase from February 2022 to June 2023. Complete recanalization and partial recanalization in the cerebral venous sinus were defined as imaging outcomes, and the modified Rankin score (mRS) at the 3-month and 6-month follow-ups was used to evaluate clinical efficacy. Results A total of 10 CVST patients aged 18-68 years were enrolled, including 5 males. All of the patients was diagnosed with ICH by noncontrast CT and with thrombosis at 3 or more venous sinuses by digital subtraction angiography (DSA). After treatment, complete recanalization was achieved in 6 patients, and partial recanalization was achieved in 4 patients. At the 3- and 6-month follow-up, all 10 patients showed neurological independence (mRS score ≤ 2), without any signs of symptom aggravation, cerebral hematoma enlargement, pulmonary embolism or other complications after treatment. Conclusion These results indicated that the combination of sliding balloon-assisted thrombectomy, aspiration and intrasinus urokinase thrombolysis may be safe and effective for the treatment of CVST patients with intracranial hemorrhage.
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Affiliation(s)
- Mingsi Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Feixin Jiang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Qingyan Wen
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Yiman Chen
- Department of Neurology, Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
| | - Zhiquan Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Min Zhang
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
| | - Jianxin Zhong
- Department of Neurology, Jiangmen Central Hospital, Jiangmen, China
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11
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Franco-Moreno A, Madroñal-Cerezo E, Martínez-Casa-Muñoz A, Ortiz-Sánchez J, Ancos-Aracil CL. Direct Oral Anticoagulants for the Treatment of Unusual-Site Venous Thrombosis: An Update. Pharmaceutics 2025; 17:342. [PMID: 40143006 PMCID: PMC11944374 DOI: 10.3390/pharmaceutics17030342] [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: 02/09/2025] [Revised: 02/28/2025] [Accepted: 03/04/2025] [Indexed: 03/28/2025] Open
Abstract
Direct oral anticoagulants (DOACs) have emerged as the preferred oral anticoagulant therapy for patients with deep vein thrombosis of the lower extremities and pulmonary embolism. DOACs offer several advantages over vitamin K antagonists, including fixed dosage, fewer drug interactions, faster onset of action, and a lower risk of major bleeding, especially intracranial. Although evidence on the use of DOACs in unusual-site venous thrombosis (USVT) is limited, their use in such cases is becoming increasingly common. This narrative review examines the evidence derived from randomized controlled trials, and large observational studies focused on the use of the DOACs in USVT, including cerebral, splanchnic, upper extremity, ovarian, renal, and retinal vein thrombosis. In addition, it also provides practical advice for their use in these clinical settings according to the updated scientific literature.
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Affiliation(s)
- Anabel Franco-Moreno
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital Universitario Infanta Leonor, Avenida Gran Via del Este, 80, 28031 Madrid, Spain
| | - Elena Madroñal-Cerezo
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, Fuenlabrada, 28942 Madrid, Spain
| | | | - Judith Ortiz-Sánchez
- Venous Thromboembolism Unit, Hospital Universitario de Torrejón, Calle Mateo Inurria, Torrejón de Ardoz, 28850 Madrid, Spain
| | - Cristina Lucía Ancos-Aracil
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, Fuenlabrada, 28942 Madrid, Spain
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12
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Liu K, Zhang M, Zhao J, Dai Q, Gao Y, Li S, Zhao L, Xu Y, Song B. Anticoagulant Therapy for Cerebral Venous Sinus Thrombosis: A Propensity Score Matching Study and Inverse Probability Weighting. Neurocrit Care 2025:10.1007/s12028-025-02225-0. [PMID: 40038179 DOI: 10.1007/s12028-025-02225-0] [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: 10/17/2024] [Accepted: 01/30/2025] [Indexed: 03/06/2025]
Abstract
BACKGROUND New oral anticoagulants (NOACs) offer potential advantages for patients with cerebral venous sinus thrombosis (CVST). There is a lack of evidence to evaluate the efficacy and safety of NOACs in CVST. The purpose of this study was to compare the benefit and safety between NOACs and warfarin in patients with CVST. METHODS We performed a single-center prospective analysis including patients with CVST from the First Affiliated Hospital of Zhengzhou University between January 1, 2018, and December 31, 2021. The primary outcome was recurrent thrombotic events during the 6-month follow-up. Secondary outcomes included the modified Rankin scale (mRS) score, bleeding events, death, and cerebral venous recanalization during anticoagulant therapy. Propensity score matching (PSM) and inverse probability weighting (IPTW) were utilized to balance covariates between groups and mitigate selection bias in our study. RESULTS A total of 650 patients were identified. NOACs were used in 184 patients, and warfarin was used in 466 patients. Baseline characteristics were balanced between groups after IPTW or PSM. After 1:2 and 1:3 PSM, there were statistically significant differences between the two groups in death (2.2% vs. 8.0%, P = 0.014) and in mRS scores ≤ 2 (95. 1% vs. 88.7%, P = 0.020) in all patients. But there were no statistically significant differences between the two groups in recurrent CVST (odds ratio [OR] 0.543; 95% confidence interval [CI] 0.258-1.143; P = 0. 108), bleeding events (OR 0.823; 95% CI 0.074-9.143; P = 0.874), and partial/complete recanalization (OR 0.980; 95% CI 0.546-1.760; P = 0.946) in all patients. Similarly, there were no significant differences in patients who received anticoagulation therapy and in patients who received endovascular therapy plus anticoagulation therapy regarding any of the clinical outcomes. These results remained similar after IPTW analysis. CONCLUSIONS Our study demonstrates that the use of NOACs in CVST has similar efficacy and safety compared to warfarin treatment. NOACs treatment may improve the clinical prognosis in patients with CVST.
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Affiliation(s)
- Kai Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Nursing School of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Mengmeng Zhang
- Nursing School of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jiawei Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qinqin Dai
- Nursing School of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuan Gao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Nursing School of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shen Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lu Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuming Xu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
| | - Bo Song
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
- Nursing School of Zhengzhou University, Zhengzhou, Henan Province, China.
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Hu S, Gu Y, Zhao T, Zhang K, Li J, Zhou C, Song H, Liu Z, Ji X, Duan J. Steroids combined with anticoagulant in acute/subacute severe cerebral venous thrombosis. Chin Med J (Engl) 2025:00029330-990000000-01460. [PMID: 40033789 DOI: 10.1097/cm9.0000000000003502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND Inflammation plays a critical role in severe cerebral venous thrombosis (CVT) pathogenesis, but the benefits of anti-inflammatory therapies remain unclear. This study aimed to investigate the association between steroid therapy combined with anticoagulation and the prognosis of acute/subacute severe CVT patients. METHODS A prospective cohort study enrolled patients with acute/subacute severe CVT at Xuanwu Hospital (July 2020-January 2024). Patients were allocated into steroid and non-steroid groups based on the treatment they received. Functional outcomes (modified Rankin scale [mRS]) were evaluated at admission, discharge, and 6 months after discharge. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), cerebrospinal fluid (CSF) IL-6, and intracranial pressure were measured at admission and discharge in the steroid group. Fundoscopic Frisén grades were assessed at admission and 6 months after discharge. Univariate and multivariate logistic regression were used to analyses were used to evaluated associations between steroid use and favorable outcomes (mRS ≤2) at the 6-month follow-up. Paired tests assessed changes in hs-CRP and other variables before and after treatment, and Spearman's correlations were used to analyzed relationships between these changes and functional improvements. RESULTS A total of 107 and 58 patients in the steroid and non-steroid groups, respectively, were included in the analysis. Compared with the non-steroid group, the steroid group had a higher likelihood of achieving an mRS score of 0-2 (93.5% vs. 82.5%, OR = 2.98, P = 0.037) at the 6-month follow-up. After adjusting for confounding factors, the result remained consistent. Pulsed steroid therapy did not increase mortality during hospitalization or follow-up, nor did it lead to severe steroid-related complications (all P >0.05). Patients in the steroid group showed a significant reduction in serum hs-CRP, IL-6, CSF IL-6, and intracranial pressure at discharge compared to at admission, as well as a significant reduction in the fundoscopic Frisén grade at the 6-month follow-up compare to at admission (all P <0.001). A reduction in serum inflammatory marker levels during hospitalization positively correlated with improvements in functional outcomes (P <0.05). CONCLUSION Short-term steroid use may be an effective and safe adjuvant therapy for acute/subacute severe CVT when used alongside standard anticoagulant treatments, which are likely due to suppression of the inflammatory response. However, these findings require further validation in randomized controlled trials. TRAIL REGISTRATION ClinicalTrials.gov, NCT05990894.
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Affiliation(s)
- Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yaqin Gu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Tingyu Zhao
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Kaiyuan Zhang
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jingkai Li
- Department of Radiology & Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chen Zhou
- Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xunming Ji
- Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Intracranial Hypertension & Cerebral Venous Disease Center, National Health Commission of China, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Li L, Yao Y, Guan S, Ji J, Lu Y, Shen L, Feng Y, Yu L. The factors related to epileptic seizures in cerebral venous sinus thrombosis in southern China: A retrospective, multicenter, self-controlled study. Seizure 2025; 126:64-70. [PMID: 39938200 DOI: 10.1016/j.seizure.2025.02.005] [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] [Received: 11/20/2024] [Revised: 01/18/2025] [Accepted: 02/05/2025] [Indexed: 02/14/2025] Open
Abstract
OBJECTIVE To investigate the risk factors for and prevention of seizures in cerebral venous sinus thrombosis patients. METHODS This retrospective study included 216 patients with cerebral venous sinus thrombosis (CVST) from 3 hospitals in southern China from January 2010 to October 2020. Patients were divided into 2 groups comprising patients with and without early seizures (within 14 days of the diagnosis of CVST). The early seizure group was divided into 2 subgroups: those with late seizures (after 14 days of CVST diagnosis) and those without seizures. The non-early seizure group was also divided into 2 subgroups. The different groups were analyzed and compared in terms of demographics, laboratory indices, imaging data and the use of antiseizure medications (ASMs). RESULTS A total of 216 patients with CVST were included in the study, including 33 patients in the early seizure group and 183 patients in the non-early seizure group. In this study, 9 (27.3 %) patients in the early seizure group and only 8 patients in the non-early seizure group experienced late seizures, and the difference in the incidence of late seizures between the two groups reached statistical significance (p < 0.05, 9/33 vs. 8/183). Univariable analysis revealed statistically significant differences in d-dimer levels (P = 0.030), parenchymal lesions (P = 0.008), intracranial hemorrhage (P < 0.001), superior sagittal sinus involvement (P = 0.003), and cortical venous involvement (P = 0.003) between the early seizure group and the non-early seizure group. Logistic regression analysis revealed that intracranial hemorrhage (P = 0.005, OR=6.303, 95 % CI 1.732-22.941) may be one of the risk factors for early seizures. There was no univariate difference between the late seizure subgroup in the early seizure group and the late seizure subgroup in the non-early seizure group, except for the involvement of three venous sinuses. CONCLUSIONS Patients with CVST who have early seizures are more likely to have late seizures than those who do not have early seizures. Intracranial hemorrhage may be one of the risk factors for early seizures. The risk factors for late seizures need to be identified in future clinical studies. There is insufficient evidence that the use of ASM prevents early seizures from progressing to late seizures.
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Affiliation(s)
- Lixia Li
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yankun Yao
- Department of Neurology, the seventh Affiliated Hospital of Guangxi Medical University, Wuzhou, China
| | - Shiping Guan
- Department of Neurology of the First People's Hospital of Yulin, Yulin, China
| | - Jingjing Ji
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanting Lu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lang Shen
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yongfeng Feng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Yu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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15
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van de Munckhof A, van Kammen MS, Tatlisumak T, Krzywicka K, Aaron S, Antochi F, Arauz A, Barboza MA, Conforto AB, Contreras DG, Heldner MR, Hernández-Pérez M, Hiltunen S, Ji X, Kam W, Kleinig TJ, Kristoffersen ES, Leker RR, Lemmens R, Poli S, Wasay M, Wu T, Yeşilot N, Chen J, Cotelli MS, Demeestere J, Duan J, Ergin N, Freitas TE, Gomes A, den Hertog HM, Lindgren E, Martinez-Majander N, Metanis I, Miraclin A, Rani LJ, Reddy YM, Saleem S, Scutelnic A, Shanmugasundaram S, van den Wijngaard IR, Gençdal IY, van Eekelen R, Vellema J, Arnold M, Neto L, Middeldorp S, de Sousa DA, Jood K, Putaala J, Ferro JM, Coutinho JM. Direct oral anticoagulants versus vitamin K antagonists for cerebral venous thrombosis (DOAC-CVT): an international, prospective, observational cohort study. Lancet Neurol 2025; 24:199-207. [PMID: 39986309 DOI: 10.1016/s1474-4422(24)00519-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 02/24/2025]
Abstract
BACKGROUND There is an unmet need for high-quality data from prospective studies on the safety and effectiveness of direct oral anticoagulants (DOACs) for the treatment of cerebral venous thrombosis (CVT). We aimed to compare the safety and effectiveness of DOACs versus vitamin K antagonists (VKAs) for the treatment of CVT in a setting that reflects daily clinical practice. METHODS DOAC-CVT was an international, prospective, observational cohort study done in 65 hospitals in 23 countries across five continents. Eligible patients were adults (aged ≥18 years) with radiologically confirmed CVT starting oral anticoagulant treatment with either DOACs or VKAs, as per local practice, within 30 days after diagnosis. Exclusion criteria were previous use of anticoagulants at the time of CVT diagnosis or an absolute contraindication to DOACs (eg, pregnancy and lactation, or severe renal or liver disease). Data were collected during routine clinical visits or telephone consultations at CVT diagnosis (baseline) and at 3 months, 6 months, and 12 months after CVT diagnosis. The primary endpoint was a composite of symptomatic venous thromboembolism and major bleeding events (International Society on Thrombosis and Haemostasis criteria) at 6 months. Main outcomes were adjusted for the confounders age, renal function, active cancer, CNS infections, concomitant antiplatelet use, country of inclusion's income status, Glasgow Coma Scale score, intracranial haemorrhage, antiphospholipid antibodies, previous major bleeding, and previous venous thromboembolism using inverse probability-of-treatment weighting. This study is registered at ClinicalTrials.gov (NCT04660747) and is ongoing. FINDINGS Between Jan 27, 2021, and Jan 15, 2024, 619 patients were included; 401 (65%) patients started DOAC treatment, and 218 (35%) patients started VKA treatment. 390 (63%) of 619 patients were female and 229 (37%) of 619 patients were male. Patients' median age was 41 years (IQR 28-51). 6-month follow-up data were available for 617 (>99%) of 619 patients. 12 (3%) of 401 patients in the DOAC group and seven (3%) of 218 patients in the VKA group had a primary outcome event (weighted odds ratio [OR] 0·99 [95% CI 0·37-3·38]). Three (1%) of 401 patients in the DOAC group died versus three (1%) of 218 patients in the VKA group (weighted OR 0·55 [95% CI 0·11-2·80]). INTERPRETATION The rate of recurrent thrombosis and major bleeding did not differ between patients with CVT treated with DOACs versus VKAs. This study adds to the increasing evidence that DOACs are a reasonable treatment option for CVT alongside VKAs. FUNDING Netherlands Thrombosis Foundation.
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Affiliation(s)
- Anita van de Munckhof
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - 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
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sanjith Aaron
- Department of Neurology, Christian Medical College Hospital, Vellore, India
| | - Florina Antochi
- Department of Neurology, Spitalul Universitar de Urgenţă Bucureşti, Bucharest, Romania
| | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico
| | - Miguel A Barboza
- Neurosciences Department, Hospital Dr Rafael A Calderón Guardia, San José, Costa Rica
| | - Adriana B Conforto
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wayneho Kam
- Duke University Hospital, Durham, NC, USA; UNC Health Rex Comprehensive Stroke Center, Raleigh, NC, USA
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Robin Lemmens
- Department of Neurosciences, Research Group Experimental Neurology, KU Leuven, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Sven Poli
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Teddy Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Nilüfer Yeşilot
- Department of Neurology, Istanbul Tip Fakültesi, Istanbul, Türkiye
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Jelle Demeestere
- Department of Neurosciences, Research Group Experimental Neurology, KU Leuven, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Jiangang Duan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Nesrin Ergin
- Department of Neurology, Medical Faculty, Pamukkale University, Kınıklı, Denizli, Türkiye
| | | | - Ana Gomes
- Stroke Unit, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | | | - 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
| | | | - Issa Metanis
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Angel Miraclin
- Department of Neurology, Christian Medical College Hospital, Vellore, India
| | - Lucia Jansi Rani
- Department of Neurology, Christian Medical College Hospital, Vellore, India
| | - Y Muralidhar Reddy
- CARE Institute of Neurological Sciences, CARE Hospital, Banjara Hills, Hyderabad, India
| | - Shafaq Saleem
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | | | - Işıl Yazıcı Gençdal
- Department of Neurology, University of Health Sciences, Bakırköy Prof Dr Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Rik van Eekelen
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Jelle Vellema
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Lia Neto
- Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Diana Aguiar de Sousa
- Department of Neurosciences, Stroke Center, Centro Hospitalar Universitário de Lisboa Central-ULS São José, CEEM and Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Gulbenkian Institute of Molecular Medicine, Lisbon, Portugal
| | - 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 and University of Helsinki, Helsinki, Finland
| | - José M Ferro
- Hospital da Luz, University of Lisbon, Lisbon, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
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16
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Yang KC, Xu Y, Lin Q, Tang LL, Zhong JW, An HN, Zeng YQ, Jia K, Jin Y, Yu G, Gao F, Zhao L, Tong LS. Explainable deep learning algorithm for identifying cerebral venous sinus thrombosis-related hemorrhage (CVST-ICH) from spontaneous intracerebral hemorrhage using computed tomography. EClinicalMedicine 2025; 81:103128. [PMID: 40093990 PMCID: PMC11909457 DOI: 10.1016/j.eclinm.2025.103128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 02/07/2025] [Accepted: 02/10/2025] [Indexed: 03/19/2025] Open
Abstract
Background Misdiagnosis of hemorrhage secondary to cerebral venous sinus thrombosis (CVST-ICH) as arterial-origin spontaneous intracerebral hemorrhage (sICH) can lead to inappropriate treatment and the potential for severe adverse outcomes. The current practice for identifying CVST-ICH involves venography, which, despite being increasingly utilized in many centers, is not typically used as the initial imaging modality for ICH patients. The study aimed to develop an explainable deep learning model to quickly identify ICH caused by CVST based on non-contrast computed tomography (NCCT). Methods The study population included patients diagnosed with CVST-ICH and other spontaneous ICH from January 2016 to March 2023 at the Second Affiliated Hospital of Zhejiang University, Taizhou First People's Hospital, Taizhou Hospital, Quzhou Second People's Hospital, and Longyan First People's Hospital. A transfer learning-based 3D U-Net with segmentation and classification was proposed and developed only on admission plain CT. Model performance was assessed using the area under the curve (AUC), sensitivity, and specificity metrics. For further evaluation, the average diagnostic performance of nine doctors on plain CT was compared with model assistance. Interpretability methods, including Grad-CAM++, SHAP, IG, and occlusion, were employed to understand the model's attention. Findings An internal dataset was constructed using propensity score matching based on age, initially including 102 CVST-ICH patients (median age: 44 [29, 61] years) and 683 sICH patients (median age: 65 [52, 73] years). After matching, 102 CVST-ICH patients and 306 sICH patients (median age: 50 [40, 62] years) were selected. An external dataset consisted of 38 CVST-ICH and 119 sICH patients from four other hospitals. Validation showed AUC 0·94, sensitivity 0·96, and specificity 0·8 for the internal testing subset; AUC 0·85, sensitivity 0·87, and specificity 0·82 for the external dataset, respectively. The discrimination performance of nine doctors interpreting CT images significantly improved with the assistance of the proposed model (accuracy 0·79 vs 0·71, sensitivity 0·88 vs 0·81, specificity 0·75 vs 0·68, p < 0·05). Interpretability methods highlighted the attention of model to the features of hemorrhage edge appearance. Interpretation The present model demonstrated high-performing and robust results on discrimination between CVST-ICH and spontaneous ICH, and aided doctors' diagnosis in clinical practice as well. Prospective validation with larger-sample size is required. Funding The work was funded by the National Key R&D Program of China (2023YFE0118900), National Natural Science Foundation of China (No.81971155 and No.81471168), the Science and Technology Department of Zhejiang Province (LGJ22H180004), Medical and Health Science and Technology Project of Zhejiang Province (No.2022KY174), the 'Pioneer' R&D Program of Zhejiang (No. 2024C03006 and No. 2023C03026) and the MOE Frontier Science Center for Brain Science & Brain-Machine Integration, Zhejiang University.
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Affiliation(s)
- Kai-Cheng Yang
- Neurology Department, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yunzhi Xu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Qing Lin
- Neurology Department, The First People's Hospital of Taizhou City, Taizhou, Zhejiang Province, China
| | - Li-Li Tang
- Neurology Department, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jia-wei Zhong
- Neurology Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang Province, China
| | - Hong-Na An
- Neurology Department, The Second People's Hospital of Quzhou, Quzhou, Zhejiang Province, China
| | - Yan-Qin Zeng
- Neurology Department, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian Province, China
| | - Ke Jia
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, Hangzhou, Zhejiang Province, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yujia Jin
- Neurology Department, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China
| | - Guoshen Yu
- Neurology Department, Haiyan People's Hospital, Jiaxing, Zhejiang Province, China
| | - Feng Gao
- Neurology Department, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China
| | - Li Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lu-Sha Tong
- Neurology Department, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China
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17
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Zichichi A, Webb A, Johnson R, Gilmore E, Singhal AB, Owusu K. Practice-pattern variation in anticoagulation intensity in acute cerebral venous thrombosis: A two-center experience. J Clin Neurosci 2025; 133:111012. [PMID: 39740644 DOI: 10.1016/j.jocn.2024.111012] [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] [Received: 11/01/2024] [Revised: 12/09/2024] [Accepted: 12/23/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND AND PURPOSE Cerebral venous thrombosis (CVT) requires acute anticoagulation. Heparin is commonly used but specific recommendations on intensity and timing are lacking. We sought to characterize practice-pattern variation in the use of unfractionated heparin (UFH) for acute CVT treatment across multiple centers. METHODS This was a two-center retrospective study performed at Yale New Haven Hospital and Massachusetts General Hospital. Adult patients with CVT between 2013 and 2021 initially managed with parenteral anticoagulation and without endovascular therapy were included. The co-primary objectives were variation in UFH dosing and time to therapeutic anticoagulation by dosing intensity. Dosing intensity was defined as high intensity (≥12 units/kg/hr) or low intensity (<12 units/kg/hr), with or without initial boluses. RESULTS Seventy-two patients were included; 62 patients (86 %) received initial anticoagulation with UFH. The median initial UFH rate was 12 (IQR 11-14) units/kg/hr and 17 (27 %) patients received initial boluses (77 units/kg, IQR 40-80). Time to therapeutic anticoagulation was 11 (IQR 6-21) hours with high intensity UFH with a bolus (n = 13) and was 27 h (IQR 20-29) with low intensity UFH with a bolus (n = 4), while time to therapeutic anticoagulation was 30 (IQR 13-35) and 30 (IQR 23-39) hours with high (n = 21) and low intensity (n = 18) UFH without a bolus, respectively. Initial boluses reduced time to therapeutic anticoagulation overall (20 vs 30 h, p = 0.003). CONCLUSIONS Practice-pattern variation in UFH dosing leads to delays in time to therapeutic anticoagulation for CVT. Bolus dosing and high intensity UFH likely reduces the time to therapeutic anticoagulation.
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Affiliation(s)
- Albert Zichichi
- Yale New Haven Hospital, Department of Pharmacy, New Haven, CT, United States.
| | - Andrew Webb
- Massachusetts General Hospital, Department of Pharmacy, Boston, MA, United States.
| | - Riley Johnson
- Massachusetts General Hospital, Department of Pharmacy, Boston, MA, United States.
| | - Emily Gilmore
- Yale University, Department of Neurology, New Haven, CT, United States.
| | - Aneesh B Singhal
- Massachusetts General Hospital, Department of Neurology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Kent Owusu
- Yale New Haven Hospital, Department of Pharmacy, New Haven, CT, United States; Sturdy Health, Population Health, Plainville, MA, United States.
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18
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Li M, Song B, Wu Y, Zhang Y, Cao X, Zhang H, Xu Y, Wu C, Li C, Zhou C, Liu L, Yan F, Li S, Chen J, Meng R, Duan J, Wu D, Zuo L, Xu Z, Li Z, Zheng Y, Jiang M, Ji X. Dumbbell-shaped thrombectomy device for cerebral venous sinus thrombus removal with controllable axial and longitudinal maneuverability. Natl Sci Rev 2025; 12:nwaf015. [PMID: 39958147 PMCID: PMC11827591 DOI: 10.1093/nsr/nwaf015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 11/17/2024] [Accepted: 01/12/2025] [Indexed: 02/18/2025] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is frequently observed in younger adults and features in large thrombus volume. Due to the triangular-like cross-sectional shape and large diameter of the superior sagittal sinus, all the commercially available artery stent retrievers are not suitable for venous vessels. In this study, a dumbbell-like stent was designed and fabricated by 3D braided technology using NiTi wires; it was manually rotatable and stretchable with controlled length/diameter ratios (2.6-14.0) and reciprocating maneuverability. Computational modeling and an in vitro study were conducted to evaluate the mechanical properties of this device and its ability to trap and remove thrombi from occluded venous vessels was verified by using a swine model. A single-center retrospective clinical study of 10 patients using the Venus-TD to treat patients with CVST was also conducted. Pre/postoperative thrombus volume in 10 patients was quantitatively analysed (12 855.3 ± 6417.1 vs. 2373.1 ± 2759.0 mm³, P < 0.001) with a high recanalization rate, yielding favorable clinical outcomes. This study offers a novel treatment option for patients with extensive CVST.
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Affiliation(s)
- Ming Li
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Baoying Song
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yan Wu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yang Zhang
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Xiaofeng Cao
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Hongkang Zhang
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Yi Xu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chuanjie Wu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chuanhui Li
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Lu Liu
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Feng Yan
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Sijie Li
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jian Chen
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ran Meng
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiangang Duan
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Di Wu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lin Zuo
- School of Bioengineering, Beihang University, Beijing 100191, China
| | - Zikai Xu
- School of Life Science, University of Glasgow, Glasgow G12 8QQ, Scotland
| | - Zhou Li
- CAS Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-Nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 100083, China
- Tsinghua Changgung Hospital, School of Clinical Medicine, School of Biomedical Engineering, Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Miaowen Jiang
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Xunming Ji
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
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19
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Brakel BA, Rebchuk AD, Ospel J, Chen Y, Heran MKS, Goyal M, Hill MD, Miao Z, Huo X, Sacco S, Yaghi S, Mai TD, Thomalla G, Boulouis G, Yamagami H, Hu W, Nagel S, Puetz V, Kristoffersen ES, Demeestere J, Qiu Z, Abdalkader M, Al Kasab S, Siegler JE, Strbian D, Fischer U, Coutinho J, Munckhof A, Aguiar de Sousa D, Campbell BCV, Raymond J, Ji X, Saposnik G, Nguyen TN, Field TS. International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis. Int J Stroke 2025; 20:319-327. [PMID: 39569543 PMCID: PMC11874609 DOI: 10.1177/17474930241304206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 11/13/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known. AIMS Here, we present a comprehensive, international characterization of practice patterns and perspectives on the use of EVT for CVT. METHODS A comprehensive 42-question survey was distributed to stroke clinicians globally from May to October 2023, asking about practice patterns and perspectives on the use of EVT for CVT. RESULTS The overall response rate was 31% (863 respondents of 2744 invited) across 61 countries. The majority of respondents (74%) supported the use of EVT for CVT in certain clinical situations. Key considerations for decision-making in using EVT favored clinical over radiographic/procedural factors and included worsening level of consciousness (86%) and worsening neurological deficits (76%). In the past 3 years, 56% of respondents used EVT for the treatment of CVT, with most (49.5%) involved in two to five cases. Among interventionalists, significant variability existed in the techniques used for EVT (p < 0.001), with aspiration thrombectomy (56%) and stent retriever (51%) being the most used overall. Regionally, interventionalists from China predominantly used intra-sinus heparin (56%), while this technique was most commonly ranked as "never indicated" throughout the rest of the world (23%). Post-procedure, low molecular weight heparin was the most used anticoagulant (83%), although North American respondents favored unfractionated heparin (37%), while imaging was primarily split between magnetic resonance (71.8%) and computed tomography (65.9%) arteriography or venography. CONCLUSION Our survey reveals significant heterogeneity in approaches to EVT for CVT, and provides a comprehensive characterization of indications, techniques, and long-term management used by clinicians internationally. This resource will aid in optimizing patient selection and endovascular treatments for future trials.
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Affiliation(s)
- Benjamin A Brakel
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexander D Rebchuk
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Johanna Ospel
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Yimin Chen
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Manraj KS Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Mayank Goyal
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Zhongrong Miao
- Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Neurological Disease Center, Beijing Anzhen Hospital, Beijing, China
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI, USA
| | - Ton Duy Mai
- Stroke Centre, Bach Mai Hospital, Ha Noi Medical University, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Grégoire Boulouis
- Departments of Diagnostic and Interventional Neuroradiology, University of Tours, Tours, France
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Wei Hu
- Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Volker Puetz
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
- Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | | | - Jelle Demeestere
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People’s Liberation Army, Hangzhou, China
| | - Mohamad Abdalkader
- Department of Neurology, Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - James E Siegler
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Jonathan Coutinho
- Department of Neurology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Anita Munckhof
- Department of Neurology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- Stroke center, Lisbon Central University Hospital—ULS S José, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- L Lopes lab, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Bruce CV Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Université de Montréal, Montreal, QC, Canada
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Gustavo Saposnik
- Stroke Outcomes Research & Decision Neuroscience Unit, Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Thalia S Field
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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20
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Pandit MV, Frishman WH. Cerebral Venous Sinus Thrombosis During Pregnancy and the Postpartum Period: A Review of Pathophysiological Mechanisms, Clinical Manifestations, and Treatment Approaches. Cardiol Rev 2025:00045415-990000000-00419. [PMID: 39928512 DOI: 10.1097/crd.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2025]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare neurological emergency associated with significant morbidity and mortality. CVST has been found to account for up to 57% of pregnancy-related strokes. Pregnancy and the postpartum period are associated with physiological changes that lead to a hypercoagulable state, increasing the risk for CVST. The pathophysiological mechanism for CVST involves increased venule and capillary pressure as well as intracranial pressure, which lead to clinical manifestations such as headaches, seizures, and focal neurological deficits. Diagnosis involves imaging including computed tomography, magnetic resonance imaging, venography, and in some cases, cerebral angiography. Treatment options during pregnancy and postpartum include anticoagulation with low molecular weight heparin and symptomatic management. Further research is needed to elucidate the safety and efficacy of endovascular treatment techniques in severe or refractory cases of CVST, particularly during pregnancy and puerperium. In this review, we describe the physiological changes of pregnancy, outline the pathophysiological mechanisms and clinical findings of CVST, and discuss treatment approaches specific to pregnancy and the postpartum period.
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Affiliation(s)
- Maya V Pandit
- From the Department of Neurology, NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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21
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van de Munckhof A, Verhoeven JI, Vaartjes ICH, van Es N, de Leeuw FE, Coutinho JM. Incidence of Newly Diagnosed Cancer After Cerebral Venous Thrombosis. JAMA Netw Open 2025; 8:e2458801. [PMID: 39928336 PMCID: PMC11811797 DOI: 10.1001/jamanetworkopen.2024.58801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 12/04/2024] [Indexed: 02/11/2025] Open
Abstract
Importance Active cancer is a risk factor for cerebral venous thrombosis (CVT), but whether CVT is associated with occult cancer is unknown. Objective To evaluate the incidence of newly diagnosed cancer after CVT. Design, Setting, and Participants This population-based cohort study used data from the Dutch Hospital Discharge Registry from January 1, 1997, to July 1, 2020. Analyses were conducted between June 2023 and April 2024. Patients admitted with a first-ever CVT were included. Patients with a history of cancer or diagnosed with cancer during hospitalization for CVT were excluded. Exposure CVT was identified using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Main Outcomes and Measures The main outcome was cumulative incidence of cancer after CVT. Standardized incidence ratios (SIRs) were calculated relative to a matched cohort from the general population using the Netherlands Cancer Registry. Results A total of 2649 patients with CVT (median [IQR] age, 44.5 [30.7-56.4] years; 1856 [70.1%] female) were included. Cancer was diagnosed in 119 patients during a median (IQR) follow-up of 4.7 (1.9-8.9) years, of whom 29 (24.4%) had hematologic cancer. The cumulative incidence of cancer was 5.9% (95% CI, 4.8%-7.2%) after 10 years and was highest in men aged 50 years or older (13.5%; 95% CI, 9.1%-18.7%). Patients with CVT had an increased rate of cancer compared with the reference cohort during the entire follow-up, but the difference narrowed over time (SIRs of 3.35 [95% CI, 2.41-4.55] and 1.40 [95% CI, 1.14-1.69] at 1 and 10 years, respectively). The rate was increased both in patients younger than 50 years (SIRs of 6.70 [95% CI, 3.97-10.59] and 1.72 [95% CI, 1.24-2.34] at 1 and 10 years, respectively) and those 50 years or older (SIRs of 2.41 [95% CI, 1.53-3.62] and 1.25 [95% CI, 0.96-1.60] at 1 and 10 years, respectively), as well as in male patients (SIRs of 3.59 [95% CI, 2.16-5.61] and 1.69 [95% CI, 1.25-2.23] at 1 and 10 years, respectively) and female patients (SIRs, 3.17 [95% CI, 1.99-4.80] and 1.22 [95% CI, 0.92-1.58] at 1 and 10 years, respectively). Conclusions and Relevance This cohort study of patients with CVT found an increased risk of cancer during follow-up regardless of age or sex. Men 50 years or older had the highest absolute risk, whereas younger patients had the highest relative risk. Physicians should be vigilant for signs of cancer after CVT, and further research on screening for cancer after CVT is warranted.
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Affiliation(s)
- Anita van de Munckhof
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jamie I. Verhoeven
- Department of Neurology, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Ilonca C. H. Vaartjes
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension, and Thrombosis, Amsterdam, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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22
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Liao Q, Zhao Y, Li X, Li X, Huang X, Su L. Cerebral venous thrombosis as a rare complication of Sjögren's syndrome: case series and literature review. Clin Rheumatol 2025; 44:739-746. [PMID: 39743644 DOI: 10.1007/s10067-024-07283-x] [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] [Received: 06/11/2024] [Revised: 11/12/2024] [Accepted: 12/12/2024] [Indexed: 01/04/2025]
Abstract
OBJECTIVE As few cerebral venous thrombosis (CVT) patients with primary Sjögren's syndrome (pSS) have been reported, little is known about the characteristics of this rare complication. This study is aimed at describing the clinical features, treatment, and outcome of CVT combined with pSS. MATERIALS AND METHODS We reported five patients of CVT and pSS admitted to our hospital and searched the relevant case reports in PubMed for literature review. RESULTS We reviewed a total of twelve patients with pSS and CVT. Among them, five patients were from our report in the present paper, and seven other patients were from the case reports searched in PubMed. In total twelve patients, eleven patients were female. The twelve patients had an average age of 43.7 ± 8.3 years (age range, 26-57 years). The symptoms of pSS included multiple caries (50%), dry mouth (41.7%), dry eyes (33.3%), arthritis symptoms (16.7%), and parotid gland swelling (8.3%). Headache was the most common neurological symptom in all patients. Four patients (33.3%) had no clinical symptoms associated with pSS. Anti-SSA antibodies were positive in all patients. Antiphospholipid antibodies (aPLs) were positive in 33.3% of patients. Unilateral transverse sinus (75.0%) was the most commonly involved venous sinus. All patients received anticoagulant therapy. Hydroxychloroquine was also administered to the patients. Seven patients were treated with glucocorticoids. All patients recovered completely with no clinical or radiological recurrence. CONCLUSION pSS combined with CVT is a rare condition. Middle-aged women with pSS should be alert to the presence of CVT. It is of great importance to screen for autoimmune diseases during the clinical course of CVT, especially in patients with unilateral transverse sinus thrombosis. Effective treatment strategies require further study. Key Points • Patients combined with CVT are very rare. • Screening for autoimmune diseases in CVT patients is great important. • Patients may have good prognosis when effective treatment is administrated.
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Affiliation(s)
- Qiuju Liao
- Department of Rheumatology & Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Zhao
- Department of Rheumatology & Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Xia Li
- Department of Rheumatology & Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuemei Li
- Department of Rheumatology & Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Huang
- Department of Rheumatology & Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Su
- Department of Rheumatology & Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
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23
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Maghbooli M, Kermani M, Sany SNT, Arfaei M. Determining the Diagnostic Value of Venous Sinus Density Indices in Non-Contrast Brain CT Scan for Early Diagnosis of Cerebral Venous Sinus Thrombosis. Brain Behav 2025; 15:e70324. [PMID: 39935195 PMCID: PMC11813980 DOI: 10.1002/brb3.70324] [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: 04/08/2024] [Revised: 12/14/2024] [Accepted: 12/19/2024] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND AND AIM A non-contrast brain CT Non-contrast computed tomography (NCCT) scan is a valuable and cost-effective way to detect cerebral venous sinus thrombosis (CVST) during its acute phase. The goal of this study was to evaluate how effective this diagnostic approach is, including its various density indices, to enable a more precise and timely diagnosis of this debilitating condition. METHOD This retrospective case-control study was conducted on 88 patients with suspected acute CVST. We analyzed NCCT scans of patients with suspected CVST using a Bayesian regression model with a 95% confidence level. We also conducted ROC analysis in R4.1.0 to determine the optimal cut-off point. RESULT We discovered a significant variance in the average sinus attenuation when comparing patients with acute CVST (p < 0.001). By utilizing an optimal cutoff of 61 HU (Hounsfield unit), we achieved sensitivities of 77.1% and specificities of 92.5% for average sinus attenuation. In addition, the optimal cutoff for standardized parameters included the ratios of HU/H (Hematocrit), HU/ICA (internal carotid artery), HU/BA (basilar artery), HU/FRONTAL lobe, HU/TEMPORAL lobe, and HU-BA, which were 1.41, 1.52, 1.63, 1.6, 1.6, and 23, respectively (p < 0.001). Area under the ROC curve for absolute venous Hounsfield was 0.88. CONCLUSION NCCT is a reliable diagnostic approach for acute cerebral venous sinus thrombosis in emergency scenarios. Standardized parameters of absolute Hounsfield unit venous sinus thrombosis increase diagnosis accuracy. It is suggested to use these parameters as a complement to each other for more accurate diagnosis.
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Affiliation(s)
- Mehdi Maghbooli
- Department of Neurology, Faculty of MedicineZanjan University of Medical SciencesZanjanIran
| | - Mohammad Kermani
- Department of Neurology, Faculty of MedicineZanjan University of Medical SciencesZanjanIran
| | - Seyed Nariman Tavakoli Sany
- Student Research Committee, Department of Neurology, Faculty of MedicineZanjan University of Medical SciencesZanjanIran
| | - Melina Arfaei
- Department of Neurology, Faculty of MedicineZanjan University of Medical SciencesZanjanIran
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24
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Al Kasab S, Almallouhi E, Shu L, Kicielinski KP, Salehi Omran S, Liebeskind DS, Zubair AS, Vedovati MC, Paciaroni M, Antonenko K, Heldner MR, de Havenon A, Henninger N, Yaghi S. Outcomes and Recurrence Rates Among Patients With Provoked and Cryptogenic Cerebral Venous Thrombosis: Analysis of the ACTION CVT. Neurol Clin Pract 2025; 15:e200381. [PMID: 39399562 PMCID: PMC11464219 DOI: 10.1212/cpj.0000000000200381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 06/27/2024] [Indexed: 10/15/2024]
Abstract
Background and Objectives Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depends on the underlying etiology. This study aims to identify prevalence, risk factors, and recurrent venous thromboembolism (VTE) rates among patients with idiopathic (cryptogenic) CVT and CVT provoked by transient (peripartum, hormonal treatment, infection, trauma) and persistent (cancer, thrombophilia) factors. Methods We used the ACTION-CVT retrospective database which included consecutive patients who were treated for CVT in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. We compared baseline characteristics and outcomes of patients with cryptogenic, transient provoked (TP) and those with persistent provoked (PP) CVT. Baseline characteristics was compared between the groups using χ2 test, t test, or Mann-Whitney U test as appropriate, followed by multivariable regression. We used Kaplan-Meier survival analysis to assess outcome occurrence. We used interaction analysis and Cox regression to assess the risks of recurrent VTE in patients with CVT. Results Among 1,025 included participants with CVT, 510 (49.8%) had no identified risk factor (cryptogenic), 363 (35.4%) had at least one transient provoking factor, and 152 (14.8%) had a persistent provoking factor. Patients with TP CVT were younger (p = 0.003) and more likely to be female patients (p < 0.001). When compared with patients with TP CVT, the risk of recurrent VTE was greater in patients with PP CVT (HR 2.59, 95% CI 1.29-5.22, p = 0.008) and nonsignificantly elevated in patients with cryptogenic CVT (HR 1.85. 95% CI 0.98-3.59, p = 0.059). In the interaction analysis, there was a trend toward higher rate of recurrent VTE in female patients with cryptogenic CVT and male patients with PP CVT. Discussion In this multicenter study, we found that outcomes of CVT differed depending on the underlying etiology. The risk of recurrent VTE in the PP and cryptogenic CVTs may be influenced by sex.
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Affiliation(s)
- Sami Al Kasab
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Eyad Almallouhi
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Liqi Shu
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Kimberly P Kicielinski
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Setareh Salehi Omran
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - David S Liebeskind
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Adeel S Zubair
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Maria C Vedovati
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Maurizio Paciaroni
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Kateryna Antonenko
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Mirjam R Heldner
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Adam de Havenon
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Nils Henninger
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
| | - Shadi Yaghi
- Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA
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25
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Qasmi ST, Kraft J, Webb A, Kumar MA, Albin CSW. A Serious Headache: Lessons Learned from the Management of Pregnancy-Associated Venous Sinus Thrombosis in a Region with Limited Abortion Access. Neurocrit Care 2025; 42:277-281. [PMID: 39322844 DOI: 10.1007/s12028-024-02122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/28/2024] [Indexed: 09/27/2024]
Affiliation(s)
| | - Jacqueline Kraft
- Departments of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam Webb
- Departments of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Monisha A Kumar
- Departments of Neurology, Neurosurgery and Anesthesiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Catherine S W Albin
- Departments of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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26
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Feng Y, Mo S, Li X, Jiang P, Wu J, Li J, Liu P, Wang S, Liu Q, Tong X. Development and validation of a score for clinical deterioration in patients with cerebral venous thrombosis. Neurosurg Rev 2025; 48:56. [PMID: 39815140 DOI: 10.1007/s10143-025-03224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 01/07/2025] [Accepted: 01/08/2025] [Indexed: 01/18/2025]
Abstract
Patients with cerebral venous thrombosis (CVT) may experience poor response to anticoagulant therapy and delayed surgical treatment may lead to clinical deterioration. However, the factors contributing to clinical deterioration remain poorly understood. Patients with CVT from three centers between January 2017 and October 2023 were included and grouped as the development cohort and validation cohort. The danger triangle was defined as the posterior two-thirds of the superior sagittal sinus, confluence of sinuses, straight sinus, and deep venous system. The primary endpoint was clinical deterioration, characterized by new or progressive bleeding or infarctions or worsened neurological conditions post-admission. Using the results of multivariable logistic analysis, the Cerebral venOus thrombosis DEterioration (CODE) score was developed within the development cohort and validated within the validation cohort. The score' performance in predicting clinical deterioration was evaluated using the area under the receiver operating characteristic curve (AUC). The development cohort included 194 CVT patients (101 males, and the median age was 38 years). clinical deterioration occurred in 45 (23.2%) patients. Multivariate logistic analysis defined D-dimer > 1.5 mg/L, Glasgow coma scale ≤ 8, intracerebral hemorrhage, danger triangle as risk factors of clinical deterioration. The CODE score integrating these factors performed well to predict patients suffering from clinical deterioration within the validation cohort (n = 79, 11 deteriorations) with an AUC of 0.83 (95%CI, 0.71-0.96) and an accuracy of 88.6% (95%CI, 81.4-95.8%). CODE score could evaluate the risk of clinical deterioration in CVT patients and may serve as a useful tool for decision-making for CVT. Clinical Deterioration in Cerebral Venous Thrombosis: A Predictive Study (CVT deterioration cohort), ClinicalTrials.gov number: NCT06266585, link: https://classic.clinicaltrials.gov/ct2/show/NCT06266585 ).
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Affiliation(s)
- Yinghe Feng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shaohua Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiong Li
- Department of Neurosurgery, Beijing Chaoyang hospital, Capital Medical University, Beijing, China
| | - Pengjun Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiangan Li
- Department of Neurosurgery and Emergency Medicine, Jiangnan University Medical Center, Wuxi, China
| | - Peng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xianzeng Tong
- Department of Neurosurgery, Beijing Friendship hospital, Capital Medical University, No. 95 Yong 'an Road, Xicheng District, Beijing, China.
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27
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Vojjala N, Peshin S, Kattamuri LPV, Iqbal R, Dharia A, Jayakumar J, Iftekhar R, Singh S, Balla M, Villa Celi CS, Ramachandran R, Prabhu R, Yadav SK, Krishnamoorthy G, Singh V, Seegobin K. Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis-Where Do We Stand? Biomedicines 2025; 13:189. [PMID: 39857772 PMCID: PMC11759824 DOI: 10.3390/biomedicines13010189] [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: 11/26/2024] [Revised: 12/16/2024] [Accepted: 12/26/2024] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke, constituting 0.5-3% of all strokes with an extremely varied spectrum of presentation, predisposing factors, neuroimaging findings, and eventual outcomes. A high index of suspicion is needed because timely diagnosis can significantly alter the natural course of the disease, reduce acute complications, and improve long-term outcomes. Due to its myriad causative factors, protean presentation, and association with several systemic diseases, CVT is encountered not only by neurologists but also by emergency care practitioners, internists, hematologists, obstetricians, and pediatricians. DISCUSSION Anticoagulation remains the mainstay of treatment for CVT. Heparin and warfarin previously had been the anticoagulation of choice. Recently there has been an increased interest in utilizing direct-acting oral anticoagulants in the treatment of CVT given comparable safety and efficacy with ease of utilization. However recent clinical guidelines given by multiple societies including the American Stroke guidelines and European guidelines do not include these agents so far in their treatment recommendations. Ongoing multicentric clinical trials are currently reviewing the role of these agents in both short-term as well as long-term. Our review of the literature supports the safety and reinforces the efficacy of DOAC in the treatment of CVT. Additionally, patient satisfaction has been shown to be better with the use of DOAC. In conclusion, DOAC continues to have a valid role in the management of CVT.
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Affiliation(s)
- Nikhil Vojjala
- Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USA; (N.V.); (R.P.); (G.K.)
| | - Supriya Peshin
- Department of Internal Medicine, Norton Community Hospital, Norton, VA 24273, USA;
| | | | - Rabia Iqbal
- Internal Medicine, Brooklyn Hospital Center, Brooklyn, NY 11201, USA; (R.I.); (J.J.)
| | - Adit Dharia
- HCA Florida Oak Hill Hospital, Brooksville, FL 34613, USA;
| | - Jayalekshmi Jayakumar
- Internal Medicine, Brooklyn Hospital Center, Brooklyn, NY 11201, USA; (R.I.); (J.J.)
| | - Rafi Iftekhar
- Department of Internal Medicine, Norton Community Hospital, Norton, VA 24273, USA;
| | - Shagun Singh
- Department of Internal Medicine, Banner Health, University of Arizona, Tucson, AZ 85719, USA; (S.S.); (R.R.)
| | - Mamtha Balla
- MD Anderson Cancer Center, Department of Infectious Disease Transplant, University of Texas, Houston, TX 77030, USA;
| | | | - Ramya Ramachandran
- Department of Internal Medicine, Banner Health, University of Arizona, Tucson, AZ 85719, USA; (S.S.); (R.R.)
| | - Rishab Prabhu
- Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USA; (N.V.); (R.P.); (G.K.)
| | - Sumeet K. Yadav
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN 56001, USA;
| | - Geetha Krishnamoorthy
- Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USA; (N.V.); (R.P.); (G.K.)
| | - Vijendra Singh
- Department of Hematology-Oncology, Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Karan Seegobin
- Department of Medical Oncology, Mayo Clinic Health System, Mankato, MN 56001, USA;
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28
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Sitthilok P, Niprapan P, Tantiworawit A, Punnachet T, Hantrakun N, Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Rattarittamrong E, Norasetthada L, Chai-Adisaksopha C. Clinical course and neurological outcomes of cerebral venous sinus thrombosis: A single center retrospective observational study. PLoS One 2025; 20:e0316849. [PMID: 39804849 PMCID: PMC11729942 DOI: 10.1371/journal.pone.0316849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/17/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a rare type of thrombosis that affects the cerebral venous system. The data on neurological outcomes are limited. OBJECTIVES This study aimed to investigate the neurological outcomes of CVST, contributing factors, clinical presentation, treatment and mortality. METHODS This was a single-center, retrospective study at a university-based referral hospital in Thailand. Consecutive patients diagnosed with CVST between January 2010 and December 2020 were included. Outcomes were neurological outcomes measured by modified Rankin Scale (mRS), anticoagulant treatment, recurrence, and mortality. RESULTS One hundred and seven CVST patients were included with a mean age (± SD) of 42.7 ± 20.4 years. Following the treatment, neurological outcomes significantly improved, with the proportion of patients with mRS 0-1 increasing from 18.7% at diagnosis to 83.2% and 85.1% at three and six months, respectively (P < 0.001). Clinical variables were associated with residual neurological symptoms (mRS≥1) included age ≥ 50 years (OR 4.1, 95% CI; 1.7-9.4, P 0.001), male sex (OR 3.0, 95%CI; 1.4-6.6, P 0.006), the thrombus involvement in deep sinus system (OR 6.1, 95%CI; 1.1-76.9, P 0.04) and cerebral vein and dural sinus thrombosis (CVT) risk score ≥ 1 (OR 3.1, 95%CI; 1.3-7.5, P 0.014). Patients whose CVST was associated with hormonal therapy were found to have a lower risk of residual neurological symptoms (OR 0.2, 95%CI 0.1-0.6, P 0.004). Hormonal therapy was associated with anticoagulant discontinuation (OR 2.7, 95% CI 1.1-7.0; P = 0.04). The presence of malignancy increased the risk of bleeding (OR 5.8, 95% CI 1.4-24.1; P 0.016). Overall mortality was 2.8%. Of which 50% were related to major bleeding. CONCLUSIONS A significant improvement in neurological outcomes was observed at 3 and 6 months after diagnosis. Older age, male sex, thrombus involvement in deep sinus system were associated with residual neurological symptoms.
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Affiliation(s)
- Pasook Sitthilok
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Piangrawee Niprapan
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teerachat Punnachet
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nonthakorn Hantrakun
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pokpong Piriyakhuntorn
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanawat Rattanathammethee
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sasinee Hantrakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekarat Rattarittamrong
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Calma AD, Tan I, Tohidi-Esfahani I, Sanders L, Kumar K, Morris K. Cerebral venous sinus thrombosis after intrathecal administration of nusinersen. BMJ Case Rep 2025; 18:e260080. [PMID: 39755539 DOI: 10.1136/bcr-2024-260080] [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: 01/06/2025] Open
Abstract
Cerebral venous sinus thrombosis is an uncommon sequela of low intracranial pressure, which may result from a lumbar puncture (LP). We describe a case of a patient in their 40s presenting with 48 hours of persistent headache following intrathecal administration of nusinersen for spinal muscular atrophy (SMA) type 3. There were no focal neurological signs or symptoms apart from baseline symmetrical proximal limb weakness attributed to SMA. Initial investigations revealed radiological evidence of an acute cerebral venous sinus thrombus (CVST). The patient was promptly started on anticoagulation. Partial recanalisation was seen as soon as 48 hours after commencement of anticoagulation, with almost full resolution of the thrombus at follow-up in 2 months. Awareness of CVST as a potential complication of intrathecal therapies and diagnostic LP allows for early identification, management and prevention of serious neurological consequences.
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Affiliation(s)
- Aicee Dawn Calma
- Neurosciences, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
| | - Irene Tan
- Radiology, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
| | - Ibrahim Tohidi-Esfahani
- Haematology, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
| | - Lauren Sanders
- Neurology and Neurosciences, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- The University of Melbourne St Vincent's Department of Medicine, Melbourne, Victoria, Australia
| | - Kishore Kumar
- Neurosciences, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
- The University of Sydney Concord Clinical School, Concord West, New South Wales, Australia
| | - Katrina Morris
- Neurosciences, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
- The University of Sydney Concord Clinical School, Concord West, New South Wales, Australia
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Fernández Carrasco M, Delgado Maroto A, Hernández Martínez Á. Cerebral thrombosis as a manifestation of poor control in inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2025; 48:502256. [PMID: 39349277 DOI: 10.1016/j.gastrohep.2024.502256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 09/11/2024] [Accepted: 09/15/2024] [Indexed: 10/02/2024]
Affiliation(s)
| | - Ana Delgado Maroto
- Servicio de Aparato Digestivo, Hospital Universitario Torrecárdenas, Almería, España
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Arrighi M, Berton Q, de Schlichting E, Kaba DI, Roblot P, Coll G. Unmasking hidden risks: cerebral venous sinus thrombosis and spontaneous subdural hematoma in women on oral contraceptives - insights from a case report and systematic literature review. Neurochirurgie 2025; 71:101603. [PMID: 39388782 DOI: 10.1016/j.neuchi.2024.101603] [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] [Received: 06/19/2024] [Revised: 08/18/2024] [Accepted: 09/03/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Cerebral venous thrombosis (CVT) is a rare but critical condition, particularly in young women, often linked to oral contraceptive use. It can lead to complications like subdural hematoma (SH), which are challenging to diagnose and manage. We report the case of a 39-year-old woman who presented with severe headaches and neurological symptoms, leading to a diagnosis of chronic SH and CVT, associated with long-term oral contraceptive use. This case is unique as it documents the first known instance of chronic SH associated with CVT induced by oral contraceptives. Our objective was to explore this association using the Bradford Hill criteria and to review the diagnostic and therapeutic challenges of CVT and SH in this population. METHODS We conducted a systematic literature review adhering to PRISMA guidelines, focusing on SH cases linked to CVT in women using oral contraceptives. RESULTS Including our case, four cases of SH associated with CVT secondary to oral contraceptive use were identified. Common symptoms included severe headache and neurological deficits. All patients received anticoagulation therapy, with surgical intervention required in severe cases. Prognosis was generally favorable with appropriate management. CONCLUSION This case emphasizes the importance of considering CVT in women presenting with spontaneous SH, particularly those on oral contraceptives. Early diagnosis, careful clinical and radiological monitoring, and timely surgical intervention are crucial for optimal outcomes.
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Affiliation(s)
- Marta Arrighi
- Service de Neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63000, France; INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, F-63000, France
| | - Quentin Berton
- Service de Neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63000, France; INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, F-63000, France
| | - Emmanuel de Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Université de Grenoble Alpes, Grenoble, France
| | - Djene Ibrahima Kaba
- Service de Neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63000, France
| | - Paul Roblot
- Service de Neurochirurgie A, Hôpital Pellegrin, CHU Bordeaux, F-33000, France
| | - Guillaume Coll
- Service de Neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63000, France; INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, F-63000, France.
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Yardibi F, Demirci S. Global trends and hot spots in cerebral venous sinus thrombosis research over the past 50 years: a bibliometric analysis. Neurol Res 2025; 47:23-34. [PMID: 39603272 DOI: 10.1080/01616412.2024.2430999] [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] [Received: 09/30/2024] [Accepted: 11/13/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is an uncommon form of cerebrovascular disease. Although our understanding of CVST has improved significantly over the past decades, there has been no bibliometric analysis of CVST until now. We aimed to examine and visualize the hotspots and trends of the research related to CVST using a bibliometric analysis based on Citespace and provide new insights for scholars in their future researches in this area. METHODS The literature on CVST was collected from the Web of Science Core Collection database. Bibliometric analysis was performed using CiteSpace (6.2.R3) Advanced software. RESULTS A total of 2396 articles were included in the analysis. Publications regarding CVST have increased over time. U.S.A. contributed the most articles. Ferro JM had the highest number of published papers. Stroke was the journal with the most publications and the most commonly cited journal. Nine out of the top 10 cited journals belong to Q1. The risk factors for CVST, emerging and current treatment of CVST, and CVST related to COVID-19 and COVID-19 vaccines are the major potential research hot spots and trends. CONCLUSIONS CVST is a rapidly expanding research area and has received increasing attention by the researchers. Our study can provide researchers valuable information on the current status and trends in this area and guide for future studies.
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Affiliation(s)
- Fatma Yardibi
- Faculty of Communication, Department of New Media and Communication, Akdeniz University, Antalya, Turkey
| | - Seden Demirci
- School of Medicine, Department of Neurology, Akdeniz University, Antalya, Turkey
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Grund B, Ebert A, Sandikci V, Neumaier-Probst E, Alonso A. Benefits of early MR-Imaging in patients with acute spontaneous intracerebral hemorrhage: a retrospective study. BMC Neurol 2024; 24:487. [PMID: 39707219 DOI: 10.1186/s12883-024-03992-7] [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] [Received: 09/16/2024] [Accepted: 12/10/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND Neuroimaging plays a vital role in the diagnosis of intracerebral hemorrhage (ICH) and in identifying the underlying etiology for appropriate therapeutic approach. This study aims to determine the significance and potential advantages of using early magnetic resonance imaging (MRI) as a diagnostic tool for ICH. METHODS This retrospective study included 359 patients with ICH treated at the Department of Neurology, Mannheim University Hospital between January 2017 and December 2021. Patient characteristics, stroke severity and imaging procedures were descriptively analyzed. Factors associated with the choice of imaging modalities were evaluated. The etiology of hemorrhage was retrospectively analyzed using the existing data. We recorded the reassignment of ICH etiology by comparing the assessment after first sole review of CT scan and then subsequent MRI review. The overall rate of reassignments and the reassignments per CT-based initial etiology were analyzed. RESULTS In the sample of 359 patients with ICH (mean age 73.1 years, 55.4% male), patients receiving an additional MRI were significantly younger (p < .001) and were less severely affected by stroke (median NIHSS score 5 vs. 15, p < .001). MRI was performed significantly less frequently in patients who died during hospitalization (11.7% vs. 63.9%, p < .001). MRI led to a reassignment of ICH etiology in 48.2% of cases (80/166), uncovering unknown underlying causes in 69% of cases (49/71). Reassignment occurred most frequently in patients with a CT-based diagnosis of hypertensive ICH (18/50). The most frequent reassigned etiologies after MR imaging were cerebral amyloid angiopathy (CAA; 36 patients) and secondary hemorrhage of an ischemic stroke (30 patients). CONCLUSIONS Early MR imaging in patients with ICH improves the determination of underlying etiology and the conception of an appropriate treatment approach, potentially contributing to better patient outcomes.
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Affiliation(s)
- Benedikt Grund
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany
| | - Anne Ebert
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany
| | - Vesile Sandikci
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany
| | - Eva Neumaier-Probst
- Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany.
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Jiang M, Xu Y, Yang L, Yan Y, Zhou H, Song W, Wang X, Sun H, Yao X, Zhao Z, Li C. Evidence-based recommendations for the prophylactic use of antiseizure medications (ASMs) in neurosurgery: a systematic review of guidelines. J Neurol 2024; 272:65. [PMID: 39680191 DOI: 10.1007/s00415-024-12764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 10/27/2024] [Accepted: 10/30/2024] [Indexed: 12/17/2024]
Abstract
OBJECTIVE This study aims to evaluate the methodological quality of guidelines concerning the prophylactic use of antiseizure medications (ASMs) in neurosurgery and to summarize relevant recommendations. METHODS PubMed, Embase, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), and other guideline repositories and official organizations were searched from 2004 to 2023 (20 years). The extracted information consisted of the guideline characteristics, relevant recommendations, levels of evidence, and strength of recommendations. Using the Guideline Research and Evaluation Tool II (AGREE II), five reviewers assessed the methodological quality of the guidelines, and the intraclass correlation coefficient (ICC) is used to assess the inter-reviewer consistency. RESULTS Of 27 eligible guidelines, AGREE II scores varied with higher scores in Clarity of Presentation (88.89%), Scope and Purpose (83.33%), and Editorial Independence (72.92%), but lower in Rigor of Development (59.17%), Stakeholder Involvement (46.67%), and Applicability (41.67%). ICC ranged from 0.51 to 0.92. Nine guidelines were recommended, eight with modifications, and ten not recommended. ASMs prophylaxis are recommended for patients with a seizure history, which means secondary prophylaxis, and specific high-risk groups, but not recommended for primary prophylaxis routinely for those without a history of seizure. CONCLUSIONS Guidelines in neurosurgical perioperative prophylactic use of ASMs are of moderate quality with domains for enhancement. Guidelines lack detailed guidance on medication initiation, dosage, and duration, highlighting the need for more high-quality clinical trials comparing newer and classical ASMs.
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Affiliation(s)
- Meizhu Jiang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Yanan Xu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Li Yang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
| | - Yilong Yan
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Han Zhou
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Wanqing Song
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Xinyue Wang
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Haiyang Sun
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Xuetong Yao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China.
| | - Cao Li
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, China.
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Patel H, Lunn I, Hameed S, Khan M, Siddiqui FM, Borhani A, Majid A, Bell SM, Wasay M. Treatment of cerebral venous thrombosis: a review. Curr Med Res Opin 2024; 40:2223-2236. [PMID: 39492709 DOI: 10.1080/03007995.2024.2423740] [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: 05/23/2024] [Revised: 09/24/2024] [Accepted: 10/28/2024] [Indexed: 11/05/2024]
Abstract
Cerebral venous thrombosis (CVT) is an uncommon cause of stroke. COVID-19 infection and vaccination have been associated with CVT. Fibrinolysis and mechanical thrombectomy may play an emerging role in management. We conducted a literature review summarizing current evidence on use of antiplatelets, anticoagulants, thrombolysis, and mechanical thrombectomy for the management of CVT and COVID-19 related CVT. This was achieved through a review of MEDLINE, PubMed, and Cochrane Reviews databases, performed using the search terms CVT AND "antiplatelets' aspirin", "ticagrelor", "clopidogrel", "eptifibatide", "Low-molecular-weight-heparin (LMWH)", "Unfractionated heparin (UH)", "warfarin", "DOACs", "rivaroxaban", "apixaban", "dabigatran", "fibrinolysis", "intra-sinus thrombolysis", "mechanical thrombectomy", and "craniectomy". We found that LMWH and UH are safe and effective for the management of acute CVT and should be considered first line. Warfarin may be used in the sub-acute phase for secondary prevention but has weak evidence. DOACs are potentially a safe warfarin alternative, but only warfarin is currently recommended in international guidelines. Antiplatelets show little evidence for the prevention or management of CVT, but studies are currently limited. COVID-19 related CVT is treated similarly to non-COVID-19 CVT; however, vaccine-related CVT is a newly recognised disease with a different pathophysiology and is treated with a combination of non-heparin anticoagulants, immunotherapy, and steroids. Decompressive craniectomy may be used to reduce intracranial pressure in life-threatening cases. There is a small body of evidence for endovascular therapy in complex cases but should be reserved for complex cases in specialist centres. This paper is of relevance to clinical practice since the safe and effective management of CVT is important to reduce the risk of disability.
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Affiliation(s)
- Hamish Patel
- Department of Neurology, Royal Hallamshire Hospital, Broomhall, UK
| | - India Lunn
- The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield Institute for Translational Neuroscience, Broomhall, UK
| | - Sajid Hameed
- The Aga Khan University, Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Maria Khan
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Fazeel M Siddiqui
- University of Michigan Health-West, Neurosciences, Wyoming, Michigan, USA
| | - Afshin Borhani
- Shiraz University of Medical Sciences, Neurology, 203 Unit, Shiraz, Iran
| | - Arshad Majid
- The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield Institute for Translational Neuroscience, Broomhall, UK
| | - Simon M Bell
- The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield Institute for Translational Neuroscience, Broomhall, UK
| | - Mohammad Wasay
- The Aga Khan University, Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Bücke P, Henkes H, Kaesmacher J, Hellstern V. Response to "Critical Insights on 'Early Versus Late Initiation of Endovascular Therapy in Patients with Severe Cerebral Venous Sinus Thrombosis' by Bücke et al.". Neurocrit Care 2024; 41:1121-1122. [PMID: 39289304 DOI: 10.1007/s12028-024-02128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Philipp Bücke
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 16, 3010, Bern, Switzerland.
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
- Medical Faculty, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Johannes Kaesmacher
- Institute for Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 16, 3010, Bern, Switzerland
| | - Victoria Hellstern
- Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
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Garcia V, Bicart‐Sée L, Crassard I, Legris N, Zuber M, Pico F, Guidoux C, Obadia M, Boulenoir N, Smadja D, Mazighi M, Lavenu‐Bombled C, Baudry E, Lapergue B, Turc G, Tuppin P, Denier C. Cerebral venous thrombosis in elderly patients. Eur J Neurol 2024; 31:e16504. [PMID: 39367633 PMCID: PMC11554858 DOI: 10.1111/ene.16504] [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] [Received: 05/30/2024] [Revised: 09/09/2024] [Accepted: 09/17/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND AND PURPOSE We aimed to report the characteristics of cerebral venous thrombosis (CVT) in elderly people (aged ≥65 years). METHODS This multicenter retrospective cohort included elderly patients hospitalized for a first CVT in nine Paris-Ile-de-France hospitals between 2011 and 2021. The estimated incidence was compared to CVT recorded by the French health insurance data system. Lariboisière Hospital's CVT registry allowed comparisons of our elderly cohort with individuals younger than 65 years. RESULTS One hundred fourteen patients were included in this study (mean age = 74.2 years, range = 65-93, 61% female). The CVT annual incidence in Ile-de-France was 5.9-7.1 per million elderly individuals versus 8.5 per million nationwide. Headaches and focal deficits were the most common initial clinical features (50% and 51%, respectively), followed by seizures and confusion (40% and 27%). Treatment included anticoagulation (93%) and, rarely, endovascular procedure (2%) or craniectomy (1%). Compared with adult patients aged <65 years (younger adults), elderly patients presented fewer headaches (50% vs. 96%, p < 0.01) and intracranial hypertension (7% vs. 22%, p < 0.01) but more seizures and focal deficits (40% vs. 27% and 51% vs. 38%, respectively, p < 0.01). Underlying cancer, hemopathy, and locoregional infections were more frequent in elderly patients than among younger adults (p < 0.01). The prognosis of patients from our elderly cohort was poorer than that of younger adults; 8% died in the acute phase, and 73% had a favorable outcome at 1 year (vs. 1.7% and 87%, respectively, p < 0.01). CONCLUSIONS CVT in elderly patients has a specific clinical presentation, epidemiology, and risk factors such as cancer or hemopathy, justifying specialized management.
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Affiliation(s)
- Victor Garcia
- Stroke Units and Department of Neurology of Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique–Hôpitaux de ParisParis Saclay UniversityParisFrance
| | - Louise Bicart‐Sée
- Stroke Units and Department of Neurology of Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique–Hôpitaux de ParisParis Saclay UniversityParisFrance
| | - Isabelle Crassard
- Hôpital Lariboisière, Assistance Publique‐Hôpitaux de Paris, University of Paris City, INSERM 1144ParisFrance
| | - Nicolas Legris
- Stroke Units and Department of Neurology of Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique–Hôpitaux de ParisParis Saclay UniversityParisFrance
| | | | | | - Céline Guidoux
- Hôpital Bichat, Assistance Publique‐Hôpitaux de ParisParisFrance
| | | | - Naouel Boulenoir
- Stroke Units and Department of Neurology of Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique–Hôpitaux de ParisParis Saclay UniversityParisFrance
| | | | - Mikael Mazighi
- Hôpital Lariboisière, Assistance Publique‐Hôpitaux de Paris, University of Paris City, INSERM 1144ParisFrance
| | - Cecile Lavenu‐Bombled
- Department of HematologyHôpital Bicêtre, Assistance Publique‐Hôpitaux de ParisParisFrance
| | - Elodie Baudry
- Department of GeriatryHôpital Bicêtre, Assistance Publique‐Hôpitaux de ParisParisFrance
| | | | | | | | - Christian Denier
- Stroke Units and Department of Neurology of Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique–Hôpitaux de ParisParis Saclay UniversityParisFrance
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Lindgren E, Shu L, Simaan N, Krzywicka K, de Winter MA, Sánchez van Kammen M, Molad J, Klein P, Hallevi H, Barnea R, Heldner MR, Hiltunen S, de Sousa DA, Ferro JM, Arauz A, Putaala J, Arnold M, Nguyen TN, Stretz C, Tatlisumak T, Jood K, Yaghi S, Leker RR, Coutinho JM, and the DIAS 3 research collaboration. Development and Validation of a Clinical Score to Predict Epilepsy After Cerebral Venous Thrombosis. JAMA Neurol 2024; 81:1274-1283. [PMID: 39432281 PMCID: PMC11581563 DOI: 10.1001/jamaneurol.2024.3481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/21/2024] [Indexed: 10/22/2024]
Abstract
Importance One of 10 patients develop epilepsy in the late phase after cerebral venous thrombosis (CVT) diagnosis but predicting the individual risk is difficult. Objective To develop and externally validate a prognostic score to estimate the individual risk of post-CVT epilepsy. Design, Setting, and Participants This observational cohort study included both retrospective and prospective patients enrolled from 1994 through 2022. For development of the DIAS3 score, data from the International CVT Consortium (n = 1128), a large international hospital-based multicenter CVT cohort, were used. For validation, data from 2 independent multicenter cohorts, the ACTION-CVT (n = 543) and the Israel CVT study (n = 556), were used. Of 2937 eligible, consecutively enrolled adult patients with radiologically verified CVT, 710 patients with a history of epilepsy prior to CVT, follow-up less than 8 days, and missing late seizure status were excluded. Exposure The prediction score (DIAS3) was developed based on available literature and clinical plausibility and consisted of 6 readily available clinical variables collected during the acute phase: decompressive hemicraniectomy, intracerebral hemorrhage at presentation, age, seizure(s) in the acute phase (excluding status epilepticus), status epilepticus in the acute phase, and subdural hematoma at presentation. Main Outcome and Measure Time to a first late seizure, defined as occurring more than 7 days after diagnosis of CVT. Results Of 1128 patients included in the derivation cohort (median age, 41 [IQR, 30-53] years; 805 women [71%]), 128 (11%) developed post-CVT epilepsy during a median follow-up of 12 (IQR, 3-26) months. According to the DIAS3 score, the predicted 1-year and 3-year risk of epilepsy in individual patients ranged from 7% to 68% and 10% to 83%, respectively. Internal and external validation showed adequate discrimination in the derivation cohort (1 year and 3 years: C statistic, 0.74; 95% CI, 0.70-0.79) and the 2 independent validation cohorts, (ACTION-CVT) 1 year: C statistic, 0.76; 95% CI, 0.67-0.84; 3 years: C statistic, 0.77; 95% CI, 0.66-0.84; and Israel CVT study 1 year: C statistic, 0.80; 95% CI, 0.75-0.86. Calibration plots indicated adequate agreement between predicted and observed risks. Conclusions and Relevance The DIAS3 score (freely available online) is a simple tool that can help predict the risk of post-CVT epilepsy in individual patients. The model can improve opportunities for personalized medicine and may aid in decision-making regarding antiseizure medication, patient counseling, and facilitation of research on epileptogenesis in CVT.
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Affiliation(s)
- Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Liqi Shu
- Department of Neurology, Brown University, Providence, Rhode Island
| | - Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed, Israel and The Azrieli Faculty of Medicine, Safed, Bar Ilan University’s, Safed Israel
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria A. de Winter
- Department of Internal Medicine, UMC Utrecht, Utrecht, the Netherlands and Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | | | - Jeremy Molad
- Department of Neurology & Stroke, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Piers Klein
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Hen Hallevi
- Department of Neurology & Stroke, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petach-Tikva, Israel
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Center, Lisbon, Portugal; CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- L Lopes Lab, Instituto de Medicina Molecular, Lisbon, Portugal
| | - José M. Ferro
- Neurology Department, ULS Santa Maria, Lisboa, Portugal; CEEM, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Antonio Arauz
- Sina Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thanh N. Nguyen
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Christoph Stretz
- Department of Neurology, Brown University, Providence, Rhode Island
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- 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 and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, Rhode Island
| | - Ronen R. Leker
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Field TS, Shu L, Kim DJ, Klein P, Siegler JE, Cushman M, Zhou LW, Nguyen TN, Yaghi S. Lead-In Parenteral Anticoagulation Prior to Direct Oral Anticoagulation for Cerebral Venous Thrombosis. Can J Neurol Sci 2024:1-6. [PMID: 39523979 DOI: 10.1017/cjn.2024.325] [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: 11/16/2024]
Abstract
BACKGROUND Growing evidence suggests that direct oral anticoagulants (DOACs) may be suitable for cerebral venous thrombosis (CVT). The optimal strategy regarding lead-in parenteral anticoagulation (PA) prior to DOAC is unknown. METHODS In this post hoc analysis of the retrospective ACTION-CVT study, we compared patients treated with DOACs as part of routine care: those given "very early" DOAC (no PA), "early" (<5 days PA) and "delayed" (5-21 days PA). We compared baseline characteristics and outcomes between the very early/early and delayed groups. The primary outcome was a composite of day-30 CVT recurrence/extension, new peripheral venous thromboembolism, cerebral edema and intracranial hemorrhage. RESULTS Of 231 patients, 11.7% had very early DOAC, 64.5% early (median [IQR] 2 [1-2] days) and 23.8% delayed (5 [5-6] days). More patients had severe clinical/radiological presentations in the delayed group; more patients had isolated headaches in the very early/early group. Outcomes were better in the very early/early groups (90-day modified Rankin Scale of 0-2; 94.3% vs. 83.9%). Primary outcome events were rare and did not differ significantly between groups (2.4% vs. 2.1% delayed; adjusted HR 1.49 [95%CI 0.17-13.11]). CONCLUSIONS In this cohort of patients receiving DOAC for CVT as part of routine care, >75% had <5 days of PA. Those with very early/early initiation of DOAC had less severe clinical presentations. Low event rates and baseline differences between groups preclude conclusions about safety or effectiveness. Further prospective data will inform care.
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Affiliation(s)
- Thalia S Field
- Division of Neurology, Stroke Program, University of British Columbia, Vancouver, BC, Canada
| | - Liqi Shu
- Department of Neurology, Brown Medical School, Providence, RI, USA
| | - Diana J Kim
- Division of Neurology, University of British Columbia Okanagan, Kelowna, BC, Canada
| | | | - James E Siegler
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Lily W Zhou
- Division of Neurology, Stroke Program, University of British Columbia, Vancouver, BC, Canada
| | | | - Shadi Yaghi
- Department of Neurology, Brown Medical School, Providence, RI, USA
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Menon D, Gupta M, Ananthasubramanian ST, Kulanthaivelu K, Raja P, Ramakrishnan S, Karnam SS, Saini J, Srijithesh PR, Kulkarni GB. Anticoagulation Status and Outcome in Cerebral Venous Thrombosis: A Single-Center Retrospective Study from South India. Ann Indian Acad Neurol 2024; 27:657-662. [PMID: 39585298 PMCID: PMC11745259 DOI: 10.4103/aian.aian_359_24] [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: 05/04/2024] [Revised: 08/07/2024] [Accepted: 09/08/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Early initiation and maintenance of anticoagulation appears to be the mainstay of treatment of cerebral venous thrombosis (CVT), but the evidence supporting the intensity and duration of anticoagulation is limited. METHODS We retrospectively collected data of patients admitted with CVT over a 5-year period, who had a minimum of 6 months of clinical follow-up and three or more prothrombin time international normalized ratio (INR) values spread over 6 months. Data collected included demographic, clinical, and radiologic parameters, anticoagulation status during the follow-up, complications, and clinical status at the last follow-up. RESULTS We identified 204 patients, and the mean age was 34.4 ± 11.1 years. The majority had a provoked etiology (194, 95.1%) for CVT. After initial anticoagulation with unfractionated heparin, all patients transitioned to acenocoumarol or warfarin and this was maintained for a mean duration of 16.02 ± 11.2 months. Time in therapeutic range of INR 2-3 was only 5.1 ± 11.8 percent days and time spent in an INR of 1-1.5 was 68.7 ± 31.8 percent days. The average INR over 6 months was 1.37 ± 0.33. Duration of follow-up was 18.9 ± 13.25 months, and a good outcome was noted in 183 (89.7%) patients. Complications were seen in 29 (14.2%) patients. Multivariate analysis showed only the CVT grading scale score to be an independent predictor of good outcome. CONCLUSIONS Maintenance of an intensive level of anticoagulation may not be required in patients with CVT and may be particularly true when a transient and treatable risk factor is the provoking etiology.
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Affiliation(s)
- Deepak Menon
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Manisha Gupta
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Pritam Raja
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sangeetha Seshagiri Karnam
- Department of Clinical Pathology and Hematology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - PR Srijithesh
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Yücel G, Arslan AK, Özgör B, Şahin MÇ, Öncül Y, Taşolar SD, Akyay A, Güngör S. Risk factors for acute symptomatic seizure in children with cerebral sinovenous thrombosis: Experience from a tertiary center. Clin Neurol Neurosurg 2024; 246:108571. [PMID: 39326278 DOI: 10.1016/j.clineuro.2024.108571] [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] [Received: 07/09/2024] [Revised: 09/20/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVE To investigate the risk factors for acute symptomatic seizure (ASS) in children with Cerebral Sinovenous Thrombosis (CSVT) and to evaluate the effect of ASS on outcome. METHODS Cross-sectional, single-center, hospital-based retrospective analysis of 42 children with neuroimaging-confirmed CSVT recorded between December 2009 and January 2023. ASS was defined as a seizure occurring within 7 days after CSVT. Predictors for ASS were analyzed by univariate and multivariate logistic regression. Functional outcomes were evaluated using the Pediatric Stroke Outcome Measure (PSOM). RESULTS The average age of the 42 patients included in the study sample was 105.36 ± 63.1 months. Almost one-third (28.6 %) of patients with CSVT developed ASS. In univariate analysis, factors associated with seizure risk were young age, low Glasgow Coma Scale at admission, long hospital stay, headache, change of consciousness, focal neurological findings, cerebral hemorrhage, motor deficit and high D-dimer level (p=0.018, p<0.001, p= 0.016, p= 0.001, p=0.014, p<0.001, p<0.001, p=0.019 and p=0.013, respectively). In multivariate analysis young age, focal neurological findings and D-dimer levels were potential predictors of ASS (p=0.004, p=0.003, p=0.036, respectively). Receiver operating characteristic (ROC) analysis for D-dimer diagnostic accuracy in patients with CSVT revealed D-dimer > 498 ng/mL (AUC=0.743). In both cohorts, PSOM scores at last follow-up were worse in those with acute seizures compared to those without (p<0.001). CONCLUSION Acute seizures occurred in approximately one-third of our cohort. Young age, focal neurological findings, and high D-dimer levels are potential predictors of ASS in children. Children with ASS had worse outcomes than those without.
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Affiliation(s)
- Gül Yücel
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Ahmet Kadir Arslan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Bilge Özgör
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Murat Çağlar Şahin
- Department of Pediatrics, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Yurday Öncül
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Sevgi Demiröz Taşolar
- Department of Pediatric Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Arzu Akyay
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Serdal Güngör
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
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Alhusseini A, Alsamarrai O, Alsultan M, Soliman N, Hamsho S. Neurobrucellosis complicated with cerebral venous sinus thrombosis in a young Syrian male: a case report. Ann Med Surg (Lond) 2024; 86:6696-6699. [PMID: 39525725 PMCID: PMC11543208 DOI: 10.1097/ms9.0000000000002022] [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: 12/23/2023] [Accepted: 03/23/2024] [Indexed: 11/16/2024] Open
Abstract
Introduction and importance Neurobrucellosis occurs when Brucella affects the nervous system and it has several presentations. One of its rarest complications is cerebral venous sinus thrombosis (CVST). Case presentation A 16-year-old male patient complaining of a sudden onset of bilateral pulsatile headache accompanied by fever, dizziness, nausea, vomiting, and blurred vision. On neurological examination the patient had neck stiffness and a bilateral 2nd degree papilledema. Brain computed tomography did not reveal any space-occupying lesions. Lumbar puncture showed an elevated lymphocyte count in the CSF and the Brucella PCR was positive. MRI with contrast and magnetic resonance venography revealed a left transverse sinus thrombosis and a diagnosis of neurobrucellosis complicated with CVST was made. Discussion CVST is a rare but serious complication of neurobrucellosis, it has been described in only a handful of cases. The diagnosis mainly consists of establishing the presence of neurobrucellosis using the CSF analysis and the Brucella PCR, and proving the existence of CVST using the brain MRI. Although, the management of this complication remains a controversy, the use of an antibiotic combination and anticoagulation therapy may improve the symptoms greatly. Conclusion Although Brucella seldom affects the nervous system, with CVST being an extremely rare complication. Physicians should consider brucella as the cause of CVST, in endemic areas. Usually, it is treated with a combination of antibiotics. However, anticoagulation should be considered in some cases and future studies must be conducted to assess the role of anticoagulation treatment.
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Affiliation(s)
| | | | | | | | - Suaad Hamsho
- Department of Rheumatology, Al Assad and Al Mouwasat University Hospitals, Faculty of Medicine, Damascus University, Damascus, Syria
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43
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Lan D, Wang M, Zhang X, Huang X, Liu N, Ren X, Fang K, Zhou D, Meng R. A retrospective cohort study on a novel marker to predict the severity and prognosis of acute cerebral venous thrombosis: D-dimer to fibrinogen ratio. Thromb J 2024; 22:95. [PMID: 39478537 PMCID: PMC11523772 DOI: 10.1186/s12959-024-00664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 10/21/2024] [Indexed: 11/03/2024] Open
Abstract
BACKGROUND AND AIM The D-dimer to fibrinogen ratio (DFR) represents an emerging and significant clinical biomarker. However, its correlation with cerebral venous thrombosis (CVT) remains underexplored. This retrospective cohort study aims to elucidate the association between DFR values and the severity and prognosis of CVT. METHODS Severe CVT was defined as the presence of at least 1 of the following risk factors: mental status disorder, coma state, intracranial cerebral hemorrhage, or thrombosis of the deep cerebral venous system. The modified Rankin Scale was utilized to assess functional outcomes. DFR measurements were obtained within 24 h of hospital admission. Logistic regression analysis was employed to determine the prognostic significance of DFR. After Bonferroni correction, a two-tailed P value < 0.017 (0.05/3) was considered statistically significant. RESULT A total of 196 patients were included in the study, among whom 85 patients were diagnosed with severe CVT, and 35 and 14 patients experienced short-term and long-term adverse outcomes, respectively. Receiver operating characteristic curve analysis demonstrated that DFR has predictive value for severe CVT, poor short-term and long-term outcomes, with area under the curve values of 0.690 [95% CI: 0.617-0.764, P < .001], 0.773 [95% CI: 0.701-0.845, P < .001], and 0.754 [95% CI: 0.619-0.886, P = .002], respectively. DFR ≥ 0.253 was identified as a significant predictor of severe CVT [adjusted odds ratio (aOR) (95% CI): 2.03 (1.10-3.75), P = .024]. Additionally, DFR ≥ 0.322 and DFR ≥ 0.754 were significantly associated with poor short-term outcomes at discharge [aOR (95% CI): 2.63 (1.43-4.76), P = .002] and poor long-term outcomes at 12 months [aOR (95% CI): 2.86 (1.32-6.25), P = .008], respectively. CONCLUSION Elevated DFR is associated with increased severity of CVT. Additionally, higher DFR levels can predict poorer clinical outcomes in CVT.
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Affiliation(s)
- Duo Lan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Mengqi Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiaoming Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiangqian Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Naiqi Liu
- Capital Medical University, Beijing, 100069, China
| | - Xiangyu Ren
- Capital Medical University, Beijing, 100069, China
| | - Kun Fang
- Capital Medical University, Beijing, 100069, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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He J, He Y, Qin Y, Liu L, Xu M, Liu Q. Pregnancy-related intracranial venous sinus thrombosis secondary to cryptococcal meningoencephalitis: a case report and literature review. BMC Infect Dis 2024; 24:1155. [PMID: 39402460 PMCID: PMC11476198 DOI: 10.1186/s12879-024-10054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 10/03/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST), a serious cerebrovascular and neurological emergency, is common in pregnant individuals and accounts for approximately 0.5-1.0% of all cerebrovascular diseases. However, CVST with cryptococcal meningoencephalitis in immunocompetent pregnant patients is rare. CASE PRESENTATION A 30-year-old woman who was 33 weeks pregnant presented with recurrent dizziness, headache, and vomiting as the main clinical manifestations, all of which were initially nonspecific. After assessment of the cerebrospinal fluid, skull computerized tomography, magnetic resonance imaging, and other laboratory and imaging examinations, the patient was diagnosed with secondary pregnancy-related CVST with cryptococcal meningoencephalitis. Despite receiving potent anticoagulant and antifungal treatment, the patient's condition deteriorated, and the patient's family opted to cease treatment. CONCLUSIONS We present a rare case of CVST with cryptococcal meningoencephalitis in an immunocompetent pregnant patient. The difficulty of diagnosing and treating secondary pregnancy-related CVST caused by cryptococcal meningoencephalitis, as well as the great challenges faced at present are highlighted. One crucial lesson from the present case is that when clinical and imaging signs are unusual for CVST during pregnancy, it is essential to account for the possibility of other central nervous system (CNS) diseases, such as CNS infections with Cryptococcus, which may cause CVST.
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Affiliation(s)
- Junbing He
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, Guangdong, China.
| | - Yufu He
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, Guangdong, China
| | - Yuting Qin
- The Intensive Care Unit, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, PR China
| | - Lizhen Liu
- The Intensive Care Unit, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, PR China
| | - Mingwei Xu
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, Guangdong, China
| | - Qinghua Liu
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, Guangdong, China.
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Sadeghi Hokmabadi E, Daei Sorkhabi A, Sarkesh A, Sadigh-Eteghad S, Mehdizadehfar E, Sadeghpoor Y, Farhoudi M. Efficacy and safety of direct oral anticoagulants versus warfarin in the treatment of cerebral venous sinus thrombosis. Acta Neurol Belg 2024; 124:1655-1662. [PMID: 38985242 DOI: 10.1007/s13760-024-02586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/14/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Given the evolving application and promising outcomes of direct oral anticoagulants (DOACs) in various thromboembolic conditions, we aimed to compare the efficacy and safety of DOACs with warfarin in the post-acute treatment of cerebral venous sinus thrombosis (CVST) using clinical and radiological parameters. METHODS A total of 140 CVST patients were enrolled, with 95 receiving warfarin and 45 receiving DOACs as post-acute treatment. Clinical and imaging parameters of the patients in follow-up visits were investigated, including the last modified Rankin Scale (mRS), venous thromboembolic events, CVST recurrence, mortality rate, recanalization status, and hemorrhagic events, to compare the efficacy and safety of treatment between the two groups. RESULTS At baseline, patients' assessments using two prognostic scores, ISCVT-RS and IN-REvASC, revealed that there was no statistically significant difference in the distribution of prognostic risk categories between the warfarin and DOACs groups. Following acute therapy, patients in the warfarin and DOACs groups were followed up for the median of 359 and 325 days, respectively. Analysis to compare the efficacy of warfarin and DOACs revealed no significant difference in last mRS scores, CVST recurrence rate, venous thromboembolic events, and recanalization status between the two groups. Additionally, there was no statistically significant difference in the risk of hemorrhagic events between warfarin and DOACs groups. CONCLUSION Our findings show that DOACs have comparable safety and efficacy in the post-acute treatment of CVST patients; however, large-scale randomized controlled trials are required to validate our findings.
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Affiliation(s)
- Elyar Sadeghi Hokmabadi
- Neurosciences Research Center (NSRC), Department of Neurology, Imam‑Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Daei Sorkhabi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aila Sarkesh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center (NSRC), Department of Neurology, Imam‑Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Mehdizadehfar
- Neurosciences Research Center (NSRC), Department of Neurology, Imam‑Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Yalda Sadeghpoor
- Neurosciences Research Center (NSRC), Department of Neurology, Imam‑Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Farhoudi
- Neurosciences Research Center (NSRC), Department of Neurology, Imam‑Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Shahid R, Zafar A. Functional outcome predictors and recanalization in cerebral venous thrombosis: A single-center cross-sectional study. Turk J Emerg Med 2024; 24:218-225. [PMID: 39564436 PMCID: PMC11573168 DOI: 10.4103/tjem.tjem_65_24] [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: 03/31/2024] [Revised: 05/26/2024] [Accepted: 05/26/2024] [Indexed: 11/21/2024] Open
Abstract
OBJECTIVES Cerebral venous thrombosis (CVT) is a rare type of stroke. Functional outcome (FOC) in CVT can be affected by different factors, and recanalization is an important determinant. This study aimed to identify the FOC predictors including recanalization in patients with CVT. METHODS This retrospective study reviewed electronic charts of patients with CVT admitted to the King Fahd Hospital of the University, a teaching and referral hospital between January 2012 and March 2023. Demographic and other clinicoradiological characteristics were noted. Factors affecting FOC were investigated using the Chi-square test, odds ratios (ORs), and 95% confidence interval (CI). RESULTS Out of 64 patients, 78% achieved good FOC. Age was significantly higher in patients having poor FOC as compared to those having good FOC (P ≤ 0.001). Women had more likelihood to be functionally independent as compared to men (OR = 1.35, 95% CI = 1.01-1.80, P = 0.02). Altered consciousness (OR = 2.94, 95% CI = 1.23-6.99, P = 0.01), venous hemorrhagic infarction (OR = 3.26, 95% CI = 1.36-7.82, P = 0.008), and nonrecanalization (OR = 1.44, 95% CI = 0.97-2.14, P = 0.02) were significantly associated with poor FOC. Hereditary thrombophilia (OR = 0.60, 95% CI = 0.31-1.12, P = 0.03) and infections (OR = 0.59, 95% CI = 0.31-1.12, P = 0.01) were associated with less likelihood of good FOC. Age ≥50 years (P = 0.01) and illness of more than 1-month duration (P = 0.01) were associated with nonrecanalization. CONCLUSION Older age, male sex, presence of venous hemorrhagic infarction, and nonrecanalization can predict poor FOC in CVT. The recanalization process can be affected by late presentation, and the plausible reason could be a delay in therapeutic anticoagulation. Further prospective and multicenter studies are needed to determine the predictors of FOC and to understand the process of recanalization in CVT.
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Affiliation(s)
- Rizwana Shahid
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, King Fahd Hospital of the University, Saudi Arabia
| | - Azra Zafar
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, King Fahd Hospital of the University, Saudi Arabia
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Chen J, Zhang J, Xiang J, Yu J, Qiu F. Impact of intelligent convolutional neural network -based algorithms on head computed tomography evaluation and comprehensive rehabilitation acupuncture therapy for patients with cerebral infarction. J Neurosci Methods 2024; 409:110185. [PMID: 38851543 DOI: 10.1016/j.jneumeth.2024.110185] [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] [Received: 03/27/2024] [Revised: 05/20/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
This work was to evaluate the impacts of comprehensive rehabilitation acupuncture therapy on the recovery of neurological function in cerebral infarction (CI) patients and to utilize convolutional neural network (CNN) intelligent algorithms to optimize head computed tomography (CT) images and improve lesion localization accuracy. 98 CI patients were divided into a control group (Ctrl group) and an experimental group (Exp group), with 48 patients in each group. The patients in the Ctrl group received CT evaluation combined with comprehensive rehabilitation acupuncture therapy. While, those in the Exp group received CT evaluation with the use of CNN algorithms for optimization, along with comprehensive rehabilitation acupuncture therapy. Acupuncture therapy included selecting acupoints on the patient's head, selecting two horizontal needling needles from top to bottom at the acupoints on the front side of the lesion, and then horizontal needling along the top midline. The differences in treatment outcomes were compared between the two groups based on Fugl-Meyer upper limb assessment (FMA) scores, Barthel Index (BI) scores, National Institutes of Health Stroke Scale (NIHSS4) scores, Modified Edinburgh-Scandinavian Stroke Scale (MESSS) scores, and hemodynamics. Simultaneously, the CT images were optimized using CNN intelligent algorithms to improve image quality and lesion localization accuracy. The results showed that the CI CT images processed by the CNN-based intelligent algorithm showed significant improvements in clarity and contrast compared to conventional CT images. The CNN-based intelligent algorithm demonstrated higher sensitivity (97.5 %, 93.8 %), higher PSNR (30.14 dB, 24.72 dB), and lower missed detection rate (0.52 %, 1.88 %) in detecting CI lesions. The total effective rate in the Exp group was 95.83 %, which was significantly higher than the 85.42 % in the Ctrl group (P < 0.05). The Exp group showed significantly higher levels in FMA and BI scores (P < 0.05). After treatment, the NIHSS4 and MESSS scores in the Exp group were lower than those in the Ctrl group (P < 0.05). Additionally, post-treatment, the plasma concentrations and whole-blood viscosity (low shear and high shear) in the Exp group were lower than those in the Ctrl group, and the plasma concentration and whole-blood viscosity (high shear) were also lower than those in the Ctrl group (P < 0.05). In conclusion, comprehensive rehabilitation acupuncture therapy had a positive impact on the recovery of neurological function in CI patients. By applying CNN-based intelligent algorithms to optimize head CT images, lesion localization accuracy can be improved, thereby guiding rehabilitation treatment more effectively.
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Affiliation(s)
- Jianlin Chen
- Department of Rehabilitation Medicine, Zhejiang Jinhua Guangfu Cancer Hospital, Jinhua, Zhejiang 321000, China
| | - Jinfeng Zhang
- Department of Rehabilitation Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China
| | - Jingjing Xiang
- Department of Geriatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China
| | - Jie Yu
- Department of Rehabilitation Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China
| | - Fanghui Qiu
- Department of Rehabilitation Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China.
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Chung Y, Ryu J, Choi SK. Surgical Thrombectomy for Extensive Cerebral Venous Sinus Thrombosis after COVID-19 Vaccination : A Novel Surgical Technique and Literature Review. J Korean Neurosurg Soc 2024; 67:578-585. [PMID: 36858803 PMCID: PMC11375069 DOI: 10.3340/jkns.2023.0026] [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: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023] Open
Abstract
Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction. Since the patient had extensive CVST, we determined that systemic anticoagulation and endovascular treatment were not suitable treatment options. Therefore, we decided on an emergency surgical treatment and performed direct surgical thrombectomy. We followed extended suboccipital approach and made multiple incisions on the sinuses, exposing the posterior superior sagittal sinus to the transverse sigmoid junction. Consequently, the clinical condition of the patient dramatically improved, resulting in a favorable outcome with a modified Rankin scale score of 0. Performing emergency open surgical thrombectomy was a technically feasible treatment option that recanalize obstructed sinuses. Importantly, the patient recovered with a good clinical outcome. Early maximal surgical thrombectomy can be an effective and lifesaving method to treat extensive CVST with hemorrhagic infarction.
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Affiliation(s)
- Yuwhan Chung
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jiwook Ryu
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
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Ranjan R, Ken‐Dror G, Martinelli I, Grandone E, Hiltunen S, Lindgren E, Margaglione M, Duchez VLC, Triquenot Bagan A, Zedde M, Giannini N, Ruigrok YM, Worrall BB, Majersik JJ, Putaala J, Haapaniemi E, Zuurbier SM, Brouwer MC, Passamonti SM, Abbattista M, Bucciarelli P, Lemmens R, Pappalardo E, Costa P, Colombi M, Aguiar de Sousa D, Rodrigues S, Canhão P, Tkach A, Santacroce R, Favuzzi G, Arauz A, Colaizzo D, Spengos K, Hodge A, Ditta R, Pezzini A, Coutinho JM, Thijs V, Jood K, Tatlisumak T, Ferro JM, Sharma P. Coma in adult cerebral venous thrombosis: The BEAST study. Eur J Neurol 2024; 31:e16311. [PMID: 38646961 PMCID: PMC11235700 DOI: 10.1111/ene.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND PURPOSE Coma is an independent predictor of poor clinical outcomes in cerebral venous thrombosis (CVT). We aimed to describe the association of age, sex, and radiological characteristics of adult coma patients with CVT. METHODS We used data from the international, multicentre prospective observational BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. Only positively associated variables with coma with <10% missing data in univariate analysis were considered for the multivariate logistic regression model. RESULTS Of the 596 adult patients with CVT (75.7% women), 53 (8.9%) patients suffered coma. Despite being a female-predominant disease, the prevalence of coma was higher among men than women (13.1% vs. 7.5%, p = 0.04). Transverse sinus thrombosis was least likely to be associated with coma (23.9% vs. 73.3%, p < 0.001). The prevalence of superior sagittal sinus thrombosis was higher among men than women in the coma sample (73.6% vs. 37.5%, p = 0.01). Men were significantly older than women, with a median (interquartile range) age of 51 (38.5-60) versus 40 (33-47) years in the coma (p = 0.04) and 44.5 (34-58) versus 37 (29-48) years in the non-coma sample (p < 0.001), respectively. Furthermore, an age- and superior sagittal sinus-adjusted multivariate logistic regression model found male sex (odds ratio = 1.8, 95% confidence interval [CI] = 1.0-3.4, p = 0.04) to be an independent predictor of coma in CVT, with an area under the receiver operating characteristic curve of 0.61 (95% CI = 0.52-0.68, p = 0.01). CONCLUSIONS Although CVT is a female-predominant disease, men were older and nearly twice as likely to suffer from coma than women.
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Affiliation(s)
- Redoy Ranjan
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
| | - Gie Ken‐Dror
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
| | - Ida Martinelli
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
- Moncucco Hospital Group, Moncucco ClinicHematology ServiceLuganoSwitzerland
| | - Elvira Grandone
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
- Medical and Surgical DepartmentUniversity of FoggiaFoggiaItaly
| | - Sini Hiltunen
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | - Veronique Le Cam Duchez
- University of Rouen Normandy, Inserm U1096, CHU RouenVascular Hemostasis Unit and Inserm CIC‐CRB 1404RouenFrance
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke UnitLocal Health Unit–Authority IRCCS of Reggio EmiliaReggio EmiliaItaly
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, Neurological InstituteUniversity of PisaPisaItaly
| | - Ynte M. Ruigrok
- UMC Utrecht Brain Centre, Department of Neurology and NeurosurgeryUniversity Medical Centre UtrechtUtrechtthe Netherlands
| | - Bradford B. Worrall
- Departments of Neurology and Public Health SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Jukka Putaala
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Elena Haapaniemi
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Susanna M. Zuurbier
- Department of Neurology, Amsterdam University Medical Centres, location AMC, Amsterdam NeuroscienceUniversity of AmsterdamAmsterdamthe Netherlands
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam University Medical Centres, location AMC, Amsterdam NeuroscienceUniversity of AmsterdamAmsterdamthe Netherlands
| | - Serena M. Passamonti
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Maria Abbattista
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Paolo Bucciarelli
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
| | - Robin Lemmens
- Department of Neurosciences, Experimental NeurologyKU Leuven–University of LeuvenLeuvenBelgium
- VIB Centre for Brain & Disease ResearchLeuvenBelgium
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Emanuela Pappalardo
- Fondazione IRCCS Ca'Granda–Ospedale Maggiore PoliclinicoA. Bianchi Bonomi Hemophilia and Thrombosis CentreMilanItaly
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
| | - Paolo Costa
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Marina Colombi
- Division of Biology and Genetics, Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Diana Aguiar de Sousa
- Stroke CentreLisbon Central University HospitalLisbonPortugal
- CEEM and Institute of Anatomy, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Sofia Rodrigues
- Centro de Estudos Egas MonizFaculdade de Medicina da Universidade de LisboaLisbonPortugal
- Department of Neurosciences, Hospital of Santa MariaUniversity of LisbonLisbonPortugal
| | - Patrícia Canhão
- Centro de Estudos Egas MonizFaculdade de Medicina da Universidade de LisboaLisbonPortugal
- Department of Neurosciences, Hospital of Santa MariaUniversity of LisbonLisbonPortugal
| | | | - Rosa Santacroce
- Medical Genetics, Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | - Giovanni Favuzzi
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
| | - Antonio Arauz
- Stroke ClinicNational Institute of Neurology and Neurosurgery Manuel Velasco SuarezMexico CityMexico
| | - Donatella Colaizzo
- Atherosclerosis and Thrombosis UnitIRCCS Home for the Relief of Suffering, S. Giovanni RotondoFoggiaItaly
| | - Kostas Spengos
- Department of Neurology, Eginition HospitalUniversity of Athens School of MedicineAthensGreece
| | - Amanda Hodge
- Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Reina Ditta
- Pathology and Molecular Medicine, Population Health Research Institute and Thrombosis and Atherosclerosis Research Institute, Hamilton Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Alessandro Pezzini
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
- Stroke Program, Department of EmergenciesParma University HospitalParmaItaly
| | - Jonathan M. Coutinho
- Department of Neurosciences, Experimental NeurologyKU Leuven–University of LeuvenLeuvenBelgium
- VIB Centre for Brain & Disease ResearchLeuvenBelgium
- Department of NeurologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - Turgut Tatlisumak
- Department of NeurologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of Clinical Neuroscience, Institute of Neuroscience and PhysiologySahlgrenska Academy at University of GothenburgGothenburgSweden
- Department of NeurologySahlgrenska University HospitalGothenburgSweden
| | - José M. Ferro
- Instituto de Medicina Molecular João Lobo AntunesUniversidade de LisboaLisboaPortugal
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal HollowayUniversity of London (ICR2UL)LondonUK
- Department of Clinical NeuroscienceImperial College Healthcare NHS TrustLondonUK
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50
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Monaco F, Guarracino F, Vendramin I, Lei C, Zhang H, Lomivorotov V, Osinsky R, Efremov S, Gürcü ME, Mazzeffi M, Pasyuga V, Kotani Y, Biondi-Zoccai G, D'Ascenzo F, Romagnoli E, Nigro Neto C, Do Nascimento VTNDS, Ti LK, Lorsomradee S, Farag A, Bukamal N, Brizzi G, Lobreglio R, Belletti A, Arangino C, Paternoster G, Bonizzoni MA, Tucciariello MT, Kroeller D, Di Prima AL, Mantovani LF, Ajello V, Gerli C, Porta S, Ferrod F, Giardina G, Santonocito C, Ranucci M, Lembo R, Pisano A, Morselli F, Nakhnoukh C, Oriani A, Pieri M, Scandroglio AM, Kırali K, Likhvantsev V, Longhini F, Yavorovskiy A, Bellomo R, Landoni G, Zangrillo A. Acute normovolemic hemodilution in cardiac surgery: Rationale and design of a multicenter randomized trial. Contemp Clin Trials 2024; 143:107605. [PMID: 38866095 DOI: 10.1016/j.cct.2024.107605] [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] [Received: 01/31/2024] [Revised: 05/12/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Minimizing the use of blood component can reduce known and unknown blood transfusion risks, preserve blood bank resources, and decrease healthcare costs. Red Blood Cell (RBC) transfusion is common after cardiac surgery and associated with adverse perioperative outcomes, including mortality. Acute normovolemic hemodilution (ANH) may reduce bleeding and the need for blood product transfusion after cardiac surgery. However, its blood-saving effect and impact on major outcomes remain uncertain. METHODS This is a single-blinded, multinational, pragmatic, randomized controlled trial with a 1:1 allocation ratio conducted in Tertiary and University hospitals. The study is designed to enroll patients scheduled for elective cardiac surgery with planned cardiopulmonary bypass (CPB). Patients are randomized to receive ANH before CPB or the best available treatment without ANH. We identified an ANH volume of at least 650 ml as the critical threshold for clinically relevant benefits. Larger ANH volumes, however, are allowed and tailored to the patient's characteristics and clinical conditions. RESULTS The primary outcome is the percentage of patients receiving RBCs transfusion from randomization until hospital discharge, which we hypothesize will be reduced from 35% to 28% with ANH. Secondary outcomes are all-cause 30-day mortality, acute kidney injury, bleeding complications, and ischemic complications. CONCLUSION The trial is designed to determine whether ANH can safely reduce RBC transfusion after elective cardiac surgery with CPB. STUDY REGISTRATION This trial was registered on ClinicalTrials.gov in April 2019 with the trial identification number NCT03913481.
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Affiliation(s)
- Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Guarracino
- Department of Cardiothoracic Anesthesia and ICU, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Igor Vendramin
- Division of Cardiac Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xi'an, China
| | - Hui Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xi'an, China
| | - Vladimir Lomivorotov
- E. Meshalkin National Medical Research Center, Department of Anesthesiology and Intensive Care, Novosibirsk, Russia; Penn State Milton S. Hershey Medical Center, Department of Anesthesiology and Perioperative Medicine, Hershey, PA, USA
| | - Roman Osinsky
- E. Meshalkin National Medical Research Center, Department of Anesthesiology and Intensive Care, Novosibirsk, Russia
| | - Sergey Efremov
- Saint Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Mustafa Emre Gürcü
- Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Vadim Pasyuga
- Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
| | - Yuki Kotani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
| | | | - Fabrizio D'Ascenzo
- Cardiovascular and Thoracic Department, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Via Pineta Sacchetti, 217, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Campus di Roma, Largo Francesco Vito, 1, 00168, Rome, Italy
| | | | | | | | | | - Ahmed Farag
- King Abdullah Medical City - Holy Capital (KAMC-HC), Makkah, Saudi Arabia
| | - Nazar Bukamal
- Cardiothoracic ICU and Anesthesia Department, Mohammed Bin Khalifa Specialist Cardiac Center, Awali 183261, Bahrain
| | - Giulia Brizzi
- Department of Cardiothoracic Anesthesia and ICU, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Rosetta Lobreglio
- Department of Anesthesia, Intensive Care and Emergency, Citta della Salute e della Scienza University Hospital, Turin, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Arangino
- Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Paternoster
- Cardiovascular Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy
| | - Matteo Aldo Bonizzoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Daniel Kroeller
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Ambra Licia Di Prima
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Valentina Ajello
- Department of Cardio Thoracic anesthesia and Intensive Care, Hospital Tor Vergata Roma, Italy
| | - Chiara Gerli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Porta
- Department of Cardiovascular Anestesia, Azienda Ospedaliera Umberto I Mauriziano, Turin, Italy
| | - Federica Ferrod
- Department of Cardiovascular Anestesia, Azienda Ospedaliera Umberto I Mauriziano, Turin, Italy
| | - Giuseppe Giardina
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Santonocito
- Anaesthesia and Intensive Care Medicine III, Policlinico University Hospital, Catania, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Pisano
- Cardiac Anesthesia and Intensive Care Unit, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
| | - Federica Morselli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Nakhnoukh
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Oriani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kaan Kırali
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valery Likhvantsev
- Department of Clinical Trials, V. Negovsky Reanimatology Research Institute, Moscow, Russian Federation; Department of Anesthesiology and Resuscitation, First Moscow State Medical University, Moscow, Russian Federation
| | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Italy
| | - Andrey Yavorovskiy
- I.M. Sechenov First Moscow State Medical University, Ministry of Public Health of Russia, Moscow, Russia
| | - Rinaldo Bellomo
- Department of Critical Care, The University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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