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OBJECTIVE: We aimed to describe clinical and laboratory characteristics and determine the predictors of outcome in patients with cerebral venous sinus thrombosis. METHODS: This prospective study was conducted over 2 years among hospitalized patients with cerebral venous sinus thrombosis. Patient outcome was assessed using the Modified Rankin Scale (mRS) score at 3 months. Outcome predictors were identified using logistic regression analysis. RESULTS: Eighty-one patients were included in this study. The median mRS outcome at 3 months was 1 (interquartile range 1-3). Poor outcomes were observed in 27.2% of patients, and the mortality rate was 9.8%. Factors associated with poor outcomes were age >60 years (relative risk [RR] 5.1), hemiparesis (RR 5.4), altered level of consciousness (RR 7.1), and transverse sinus involvement (RR 1.1). In general, mRS scores were not associated with D-dimer levels (RR 2.4). However, older patients with elevated D-dimer levels showed a significant association with poor outcomes (1.6) according to mRS scores. CONCLUSION: Older age, hemiparesis, and altered consciousness levels were independent predictors of poor outcomes in patients with cerebral venous sinus thrombosis. High D-dimer level showed no association with functional disability, except in older patients.
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Productos de Degradación de Fibrina-Fibrinógeno , Trombosis de los Senos Intracraneales , Humanos , Femenino , Masculino , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/mortalidad , Persona de Mediana Edad , Adulto , Bangladesh/epidemiología , Estudios Prospectivos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Pronóstico , Derivación y Consulta , Anciano , Factores de Riesgo , Paresia/etiologíaAsunto(s)
Lupus Eritematoso Sistémico , Trombosis de los Senos Intracraneales , Humanos , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Imagen por Resonancia Magnética/métodos , Trombosis de los Senos Intracraneales/etiología , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND: Cerebral venous thrombosis (CVT) is an uncommon and frequently unrecognized type of stroke that affects approximately five people per million annually, accounts for 0.5 to 1% of all strokes, and is more commonly seen in young individuals. The exact incidence of CVT in India remains unknown. The risk factors for venous thrombosis in general are linked classically to the Virchow's triad of stasis of the blood, changes in the vessel wall, and changes in the composition of the blood. There have been numerous studies evaluating long-term as well as short-term outcomes in the presence of these inflammatory mediators. They have been reported to be beneficial in predicting outcome and, hence, potentially in guiding management. AIMS: Evaluation of prevailing risk factors associated with cerebral venous sinus thrombosis (CVST). Description of the distribution of newer inflammatory markers among the study population and their association with functional and neurologic outcome at 30 days following the occurrence of cerebral VST. MATERIALS AND METHODS: Approval from the Institutional Review Board was obtained. Written informed consent was given by willing patients, explained in vernacular. Relevant details were obtained via a clinical history and laboratory values and imaging data obtained from the hospital's electronic health information system, which were then recorded in the proforma. No personal identifying data was collected. The sample size for this study was lower than originally planned, owing to the coronavirus disease 2019 (COVID-19) pandemic. The patients were called for follow-up after 1 month of the detection of VST, and their neurologic status was recorded on the Glasgow Coma Scale (GCS) and functional status on the modified Rankin Scale (mRS). Descriptive analysis of baseline characteristics was done. Mann-Whitney U and Kruskal-Wallis H tests of significant difference between means for nonparametric data were used. Linear regression was carried out on the variables found to differ significantly among subpopulations having good and poor neurologic outcomes. Receiver operating characteristic (ROC) curves were then derived for both outcome categories. RESULTS: The study enrolled 30 patients, with ages from 18 to 70 years, of which 19 (63.3%) were male and 11 (36.67%) were female. No risk factor was identified in 23.3% of cases. The most common risk factor was the presence of substance abuse. Among presenting features, headaches were the most common, followed by seizures and focal neurologic deficits (83.3, 30, and 23.3, respectively). Coexisting intraparenchymal hemorrhage was seen in 46.67% of patients, with the transverse sinuses most commonly involved (28.77%). The median neutrophil-to-lymphocyte ratio (NLR) was 3.415 [interquartile range (IQR) 2.634-5.637], with median platelet-to-lymphocyte ratio (PLR) 160.728 (IQR 107.728-227.776) and median systemic immune-inflammation index (SII) 1067.883 (IQR 509.694-1522.837). The NLR, PLR, and SII values were found to differ significantly among subgroups having good and poor neurologic outcome on the mRS. PLR and SII significantly differed among subgroups with venous involvement and among subgroups with good and poor neurologic status on GCS, on admission as well as 30-day follow-up. NLR, PLR, and SII values on admission showed a positive association with poor neurologic outcomes. CONCLUSION: Here, a significant correlation is seen between the values of complete blood count (CBC)-derived inflammatory markers on admission. Higher-powered studies are needed to assess the potential benefits of incorporating these markers in existing risk stratification models to improve their predictive accuracy.
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Trombosis de los Senos Intracraneales , Humanos , Trombosis de los Senos Intracraneales/epidemiología , Trombosis de los Senos Intracraneales/diagnóstico , Femenino , Masculino , Adulto , Factores de Riesgo , Persona de Mediana Edad , India/epidemiología , Adulto Joven , Adolescente , Biomarcadores/sangreRESUMEN
Females are at higher risk than males for a multitude of cerebrovascular conditions, both common and rare; partially resulting from a complex interplay between differing process involving genetics, hormonal influences, common cerebrovascular risk factors among others. Specific topics including cervical artery dissection, cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, migraine, along with these disorders in the setting of pregnancy, puerperium and oral contraceptive utilization. Epidemiology, pathophysiology, presentation, basics of management and outcomes are presented, with sex differences throughout.
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Trastornos Migrañosos , Trombosis de los Senos Intracraneales , Vasoconstricción , Humanos , Femenino , Embarazo , Trastornos Migrañosos/fisiopatología , Trastornos Migrañosos/diagnóstico , Factores de Riesgo , Masculino , Trombosis de los Senos Intracraneales/fisiopatología , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/complicaciones , Factores Sexuales , Anticonceptivos Orales/efectos adversos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/etiología , Periodo Posparto , Disparidades en el Estado de Salud , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/complicaciones , Disección Aórtica/fisiopatología , Medición de Riesgo , Pronóstico , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Circulación CerebrovascularRESUMEN
Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting illness that can progress to systemic lupus erythematosus (SLE) in approximately 30% of cases. Neurological injuries can occur in both diseases, albeit with distinct presentations. Venous sinus thrombosis is a serious cerebrovascular complication in patients with neuropsychiatric SLE but is rarely observed in patients with KFD. The involvement of various antibodies, particularly antiphospholipid antibodies, can cause vascular endothelial cell injury, resulting in focal cerebral ischemia and intracranial vascular embolism in SLE. However, there are cases in which thrombotic pathology occurs without antiphospholipid antibody positivity, attributed to vascular lesions. In this report, we present a case of KFD and lupus encephalopathy featuring cerebral venous sinus thrombosis, despite the patient being negative for antiphospholipid antibody. We also conducted a comparative analysis of C3 and C4 levels in cerebrospinal fluid (CSF) and peripheral blood, along with the protein ratio in CSF and serum, to elucidate the pathological changes and characteristics of lupus encephalopathy.
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Linfadenitis Necrotizante Histiocítica , Lupus Eritematoso Sistémico , Trombosis de los Senos Intracraneales , Humanos , Linfadenitis Necrotizante Histiocítica/diagnóstico , Linfadenitis Necrotizante Histiocítica/complicaciones , Linfadenitis Necrotizante Histiocítica/patología , Trombosis de los Senos Intracraneales/etiología , Trombosis de los Senos Intracraneales/diagnóstico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Femenino , AdultoRESUMEN
Objective: To explore the clinical characteristics of neutrophil extracellular trap (NET) in patients with severe cerebral venous sinus thrombosis (CVST) and to study their prognostic value in the acute and subacute phases. Methods: This study is a retrospective case series analysis. Clinical and pathological data of 52 patients with severe cerebral venous sinus thrombosis who underwent endovascular treatment in the Department of Neurosurgery, Tianjin Huanhu Hospital from June 2019 to June 2022 were retrospectively analyzed. There were 20 males and 32 females, with an age of (40.1±13.6) years(range:18 to 66 years). Forty-five healthy physical examinees were included in the control group. High-resolution MRI was used to stage the thrombus, with 11 cases in the acute group, 28 cases in the subacute group, and 13 cases in the chronic group. Thrombus specimens were obtained through endovascular treatment, and the fluorescence intensity of NET in peripheral blood at different time points was analyzed by immunofluorescence contrast,including the double-stranded DNA structure and adhesion protein components (citrolinated histone H3 (CitH3), myeloperoxidase-DNA complex(MPO-DNA), neutrophil elastase (NE)). The NET markers were determined by ELISA. Spearman rank correlation analysis was used to analyze the correlation between the NET markers in peripheral blood of patients with severe cerebral venous sinus thrombosis in the acute and subacute phases and the volume of venous sinus thrombus, the degree of venous sinus recanalization after treatment, and the discharge modified Rankin scale(mRS)score. The accuracy of NET markers in predicting the prognosis of patients with severe cerebral venous sinus thrombosis was analyzed by drawing receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Results: The results of immunofluorescence staining and ELISA showed that no NET structure was formed in the peripheral blood of the control group, while CitH3, MPO-DNA and NE levels in the peripheral blood of CVST patients were increased, among which the acute stage group was the highest, followed by the subacute group, and the chronic group was the lowest. Spearman correlation analysis showed that CitH3, MPO-DNA and NE levels in peripheral blood of patients in acute group and subacute group were positively correlated with thrombus volume and mRS score at discharge (P<0.05). The levels of CitH3 and MPO-DNA in peripheral blood of patients with complete venous sinus recanalization were lower than those of patients with partial venous sinus recanalization (P<0.01). ROC curve analysis results showed that MPO-DNA and NE had no predictive ability for the prognosis of CVST patients (P values were 0.614 and 0.324, respectively), and the AUC of CitH3 was 0.800 (95%CI: 0.638~0.962, P=0.032), the best cut-off value was 13.5 µg/L, the sensitivity was 100%, and the specificity was 58.8%. Conclusions: A large number of NET are formed in patients with severe cerebral venous sinus thrombosis in acute stage. Patients with severe cerebral venous sinus thrombosis in acute stage and subacute stage with high peripheral blood NET content has a low rate of complete sinus revascularization and poor neurological function recovery after treatment.
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Trampas Extracelulares , Trombosis de los Senos Intracraneales , Humanos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Trombosis de los Senos Intracraneales/diagnóstico , Persona de Mediana Edad , Pronóstico , Trampas Extracelulares/metabolismo , Adulto Joven , Adolescente , Anciano , Neutrófilos , Elastasa de Leucocito/sangre , Elastasa de Leucocito/metabolismo , Peroxidasa/metabolismo , Imagen por Resonancia MagnéticaRESUMEN
PURPOSE: We hope that by analyzing the clinical features of cerebral venous sinus thrombosis (CVST), we can help ophthalmologists reduce misdiagnosis or delayed diagnosis. DESIGN: We evaluated 47 patients with CVST in terms of clinical manifestations. METHODS: All cases were analyzed in terms of risk factors, clinical symptoms, ophthalmic examination, imaging examination and lumbar puncture. RESULTS: The body mass indices (BMIs) of 41 patients (87.2%; 95% CI, 77.7-96.8%) were≥24, which is overweight by Chinese standards. There were 22 patients (46.8%; 95% CI, 32.5-61.1%) with BMIs≥28, who were considered obese. Thirteen were hypertensive (27.7%; 95% CI, 14.9-40.5%). The initial symptoms included blurred vision (23, 48.9%; 95% CI, 34.6-63.2%), amaurosis fugax (13, 27.7%; 95% CI, 14.9-40.5%), headache (11 patients, 23.4%; 95% CI, 11.3-35.5%), dizziness (3, 6.4%; 95% CI, -0.6-13.4%), and bilateral diplopia (3, 6.4%; 95% CI, -0.6-13.4%). There were 9 patients (9, 19.2%; 95% CI, 7.9-30.4%) with blindness, 23 patients (48.9%; 95% CI, 34.6-63.2%) with pupillary abnormalities, and 40 patients (85.1%; 95% CI, 74.9-95.2%) with papilledema. Forty-three of the 45 patients who successfully underwent a routine lumbar puncture showed high intracranial pressure (91.7%; 95.6% CI, 89.6-101.6%). Finally, two cases are reported in greater detail for illustrative purposes. CONCLUSION: The main reasons interfering with the diagnosis of CVST might be its nonspecific ocular symptoms and the physicians' clinical thought process being limited to the scope of common ophthalmological diseases.
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Oftalmología , Trombosis de los Senos Intracraneales , Humanos , Pacientes Internos , Ojo , Amaurosis Fugax , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/epidemiologíaRESUMEN
We describe a rare and complex case of septic cavernous sinus thrombosis (SCST) in a 70-year-old patient who initially presented with ocular symptoms that rapidly progressed to severe intracranial vascular complications, including subarachnoid hemorrhage (SAH). Despite the use of broad-spectrum antibiotics and anticoagulants, the patient's condition deteriorated. SCST, often caused by sinus infections, presents a significant diagnostic and therapeutic dilemma, with mortality rates exceeding 20%. This report underscores the diversity of clinical presentations, ranging from mild headaches to severe cranial nerve deficits, that complicate diagnosis and treatment. The inability to detect any aneurysms in our patient using magnetic resonance imaging (MRI) and computed tomography angiography (CTA) may indicate an alternative pathogenesis. This could involve venous hypertension and endothelial hyperpermeability. This case illustrates the need for personalized treatment approaches, as recommended by the European Federation of Neurological Societies, and the importance of a multidisciplinary perspective when managing such intricate neurological conditions. Our findings contribute to the understanding of SCST coexisting with SAH.
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Trombosis del Seno Cavernoso , Trombosis de los Senos Intracraneales , Hemorragia Subaracnoidea , Humanos , Anciano , Trombosis del Seno Cavernoso/complicaciones , Trombosis del Seno Cavernoso/diagnóstico , Hemorragia Subaracnoidea/complicaciones , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Imagen por Resonancia Magnética/efectos adversosRESUMEN
PURPOSE: Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening event with significant neurologic and visual morbidity. In this study, we report on the natural history and visual outcomes of papilledema in children with CVST. DESIGN: Retrospective case series. METHODS: Patients with CVST evaluated by the Department of Ophthalmology between 2000 and 2023 were included. Records were reviewed for presence and course of papilledema, treatment, and final visual outcomes following papilledema resolution. RESULTS: The study included 35 patients with a mean age of 9 ± 5 years and 40% were female. The most common risk factors for CVST were infection (69%), dehydration (26%), and hypercoagulability (23%). 31 patients (89%) had papilledema. Of these patients, 9 (29%) had progression of papilledema despite treatment, 17 patients (55%) did not have progression, and 5 patients (16%) lacked follow-up records. Initial Frisén grade among all cases was 2 ± 1, and cases with progression reached a grade of 4 ± 1 between 10 and 32 days following initial identification. Most patients (97%) were treated with anticoagulation and 100% required acetazolamide and/or lumbar puncture. Among 26 patients with follow-up, papilledema resolved in 107 ± 128 days. Fifty-four percent of patients had permanent ophthalmic sequelae. An initial Frisén grade ≥3 (odds ratio 7.54, 95% confidence interval 6.53-8.70, P< .001) was significantly associated with eventual optic atrophy. CONCLUSIONS: Children with CVST are at high risk for ophthalmologic sequelae. Papilledema can progress despite appropriate therapy. Our results highlight the importance of ophthalmologic follow-up during treatment course to prevent irreversible vision loss.
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Anticoagulantes , Papiledema , Trombosis de los Senos Intracraneales , Agudeza Visual , Humanos , Papiledema/diagnóstico , Papiledema/etiología , Papiledema/tratamiento farmacológico , Papiledema/fisiopatología , Femenino , Masculino , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/fisiopatología , Estudios Retrospectivos , Niño , Agudeza Visual/fisiología , Adolescente , Anticoagulantes/uso terapéutico , Preescolar , Factores de Riesgo , Progresión de la Enfermedad , Estudios de Seguimiento , Acetazolamida/uso terapéutico , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVE: To derive a clinical decision rule to exclude cerebral venous sinus thrombosis (CVST) in the ED. A secondary aim was to derive a rule that incorporated clinical parameters and the non-contrast CT brain. METHODS: Single-centre, retrospective cohort study. Patients suspected of CVST were identified from the radiology database for CT/MR venograms. Clinical features included in the rule were determined by literature review. The presence of these features in participants was determined by chart review. Variables were tested for univariate association with CVST using logistic regression. Variable selection was accomplished using a forward-stepwise process, calculating the sensitivity/specificity of a rule containing the variable of most significance, then repeating the process after adding the next most significant variable. RESULTS: Forty-five out of 912 participants had confirmed CVST. The primary clinical rule was answering 'no' to all the following: any prothrombotic risk factor, age ≥54 years, confusion: sensitivity 95.6% (95% confidence interval [CI] 84.9-99.5%), specificity 40.9% (95% CI 37.6-44.2%), negative predictive value 99.4% (95% CI 97.9-99.9%) and positive predictive value 7.7% (95% CI 7.1-8.3%). The rule classified 39.5% of participants as CVST ruled out. The rule incorporating the non-contrast CT brain was answering 'no' to all the following: abnormal non-contrast CT brain, any prothrombotic risk-factor, age ≥54 years, confusion: sensitivity 100.0% (95% CI 91.6-100.0%), specificity 42.0% (95% CI 38.7-45.4%), negative predictive value 100.0% (95% CI not calculated) and positive predictive value 7.8% (95% CI 7.4-8.2%). The rule classified 40.0% of participants as CVST ruled out. CONCLUSIONS: A clinical decision rule was derived to rule out CVST. These results require validation before adoption into clinical practice.
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Trombosis de los Senos Intracraneales , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Trombosis de los Senos Intracraneales/diagnóstico , Reglas de Decisión Clínica , Factores de Riesgo , Servicio de Urgencia en HospitalRESUMEN
Cerebral venous thrombosis is a rare condition and represents a neurological emergency. It is a particular subtype of stroke, characterized by a huge diversity of neurological symptoms. Due to the diversity of its potential clinical presentations, medical imaging plays an important role in its early detection, even on non-dedicated examinations often performed in search of another acute neurological pathology. The aim of this case report is to illustrate the different radiological signs of cerebral venous thrombosis and to discuss the difficulties in diagnosing it by imaging at the acute stage.
La thrombose veineuse cérébrale (TVC) est une pathologie rare et constitue une urgence neurologique. Il s'agit d'un sous-type d'accident vasculaire cérébral (AVC) particulier, aux manifestations symptomatiques neurologiques très variées. De par la diversité de ses potentielles présentations cliniques, l'imagerie médicale joue un rôle important dans sa détection précoce et ce, y compris sur des examens non dédiés, réalisés à la recherche d'une autre pathologie neurologique aiguë. L'objectif de ce cas clinique est d'illustrer les différents signes radiologiques de la TVC et d'insister sur les difficultés, au stade aigu, de poser son diagnostic par imagerie.
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Trombosis de los Senos Intracraneales , Trombosis de la Vena , Humanos , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Background: Due to effective treatment of middle ear infections there is a change in etiologies causing lateral sinus thrombosis (LST) and outcome. There is a paucity of literature describing homogenous group of patients with nonseptic LST (NS-LST). Objective: To describe the clinical profile, risk factors, outcome of patients of NS-LST seen at a single center from South India. Methods and Materials: Prospective, observational study of 100 patients of NS-LST patients, diagnosed by magnetic resonance imaging (MRI) seen at the stroke unit. Results: During 2 years, 100 patients of NS-LST (isolated: combined: 27:73) (male: female: 44:56), mean age: 31.45 ± 11.13 years, were seen. Subacute presentation (74%) with headache, seizures, focal deficits, and features of raised intracranial pressure were presenting features. Hyperhomocysteinemia (61%), anemia (57%), postpartum state (41%), OCP use (37%), and low VitB12 (32%) were commonly seen risk factors. Imaging with MRI compared withcomputerized tomography (CT) had better diagnostic sensitivity (100% vs. 67%), detection of parenchymal (81% vs. 67%)/hemorrhagic (79% vs. 74%) lesions, and cortical vein thrombosis (31% vs. 15.46%). Treatment with anticoagulation and supportive therapy resulted in good outcome (mRS (0-2)) at 3 months in 81%.There were four deaths, all during admission (one - isolated, three - combined) and 11 patients underwent decompressive surgery. Patients with low GCS level of sensoriumat admission, hemiparesis, combined LST, cerebellar involvement, and decompressive craniectomy had a poor outcome. Conclusion: This single-center large cohort study of NS-LST patients brings out the clinical features, risk factors (peculiar to developing countries), and the superiority of MRI in the diagnosis. Majority of patients have good outcome, with low mortality with 10% requiring decompressive surgery.
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Trombosis del Seno Lateral , Trombosis de los Senos Intracraneales , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Trombosis del Seno Lateral/diagnóstico , Trombosis del Seno Lateral/etiología , Trombosis del Seno Lateral/terapia , Estudios de Cohortes , Estudios Prospectivos , Países en Desarrollo , Tomografía Computarizada por Rayos X , Imagen por Resonancia Magnética , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/complicaciones , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: The multi-inflammatory index (MII) is a novel marker that indicates the diagnosis, prognosis, and clinical severeness of inflammation-associated diseases. It is indicated that inflammatory biomarkers may help predict the occurrence of acute symptomatic seizures(ASS) after ischemic stroke. OBJECTIVE: Our goal was to search the predictive and prognostic capability of the MII-1 and MII-2 for ASS in cerebral venous sinus thrombosis (CVST) patients. METHOD: 91 patients with CVST were retrospectively analyzed from the medical records of patients between 2010 and 2023 and divided into the ASS group and non-ASS group. The MII-1 and MII-2 levels on admission, demographic and clinic features, predisposing risk factors, radiological characteristics involving thrombotic cerebral veins, and the type of parenchymal lesions were documented. Modified Rankin Scale (mRS) on admission and at the 3rd month were evaluated to determine the disability. RESULTS: MII-1 and MII-2 were statistically significantly higher in the ASS group and predictors for the occurrence of seizures with CVST in multivariate analysis. The area under the curve (AUC) of the receiver operating characteristics (ROC) curve for MII-1 was 0.791 (95 %CI = 0.691-0.891, p < 0.001), and AUC for MII-2 was 0.761 (95%CI = 0.660-0.861, p < 0.001). When the clinical variables that were included in the multivariate analysis and MII-1 and MII-2 were combined, the predictive power was greater with the AUC of 0.959. A significant positive correlation was found between mRS at the 3rd month and MII-1 and MII-2 in the ASS group. CONCLUSION: MII-1 and MII-2 can be used as new predictive and prognostic markers of ASS in patients with CVST.
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Trombosis de los Senos Intracraneales , Humanos , Pronóstico , Estudios Retrospectivos , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Convulsiones/diagnóstico , Convulsiones/etiología , Factores de RiesgoRESUMEN
Cerebral venous sinus thrombosis (CVST) has become a rare but potentially life-threatening condition in perinatal women. Early and rapid identification of CVST in pregnant women is a challenge for frontline clinical workers. In this study, 40 perinatal patients with CVST in our hospital were included in the five-year period, and 120 normal perinatal pregnant women in the obstetrics and gynecology department of our hospital were randomly enrolled in the five-year period as the control group, including 60 cases in pregnancy and puerperium. 5â mL of fasting venous blood was collected from puerperal CVST patients in the acute phase of onset (within 72â h of onset) and the recovery phase (fourth week of treatment). In the control group, 5â mL of fasting venous blood was collected. Coagulation factors X, XI, and XII, plasma D-Dimer were analyzed and compared. Coagulation factors X, XI, and XII in plasma of CVST patients were significantly increased compared with controls. Plasma coagulation factors X, XI, and XII and their combined detection (Union Model = 0.056 * FX: C + 0.046 * FXI: C + 0.081 * FXII: C) have diagnostic values for perinatal CVST. Plasma coagulation factors X, XI, and XII were significantly positively correlated with plasma D-dimer levels in perinatal CVST patients. Plasma coagulation factors X, XI, and XII have diagnostic values for perinatal CVST.
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Factor X , Trombosis de los Senos Intracraneales , Humanos , Femenino , Embarazo , Trombosis de los Senos Intracraneales/diagnóstico , Periodo PospartoAsunto(s)
Meningitis , Trombosis de los Senos Intracraneales , Humanos , Anticuerpos Anticitoplasma de Neutrófilos , Duramadre/diagnóstico por imagen , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Cráneo , Meningitis/complicaciones , Meningitis/diagnóstico , Hipertrofia , Imagen por Resonancia MagnéticaRESUMEN
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2023;25(4):22f03471. Author affiliations are listed at the end of this article.
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Catatonia , Trastornos Mentales , Psiquiatría , Trombosis de los Senos Intracraneales , Humanos , Catatonia/diagnóstico , Catatonia/terapia , Comorbilidad , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/terapia , Derivación y Consulta , Hospitales GeneralesRESUMEN
Cerebral venous sinus thromboses (CVSTs) are rare complications of neurosurgical interventions and their management remains controversial as most of cases appear clinically silent. Here, we analyzed our institutional series of patients with CVSTs evaluating clinical and neuroradiological characteristics, risk factors, and outcome. From the analysis of our institutional PACS, we collected a total of 59 patients showing postoperative CVSTs after supratentorial or infratentorial craniotomies. For every patient, we collected demographics and relevant clinical and laboratory data. Details on thrombosis trend were retrieved and compared along the serial radiological assessment. A supratentorial craniotomy was performed in 57.6% of cases, an infratentorial in 37.3%, while the remaining were a single cases of trans-sphenoidal and neck surgery (1.7%, respectively). A sinus infiltration was present in almost a quarter of patients, and in 52.5% of cases the thrombosed sinus was exposed during the craniotomy. Radiological signs of CVST were evident in 32.2% of patients, but only 8.5% of them developed a hemorrhagic infarct. CVST-related symptoms were complained by 13 patients (22%), but these were minor symptoms in about 90%, and only 10% experienced hemiparesis or impaired consciousness. The majority of patients (78%) remained completely asymptomatic along the follow-up. Risk factors for symptoms occurrence were interruption of preoperative anticoagulants, infratentorial sinuses involvement and evidence of vasogenic edema and venous infarction. Overall, a good outcome defined mRS 0-2 was observed in about 88% of patients at follow-up. CVST is a complication of surgical approaches in proximity of dural venous sinuses. CVST usually does not show progression and courses uneventfully in the vast majority of cases. The systematic use of post-operative anticoagulants seems to not significantly influence its clinical and radiological outcome.
Asunto(s)
Trombosis de los Senos Intracraneales , Humanos , Estudios Retrospectivos , Trombosis de los Senos Intracraneales/cirugía , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/etiología , Anticoagulantes/uso terapéutico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/tratamiento farmacológico , Factores de RiesgoRESUMEN
PURPOSE: Accurate assessment of dural sinus, deep and cortical venous thrombosis on MR imaging is challenging. The aim of this study is to evaluate the accuracy of 3D-T1 turbo spin echo (T1S), sequences in detecting venous thrombosis and comparing it with susceptibility-weighted imaging (SWI), magnetic resonance venography (MRV) and post contrast T1 magnetization-prepared rapid acquisition gradient echo (T1C). METHODS: A blinded retrospective observational analysis of 71 consecutive patients evaluated for cerebral venous thrombosis (CVT) and 30 control patients was performed. Multimodality reference standard adopted included T1C, SWI with MRV. Sub-analyses in superficial, deep and cortical venous segments were performed in addition to correlation of signal intensity of thrombus with the clinical stage. RESULTS: A total of 2222 segments in 101 complete MRI examinations were evaluated. Sensitivity/specificity/positive predictive value/negative predictive value/accuracy and precision of T1S for detection of cortical vein thrombosis was 0.994/1/1/0.967/0.995/1, 1/0.874/0.949/1/0.963/0.950 for detection of superficial venous sinus thrombosis and 1/1/1/1/1/1 for deep venous thrombosis. The AUC yield for T1S was 0.997 for cortical, 1 for deep and 0.988 for superficial venous segments. CONCLUSION: T1S paralleled the accuracy of conventional sequences in the overall detection of CVT but showed superior accuracy in the detection of cortical venous thrombosis. It makes a fitting addition to the CVT MRI protocol in scenarios demanding negation of gadolinium administration.