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1.
Brain Behav ; 14(4): e3353, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38622893

RESUMO

BACKGROUND AND RATIONALE: Cerebral venous thrombosis (CVT) is a rare cerebrovascular disorder that mainly affects young and middle-aged adults. Epidemiological data on the incidence, risk factors, diagnosis, treatment, and prognosis of CVT are lacking in China. In addition, there is a lack of evidence from large, multicenter, real-world studies on the efficacy and safety of endovascular. AIM: To understand the incidence, diagnosis and treatment status of CVT in China and to estimate the effectiveness and safety of endovascular treatment in the real-world. METHODS: A multicenter, retrospective observational cohort study will be conducted on CVT patient records from 104 hospitals, between January 1, 2018 and June 30, 2022, identified using a 2-stage cluster sampling design based on per capita gross domestic product. Each enrolled participant is required to complete a further follow-up, which includes the current situation and the assessment at 3 and 12 months after discharge. STUDY OUTCOMES: The outcomes of this study will include the current status of the incidence, pathogenesis, etiology, clinical symptoms, diagnosis, and treatment of CVT in China, as well as the effectiveness and safety of endovascular treatment in the real-world. DISCUSSION: Results from this study will provide evidence on the incidence, specific risk factors, symptomatic and imaging features, and clinical outcomes of CVT in China as well as indicate whether endovascular treatment is superior to medical management alone for patients with acute CVT in the real-world. TRIAL REGISTRATION: http://www. CLINICALTRIALS: gov. IDENTIFIER: NCT05448248.


Assuntos
Trombose Intracraniana , Trombose Venosa , Adulto , Pessoa de Meia-Idade , Humanos , Estudos Retrospectivos , Trombose Venosa/epidemiologia , Trombose Venosa/terapia , Trombose Venosa/diagnóstico , Trombose Intracraniana/terapia , Prognóstico , Sistema de Registros
2.
J Stroke Cerebrovasc Dis ; 33(6): 107720, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38614162

RESUMO

OBJECTIVES: Prognostication for cerebral venous thrombosis (CVT) remains difficult. We sought to validate the SI2NCAL2C score in an international cohort. MATERIALS AND METHODS: The SI2NCAL2C score was originally developed to predict poor outcome (modified Rankin Scale (mRS) 3-6) at 6 months, and mortality at 30 days and 1 year using data from the International CVT Consortium. The SI2NCAL2C score uses 9 variables: the absence of any female-sex-specific risk factors, intracerebral hemorrhage, central nervous system infection, focal neurological deficits, coma, age, lower level of hemoglobin, higher level of glucose, and cancer. The ACTION-CVT study was an international retrospective study that enrolled consecutive patients across 27 centers. The poor outcome score was validated using 90-day mRS due to lack of follow-up at the 6-month time-point in the ACTION-CVT cohort. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Missing data were imputed using the additive regression and predictive mean matching methods. Bootstrapping was performed with 1000 iterations. RESULTS: Mortality data were available for 950 patients and poor outcome data were available for 587 of 1,025 patients enrolled in ACTION-CVT. Compared to the International CVT Consortium, the ACTION-CVT cohort was older, less often female, and with milder clinical presentation. Mortality was 2.5% by 30 days and 6.0% by one year. At 90-days, 16.7% had a poor outcome. The SI2NCAL2C score had an AUC of 0.74 [95% CI 0.69-0.79] for 90-day poor outcome, 0.72 [0.60-0.82] for mortality by 30 days, and 0.82 [0.76-0.88] for mortality by one year. CONCLUSIONS: The SI2NCAL2C score had acceptable to good performance in an international external validation cohort. The SI2NCAL2C score warrants additional validation studies in diverse populations and clinical implementation studies.


Assuntos
Avaliação da Deficiência , Estado Funcional , Trombose Intracraniana , Valor Preditivo dos Testes , Trombose Venosa , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose Venosa/mortalidade , Trombose Venosa/diagnóstico , Trombose Venosa/terapia , Fatores de Risco , Adulto , Reprodutibilidade dos Testes , Fatores de Tempo , Prognóstico , Idoso , Trombose Intracraniana/mortalidade , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/terapia , Técnicas de Apoio para a Decisão , Medição de Risco
3.
Rev Clin Esp (Barc) ; 224(4): 237-244, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38428733

RESUMO

Cerebral venous thrombosis is part of the so-called thrombosis in unusual sites. It is defined as an occlusion in the cerebral venous territory. Its incidence is progressively increasing, especially in developing countries. It is more frequently observed in young women, with hormonal factors such as pregnancy or hormonal contraception being significant risk factors in the development of this condition. The clinical presentation will depend fundamentally on the topography of the thrombosis, with a confirmatory diagnosis based mainly on imaging tests. The treatment generally consists of anticoagulation, and other options may be considered depending on the severity of the case. Overall, the prognosis is better than that of other intracranial vascular disorders. This review describes the current evidence available regarding cerebral venous thrombosis.


Assuntos
Transtornos Cerebrovasculares , Trombose Intracraniana , Trombose , Doenças Vasculares , Trombose Venosa , Gravidez , Humanos , Feminino , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/etiologia , Trombose Intracraniana/terapia , Fatores de Risco , Trombose Venosa/diagnóstico , Trombose Venosa/terapia
4.
Neurol Sci ; 45(5): 2341-2345, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38221542

RESUMO

BACKGROUND: Endovascular thrombectomy (EVT) is a treatment option in patients with a cerebral venous thrombosis (CVT) who deteriorate despite anticoagulant treatment. Assessment of thrombus composition in CVT may provide insights into the pathophysiology of the disease and suggest new therapeutic strategies. CASE REPORT: A 47-year-old woman (smoking habit and estradiol/progesterone-releasing intra-uterine device) diagnosed with massive CVT underwent EVT (complete recanalization via aspiration catheter and stentriever) due to acute-onset left-sided weakness and dysarthria despite 72 h of full-dose subcutaneous low-molecular heparin. Two main reddish clots (maximum diameter 15 mm) were retrieved. Microscopic assessment showed an erythrocyte-rich thrombus (83.9% of entire thrombus surface) with layers of platelets/fibrin (lines of Zahn: 13.9% fibrin and 38.5% platelet [CD61+]). The immunological profile was dominated by neutrophils (30% MPO+), with neutrophil extracellular traps (NETs) in 1.9% of thrombus surface. T- (CD3+), B-lymphocytes (CD20+), and monocytes/macrophages (CD68+) were rather rare (2.2%, 0.7%, and 2.0% respectively). We found no evidence (0.0%) of hemosiderin and endothelial cells (CD34+). Full clinical recovery occurred prior to discharge. CONCLUSION: This is the first case report of a CVT with histologic assessment of the thrombus retrieved via EVT. Evaluating thrombi in CVT can provide key insights into disease pathophysiology and guide treatment advancements.


Assuntos
Trombose Intracraniana , Trombose , Trombose Venosa , Feminino , Humanos , Pessoa de Meia-Idade , Células Endoteliais/patologia , Trombectomia , Trombose Intracraniana/complicações , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia , Fibrina
5.
Stroke ; 55(3): e77-e90, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38284265

RESUMO

Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.


Assuntos
Trombose Intracraniana , Trombose dos Seios Intracranianos , Trombose Venosa , Humanos , Feminino , American Heart Association , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Angiografia por Ressonância Magnética , Cavidades Cranianas , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia , Trombose dos Seios Intracranianos/tratamento farmacológico
6.
Neurologia (Engl Ed) ; 39(3): 226-234, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37442428

RESUMO

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE: The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS: We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS: We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P =  .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION: The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.


Assuntos
Trombose Intracraniana , Acidente Vascular Cerebral , Trombose Venosa , Adulto Jovem , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Espanha , Trombose Venosa/terapia , Trombose Venosa/tratamento farmacológico , Trombose Intracraniana/terapia , Trombose Intracraniana/tratamento farmacológico
7.
Medicine (Baltimore) ; 102(48): e36366, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38050259

RESUMO

Cerebral venous thrombosis is a rare cause of stroke in young mostly female adults which is frequently overlooked due to its variable clinical and radiological presentation. This review summarizes current knowledge on it risk factors, management and outcome in adults and highlights areas for future research. Females are 3 times more commonly affected and are significantly younger than males. The presenting symptoms can range from headache to loss of consciousness. However, the often-nebulous nature of symptoms can make the diagnosis challenging. Magnetic resonance imaging with venography is often the diagnostic imaging of choice. While unfractionated or low molecular-weight heparin is the mainstay of treatment, endovascular intervention with thrombolysis or thrombectomy and decompressive craniectomy may be required depending on clinical status. Nevertheless, approximately 80% of patients have a good recovery but mortality rates of -5% to 10% are not uncommon. Diagnosing cerebral venous thrombosis can be challenging but with vigilance and expert care patients have the best chance of a good clinical outcome.


Assuntos
Trombose Intracraniana , Trombose dos Seios Intracranianos , Trombose Venosa , Masculino , Adulto , Humanos , Feminino , Trombose Intracraniana/terapia , Trombose Intracraniana/tratamento farmacológico , Heparina de Baixo Peso Molecular/uso terapêutico , Imageamento por Ressonância Magnética , Cavidades Cranianas , Trombose Venosa/diagnóstico , Trombose Venosa/terapia , Trombose Venosa/patologia , Trombose dos Seios Intracranianos/terapia , Trombose dos Seios Intracranianos/tratamento farmacológico
8.
J Am Heart Assoc ; 12(19): e030421, 2023 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-37753785

RESUMO

Background Identifying factors associated with delayed diagnosis of cerebral venous thrombosis (CVT) can inform future strategies for early detection. Methods and Results We conducted a retrospective cohort study including all participants from ACTION-CVT (Anticoagulation in the Treatment of Cerebral Venous Thrombosis) study who had dates of neurologic symptom onset and CVT diagnosis available. Delayed diagnosis was defined as CVT diagnosis occurring in the fourth (final) quartile of days from symptom onset. The primary study outcome was modified Rankin Scale score of ≤1 at 90 days; secondary outcomes included partial/complete CVT recanalization on last available imaging and modified Rankin Scale score of ≤2. Logistic regression analyses were used to identify independent variables associated with delayed diagnosis and to assess the association of delayed diagnosis and outcomes. A total of 935 patients were included in our study. Median time from symptom onset to diagnosis was 4 days (interquartile range, 1-10 days). Delayed CVT diagnosis (time to diagnosis >10 days) occurred in 212 patients (23%). Isolated headache (adjusted odds ratio [aOR], 2.36 [95% CI, 1.50-3.73]; P<0.001), older age (aOR by 1 year, 1.02 [95% CI, 1.004-1.03]; P=0.01), and papilledema (aOR, 2.00 [95% CI, 1.03-3.89]; P=0.04) were associated with diagnostic delay, whereas higher National Institutes of Health Stroke Scale score was inversely associated with diagnostic delay (aOR by 1 point, 0.95 [95% CI, 0.89-1.00]; P=0.049). Delayed diagnosis was not associated with modified Rankin Scale score of ≤1 at 90 days (aOR, 1.08 [95% CI, 0.60-1.96]; P=0.79). Conclusions In a large multicenter cohort, a quarter of included patients with CVT were diagnosed >10 days after symptom onset. Delayed CVT diagnosis was associated with the symptom of isolated headache and was not associated with adverse clinical outcomes.


Assuntos
Trombose Intracraniana , Trombose Venosa , Humanos , Diagnóstico Tardio , Estudos Retrospectivos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/complicações , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Cefaleia/complicações , Fatores de Risco
9.
CNS Neurosci Ther ; 29(10): 2760-2774, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37365966

RESUMO

BACKGROUND: Cerebral venous thrombosis, a rare stroke, is characterized by neurological dysfunction caused by bleeding and/or infarction resulting from venous sinus thrombosis, the so-called venous stroke. Current guidelines recommend anticoagulants as first-line therapy in the treatment of venous stroke. With complicated causes of cerebral venous thrombosis, treatment is difficult, especially when combined with autoimmune diseases, blood diseases, and even COVID-19. AIMS: This review summarizes the pathophysiological mechanisms, epidemiology, diagnosis, treatment, and clinical prognosis of cerebral venous thrombosis combined with autoimmune diseases, blood diseases, or infectious diseases such as COVID-19. CONCLUSION: A systematic understanding of particular risk factors that should not be neglected when unconventional cerebral venous thrombosis occurs and for a scientific understanding of pathophysiological mechanisms, clinical diagnosis, and treatment, thus contributing to knowledge on special types of venous stroke.


Assuntos
Doenças Autoimunes , COVID-19 , Trombose Intracraniana , Trombose dos Seios Intracranianos , Acidente Vascular Cerebral , Trombose Venosa , Humanos , COVID-19/complicações , Anticoagulantes/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Trombose Intracraniana/complicações , Trombose Intracraniana/terapia , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico , Doenças Autoimunes/tratamento farmacológico , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/terapia , Trombose dos Seios Intracranianos/induzido quimicamente
10.
J Atheroscler Thromb ; 30(7): 701-709, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37183021

RESUMO

Intracranial branch atheromatous disease (BAD) is a pathological condition characterized by the occlusion of a relatively large perforating branch (700-800 µm) near the orifice of a parent artery due to atherosclerotic plaque-based thrombus (microatheroma). BAD is refractory to treatment and follows a course of progressive exacerbation, especially motor paralysis. Uniform treatment for common atherothrombotic cerebral infarction or lacunar infarction does not prevent the progressive exacerbation of BAD, and consequently affects functional prognosis. To date, various combinations of treatments have been investigated and proposed to attenuate the worsening symptoms of BAD. However, no therapy with established efficacy is yet available for BAD. Since it is the most difficult condition to treat in the area of cerebral infarction, the establishment of optimal treatment methods for BAD is keenly awaited. This review presents an overview of the acute treatments available for BAD and discusses the prospects for optimal treatment.


Assuntos
Trombose Intracraniana , Placa Aterosclerótica , Placa Aterosclerótica/fisiopatologia , Placa Aterosclerótica/terapia , Humanos , Trombose Intracraniana/fisiopatologia , Trombose Intracraniana/terapia , Infarto Cerebral , Acidente Vascular Cerebral Lacunar , Terapia Antiplaquetária Dupla
11.
Cerebrovasc Dis ; 52(4): 393-400, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36566747

RESUMO

INTRODUCTION: Cerebral venous thrombosis (CVT) associated with pregnancy and puerperium has long been recognized, with poor information in terms of functional outcomes. Our objective was to analyze risk factors, clinical, imaging, and laboratory variables to predict functional outcome and death in this population. METHODS: CVT registries from three referral centers from Pakistan, Turkey, and Mexico, recruiting prospective cases, were combined for CVT associated with pregnancy or puerperium. Datasets and variables were standardized. Demographic characteristics, presentation, risk factors, and functional outcomes in pregnancy/puerperium-related CVT were analyzed. Binary logistic regression was used to assess predictors of outcome. The main outcome was modified Rankin score >2 at 30 days and mortality at 30 days. RESULTS: Five hundred fifty-three cases (median age 28 years [IQR 23-34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified. Predictors of poor outcome (mRS >2) were encephalopathy (OR 12.8, p < 0.001), cases from Mexican origin (OR 3.1, p = 0.004), fever/puerperal infection (OR 2.7, p = 0.02), and anemia (OR 2.2, p = 0.01). Cases from Mexican origin (OR 12.0, p = 0.003) and Encephalopathy (OR 7.7, p < 0.001), presented with the highest mortality association in the final adjusted model. DISCUSSION/CONCLUSION: In CVT associated with pregnancy and puerperium, encephalopathy, fever/puerperal infection, and anemia are associated with bad functional outcomes, meanwhile encephalopathy and cases from Mexican origin with higher mortality in the acute (30-days) of CVT onset. Anemia and infection are potential reversible predictors of poor outcome that clinicians should be aware of in order to prevent poor outcomes in these patients.


Assuntos
Anemia , Encefalopatias , Trombose Intracraniana , Infecção Puerperal , Trombose Venosa , Gravidez , Feminino , Humanos , Adulto , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Anemia/complicações , Encefalopatias/complicações , Período Pós-Parto , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
12.
Cerebrovasc Dis ; 52(2): 130-136, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35981508

RESUMO

Epidemiological data on cerebral venous thrombosis in China are still lacking at present on the aspects of incidence, recurrence, risk factors, and so on. Herein, we aimed to fill the gap, based on the result of this multicenter prospective cohort study. A total of 26 top tertiary hospitals distributed in China Mainland will take part in this study. For the first time, a dataset of cerebral venous thrombosis cohort (including multiethnic patients of all ages in almost all regions of Mainland China, regardless of gender) will be built. Inclusion criteria were as follows: (1) aged ≥14 years, (2) neuroimaging-confirmed cerebral venous thrombosis, (3) symptom onset was within 30 days prior to enrollment, (4) signed the informed consent form. Demographic data, risk factors, clinical and neuroimaging features, ophthalmologic and aural results, blood tests, cerebrospinal fluid examination, therapeutic strategies, and adverse events were analyzed. Two milliliters of fasting venous blood and 2 mL of cerebrospinal fluid will be collected and stored. Furthermore, patients will be followed up at months 1, 3, 6, and 12 after baseline assessment. Primary outcome will be all-cause mortality. Secondary outcomes: (1) cerebrospinal fluid pressure and Frisen grade; (2) recanalization rate on imaging; (3) rating scales such as GCS, NIHSS, mRS, Mini-Mental State Examination, Montreal Cognitive Assessment, Patient Health Questionnaire 9-item, HIT-6, and Tinnitus Handicap Index. This study will for the first time provide strong evidence on the incidence rate, recurrence rate, and demographic data, as well as special risk factors, clinical outcomes, symptomatic and imaging features of cerebral venous thrombosis in Chinese population. The results of this study will also provide an important reference on prevention, early diagnosis, and customized treatment of cerebral venous thrombosis in Chinese patients.


Assuntos
Trombose Intracraniana , Trombose Venosa , Humanos , Estudos Prospectivos , China , Neuroimagem , Trombose Venosa/tratamento farmacológico , Trombose Intracraniana/terapia , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto
13.
Arq Neuropsiquiatr ; 80(5 Suppl 1): 53-59, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35976298

RESUMO

Cerebral venous sinus thrombosis (CVT) consists of partial or complete occlusion of a sinus or a cerebral vein. CVT represents 0.5-1% of all strokes and is more frequent in young women. This review discusses particular aspects of CVT diagnosis and management: decompressive craniectomy (DC), anticoagulation with direct oral anticoagulants (DOACs), CVT after coronavirus-disease 19 (COVID-19) and Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT).


Assuntos
COVID-19 , Veias Cerebrais , Trombose Intracraniana , Trombose Venosa , Anticoagulantes/uso terapêutico , Feminino , Humanos , Trombose Intracraniana/terapia , Trombose Venosa/terapia
15.
Semin Thromb Hemost ; 48(3): 309-317, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35170006

RESUMO

Cerebral venous thrombosis (CVT) is a rare form of stroke that often affects younger age groups, especially reproductive age group females. CVT is a potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. Headache is the most common presenting symptom. However, a wide range of symptoms can be present and the symptom onset can be acute, subacute, or chronic. Neuroimaging is mandatory in cases where CVT is suspected. Both magnetic resonance venography and computed tomography venography can confirm a diagnosis of CVT. Anticoagulation with low-molecular-weight heparin is the mainstay of treatment. Intracranial hemorrhage is not considered a contraindication to the use of anticoagulants in CVT. Endovascular intervention is still controversial but can be a treatment option for patients with neurological deterioration or thrombus progression, despite the use of anticoagulation or with development of new or worsening intracerebral hemorrhage. Patients with CVT have an increased risk of recurrence of CVT and other types of venous thromboembolism. This review provides an overview of the epidemiology, diagnosis, and treatment of CVT in adults. Commentary about increased presentation of CVT in patients with coronavirus disease 2019 (COVID-19), or after immunization against COVID-19, is also provided.


Assuntos
COVID-19 , Trombose Intracraniana , Trombose Venosa , Adulto , Anticoagulantes/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Trombose Intracraniana/tratamento farmacológico , Trombose Intracraniana/terapia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/terapia
16.
Emerg Nurse ; 30(2): 27-31, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34697934

RESUMO

The increased risk of stroke during pregnancy and the puerperium - defined as being the first six weeks post-partum - has been well documented. The incidence, however, is still very low and has been estimated at 30 per 100,000 pregnancies. Strokes can result from several causes, including ischaemia, intracerebral bleeds, subarachnoid bleeds and venous thrombosis. Cerebral venous thrombosis (CVT) - a complete or partial occlusion of the major cerebral venous sinuses or cortical veins - accounts for 27%-57% of all pregnancy and puerperium-related strokes, which would equate to an incidence of 8-16 episodes per 100,000 deliveries. This article discusses the case of a young woman who presented to the emergency department complaining of bilateral eye pain. It considers the causes, the variability of presenting symptoms, diagnosis and treatment options for CVT. Given the variability of the condition's presentation, this article aims to assist nurses in identifying at-risk patients and promotes the benefits of collaboration with colleagues to improve patient outcomes.


Assuntos
Trombose Intracraniana , Acidente Vascular Cerebral , Trombose Venosa , Feminino , Humanos , Trombose Intracraniana/complicações , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/terapia , Período Pós-Parto , Gravidez , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Trombose Venosa/diagnóstico
17.
J Stroke Cerebrovasc Dis ; 30(9): 105954, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217069

RESUMO

OBJECTIVES: An isolated intraventricular cerebral varix is a rare entity. Although it is generally asymptomatic, there have been reports of symptomatic cases. Here, we report a case of right hemiplegia and aphasia due to venous infarction caused by thrombosis of the intraventricular varix. CASE PRESENTATION: A 79-year-old woman presented with right-sided hemiplegia and aphasia accompanied by conjugate eye deviation to the left. She had a history of hypertension, dyslipidemia, and asymptomatic isolated cerebral varix located in the left lateral ventricle. Blood analysis indicated no abnormalities in coagulation or fibrinolysis. Plain head computed tomography showed an intraventricular varix in the form of a high-density mass, indicating acute phase thrombosis, and contrast-enhanced computed tomography depicted a filling defect in the varix. In addition, fluid-attenuated inversion recovery imaging showed hyperintense lesions in the deep white matter of the frontal-parietal lobe, indicating venous infarction due to occlusion of the varix of the thalamostriate vein. Glycerol and prophylactic levetiracetam were administered, and she was transferred to another hospital for rehabilitation 23 days after treatment initiation. CONCLUSION: This is the first reported case in which a typically asymptomatic condition, intraventricular cerebral varix, caused venous infarction due to thrombosis and occlusion of the varix of the thalamostriate vein. Careful selection of the treatment strategy is required on a case-by-case basis because an intraventricular varix can cause both bleeding and infarction, which are treated differently.


Assuntos
Infarto Cerebral/etiologia , Trombose Intracraniana/etiologia , Varizes/complicações , Trombose Venosa/etiologia , Idoso , Afasia/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Feminino , Hemiplegia/etiologia , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/terapia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
19.
World Neurosurg ; 152: e467-e475, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34089913

RESUMO

BACKGROUND: Focal brain edema in unruptured brain arteriovenous malformations (AVMs) is rare and associated with venous outflow abnormalities and aneurysm growth. These patients have an increased rate of progressive neurologic symptoms, as well as a potentially increased risk of hemorrhage. In this study, we aim to assess in further detail the relationship between perifocal edema and enhancement of the vessel wall in symptomatic patients with an unruptured brain AVM. METHODS: A single-center retrospective cohort study of all patients presenting with an unruptured AVM at Toronto Western Hospital from 2009 to 2019 was performed. Patients were included for review if they had focal edema surrounding an AVM on magnetic resonance imaging (MRI) and a contrast-enhanced MRI scan. Associated digital subtraction angiography studies were reviewed. RESULTS: A total of 122 patients presented with an unruptured AVM. Twelve symptomatic patients presented with focal edema surrounding the AVM. Six patients had focal edema and contrast-enhanced MRI performed. All 6 demonstrated luminal thrombosis at the level of the brain edema on MRI. Moreover, the vessel wall demonstrated enhancement at the level of the luminal thrombus in all. CONCLUSIONS: Vessel wall enhancement, perifocal edema, and luminal thrombosis demonstrated in all patients with unruptured AVM points towards a common mechanism. We suspect an interplay between vascular hypoxia, the innate immune system, and thrombosis formation. Current research in the field of immunothrombosis supports this theory. Unravelling the mechanisms involved is important because it might guide therapy for patients with an unruptured AVM towards noninvasive options.


Assuntos
Vasos Sanguíneos/patologia , Edema Encefálico/terapia , Malformações Arteriovenosas Intracranianas/terapia , Trombose Intracraniana/terapia , Idoso , Angiografia Digital , Encéfalo/patologia , Edema Encefálico/etiologia , Edema Encefálico/cirurgia , Circulação Cerebrovascular , Estudos de Coortes , Procedimentos Endovasculares/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/cirurgia , Trombose Intracraniana/etiologia , Trombose Intracraniana/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
J Stroke Cerebrovasc Dis ; 30(8): 105755, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34116489

RESUMO

OBJECTIVE: The aim of the present study was to determine whether there is a correlation between thrombotic pathology and prognosis of endovascular treatment (EVT) for acute ischemic stroke (AIS). METHODS: Thrombi were taken from 58 patients with cerebral ischemic thrombosis who were consecutively selected for EVT for AIS. The collected thrombi then underwent hematoxylin-eosin staining for pathological examinations to determine the red blood cell (RBC) ratio and fibrin/platelet components. The patients were divided into the following three groups according to their proportions of RBCs in thrombi: RBC-rich group (RBC ratio ≥ 70%), mixed group (RBC ratio at 31-69%), and fibrin/platelet-rich group (RBC ratio ≤ 30%). Prognosis was classified into good (0-2 points on modified Rankin scale [mRS] at postoperative 90 days) and poor (3-6 points on mRS at postoperative 90 days). Correlational analysis was performed between thrombotic pathology and prognosis of EVT for AIS. RESULTS: Among all patients, the distributions were as follows: 18.96% (11/58) patients in the RBC-rich group, 63.79% (37/58) patients in the mixed group, and 17.24% (10/58) patients in the fibrin/platelet-rich group. In addition, 43.10% (25/58) of the patients had good prognosis and 56.90% (33/58) had poor prognosis.There was no statistically significant difference between the good prognosis and the poor prognosis in the RBC-rich group, the mixed group, and the fibrin/platelet-rich group (P=0.713, 0.829, 0.748).Multivariate logistic regression analysis to explored the association between RBC-rich group and good prognosis while adjusting for other baseline prognostic factors (age, ASPECTS, NIHSS score, and PRT and intravenous alteplase-bridging therapy). Compared to the fibrin/platelet-rich group, the odds ratio(OR) of achieving good prognosis was 0.60 (P = 0.592) for the mixed group and OR = 0.74 (P = 0.793) for the RBC-rich group.Notably, age was found to be negatively associated with good prognosis (OR = 0.91, P = 0.013). The ASPECTS score was found to be positively associated with good prognosis (OR = 2.01, P = 0.002). Alteplase bridging was associated with a marginally significant positive association with good prognosis (OR = 4.23, P = 0.083). CONCLUSIONS: No correlation was found between thrombotic pathology and prognosis of EVT for AIS. Good prognosis after endovascular treatment was associated with low age, high ASPECTS at admission, and alteplase bridging.


Assuntos
Plaquetas/patologia , Procedimentos Endovasculares , Eritrócitos/patologia , Trombose Intracraniana/terapia , AVC Isquêmico/terapia , Fatores Etários , Idoso , Plaquetas/química , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Fibrina/análise , Fibrinolíticos/uso terapêutico , Humanos , Trombose Intracraniana/sangue , Trombose Intracraniana/patologia , AVC Isquêmico/sangue , AVC Isquêmico/patologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Stents , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
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