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1.
Epilepsia ; 2021 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-33464599

RESUMEN

OBJECTIVE: There is a growing recognition of immune-mediated causes in patients with focal drug-resistant epilepsy (DRE); however, they are not systematically assessed in the pre-surgical diagnostic workup. Early diagnosis and initiation of immunotherapy is associated with a favorable outcome in immune-mediated seizures. Patients with refractory focal epilepsy with neuronal antibodies (Abs) tend to have a worse surgical prognosis when compared to other etiologies. METHODS: We studied the prevalence of serum Abs in patients ≥18 years of age with DRE of unknown cause before surgery. We proposed and calculated a clinical APES (Antibody Prevalence in Epilepsy before Surgery) score for each subject, which was modified based on Dubey's previously published APE2 score. RESULTS`: A total of 335 patients were screened and 86 subjects were included in final analysis. The mean age at the time of recruitment was 44.84 ± 14.86 years, with age at seizure onset 30.89 ± 19.88 years. There were no significant differences among baseline clinical features between retrospective and prospective sub-cohorts. The prevalence of at least one positive Ab was 33.72%, and central nervous system (CNS)-specific Abs was 8.14%. APES score ≥4 showed slightly better overall prediction (area under the curve [AUC]: 0.84 vs 0.74) and higher sensitivity (100% vs 71.4%), with slightly lower but similar specificity (44.3% vs 49.4%), when compared to APE2 score ≥4. For subjects who had available positron emission tomography (PET) results and all components of APES score (n = 60), the sensitivity of APES score ≥4 yielded a similar prediction potential with an AUC of 0.80. SIGNIFICANCE: Our findings provide persuasive evidence that a subset of patients with focal DRE have potentially immune-mediated causes. We propose an APES score to help identify patients who may benefit from a workup for immune etiologies during the pre-surgical evaluation for focal refractory epilepsy with unknown cause.

2.
Clin Neurophysiol ; 131(1): 193-198, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31809982

RESUMEN

OBJECTIVE: To assay EEG signal quality recorded with tripolar concentric ring electrodes (TCREs) compared to regular EEG electrodes. METHODS: EEG segments were recorded simultaneously by TCREs and regular electrodes, low-pass filtered at 35 Hz (REG35) and 70 Hz (REG70). Clips were rated blindly by nine electroencephalographers for presence or absence of key EEG features, relative to the "gold-standard" of the clinical report. RESULTS: TCRE showed less EMG artifact (F = 15.4, p < 0.0001). Overall quality rankings were not significantly different. Focal slowing was better detected by TCRE and spikes were better detected by regular electrodes. Seizures (n = 85) were detected by TCRE in 64 cases (75.3%), by REG70 in 75 (88.2%) and REG35 in 69 (81.2%) electrodes. TCRE detected 9 (10.6%) seizures not detected by one of the other 2 methods. In contrast, 14 seizures (16.5%) were not detected by TCRE, but were by REG35 electrodes. Each electrode detected interictal spikes when the other did not. CONCLUSIONS: TCRE produced similar overall quality and confidence ratings versus regular electrodes, but less muscle artifact. TCRE recordings detected seizures in 7% of instances where regular electrodes did not. SIGNIFICANCE: The combination of the two types increased detection of epileptiform events compared to either alone.


Asunto(s)
Artefactos , Electrodos , Electroencefalografía/instrumentación , Diseño de Equipo , Convulsiones/fisiopatología , Calibración , Electroencefalografía/normas , Humanos , Músculos
3.
Epilepsy Behav ; 94: 151-157, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30939410

RESUMEN

People with epilepsy are at increased risk for neuropsychological dysfunction due to multiple factors, of which the most amendable are antiseizure medications (ASMs). Antiseizure medication effectiveness is frequently determined by tolerability. In this study, we compared the neuropsychological effects of eslicarbazepine acetate (ESL) and carbamazepine immediate-release (CBZ) using a randomized, double-blind, crossover design in healthy volunteers with a 2-week titration and 4-week maintenance phase in each treatment arm (CBZ = 400 mg BID and ESL = 800 mg qAM). Neuropsychological testing was performed at the initial visit, repeated at 1st baseline nondrug condition, end treatment #1, 2nd nondrug condition one month after treatment #1, end treatment #2, and 3rd nondrug condition one month after treatment #2. Neuropsychological testing was conducted 2 h after morning dose and included computer (i.e., dual task test, selective attention test, symbol digit, verbal memory, visuospatial memory, and 1- & 2-back continuous performance) and noncomputer tasks (i.e., Medical College of Georgia (MCG) paragraph memory, Stroop, Symbol Digit Modalities Test, Profile of Mood States). z-Scores calculated from nondrug conditions were used to compare ESL and CBZ for the 23 completers. Follow-up analyses included individual test scores and distribution of individual raw means. Mean blood levels on test day were CBZ = 8.9 µg/ml and ESL = 15.3 µg/ml. Omnibus z-score was significantly better for ESL (p = .0001). For individual measures, executive function and selective attention tests were statistically significantly better for ESL. Individual test raw means favored ESL over CBZ on 22 of 30 measures (p = .016, 2-tailed sign test). Eslicarbazepine acetate demonstrated less adverse neuropsychological effects than CBZ.


Asunto(s)
Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Dibenzazepinas/efectos adversos , Epilepsia/tratamiento farmacológico , Epilepsia/psicología , Adolescente , Adulto , Afecto/efectos de los fármacos , Atención/efectos de los fármacos , Estudios Cruzados , Método Doble Ciego , Femenino , Voluntarios Sanos , Humanos , Masculino , Memoria/efectos de los fármacos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Desempeño Psicomotor/efectos de los fármacos , Memoria Espacial/efectos de los fármacos , Test de Stroop , Resultado del Tratamiento , Adulto Joven
4.
J Clin Neurosci ; 63: 68-71, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30772199

RESUMEN

Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization procedures. We present a series of patients undergoing endovascular intracranial embolization predominantly for AVMs both under general anesthesia and awake with the use of IONM. We reviewed our database to identify all patients undergoing endovascular procedures between January 1, 2014 and January 1, 2016. Awake patients were tested with SSEP, EEG and real time neurologic examination while TcMEPs were performed in all anesthetized patients. BAEPs were performed in anesthetized patients if indicated. Methohexital was administered as an injection at a dose of 5 mg or 10 mg and repeat testing was performed if needed.Sixty-three endovascular procedures that met criteria were performed in 32 patients. 54 procedures in 28 patients were performed under general anesthesia, 9 procedures in 4 patients were performed in wakefulness. PT was negative in 61 procedures and subsequently completed embolizations without neurological sequelae. In two cases, the testing was positive and the procedure was terminated without embolization in one patient. The other patient underwent embolization at an alternative site without repeat PT. There were no new postoperative neurologic deficits after any of these procedures. Specificity of PT was 100% as none of the patients with a negative provocative test developed a new postoperative neurologic deficit after embolization. To our knowledge, this is the first review of PT with the use of neurophysiologic IONM techniques under general anesthesia. These data suggest a high specificity comparable to awake testing.


Asunto(s)
Anestésicos Intravenosos/uso terapéutico , Embolización Terapéutica/métodos , Malformaciones Arteriovenosas Intracraneales/cirugía , Monitorización Neurofisiológica Intraoperatoria/métodos , Metohexital/uso terapéutico , Complicaciones Posoperatorias/epidemiología , Adulto , Anestésicos Intravenosos/efectos adversos , Embolización Terapéutica/efectos adversos , Femenino , Humanos , Monitorización Neurofisiológica Intraoperatoria/efectos adversos , Masculino , Metohexital/efectos adversos , Persona de Mediana Edad
6.
Epilepsy Behav ; 89: 37-41, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30384097

RESUMEN

BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive alternative with less cognitive risks compared with traditional surgery for focal drug-resistant epilepsy. OBJECTIVE: We describe seizure outcomes and complications after LITT in our cohort with intractable mesial temporal lobe epilepsy (MTLE). MATERIAL AND METHODS: We prospectively tracked Stanford's MTLE cases treated with LITT from October 2014 to October 2017. Primary endpoints were seizure outcomes by (1) Engel classification and (2) reduction in baseline seizure frequency. Secondary outcomes were postablation complications. RESULTS: A total of 30 patients underwent selective amygdalohippocampotomy via LITT. Mesial temporal sclerosis (MTS) was present in 23/30 (77%) patients. Median follow-up was 18 ±â€¯12 months (range: 6-44 months). Almost all 28/29 (97%) patients had >50% reduction, and 22/29 (76%) patients had >90% reduction in seizure frequency. Engel Class I outcome was achieved in 18/29 (62%) patients; with complete seizure freedom in 9/29 (31%) patients (Engel Class IA). Three (10%) patients have had only focal aware seizures (Engel Class 1B). Seizures only occurred with medication withdrawal in 6/29 (21%) patients (Engel Class ID). Class II was achieved by 6/29 (21%) and Class III by 5/29 (17%) patients. Complications included perioperative seizures in 10/29 (34%) and nonseizure complaints in 6/29 (21%) patients. Three (10%) patients had neurological deficits including one permanent superior quadrantanopsia, one transient trochlear, and one transient oculomotor nerve palsy. CONCLUSIONS: Overall, Engel Class I outcome was achieved in 62% of patients with MTLE, and 97% of patients achieved >50% seizure frequency reduction. Complications were largely temporary, though there was one persistent visual field deficit. Laser ablation is well-tolerated and offers marked seizure reduction for the majority of patients.


Asunto(s)
Epilepsia Refractaria/diagnóstico por imagen , Epilepsia Refractaria/cirugía , Epilepsia del Lóbulo Temporal/diagnóstico por imagen , Epilepsia del Lóbulo Temporal/cirugía , Terapia por Láser/métodos , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Convulsiones/diagnóstico por imagen , Convulsiones/cirugía , Resultado del Tratamiento , Adulto Joven
7.
Clin Imaging ; 51: 155-159, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29501883

RESUMEN

A middle-aged patient underwent staged endovascular embolization of a Spetzler-Martin grade V right parietal arteriovenous malformation(AVM).In the fifth endovascular embolization, after methohexital 10 mg injection into a right posterior choroidal artery feeding the AVM nidus, there was an immediate change in the electroencephalogram (EEG) with simultaneous loss of motor evoked potentials (MEPs) in the bilateral upper and lower extremities and a delayed change in somatosensory evoked potential responses (SSEPs). No embolization was made and procedure was terminated. This case demonstrates the utility of intraoperative neurophysiologic monitoring (IONM) with pharmacologic provocative testing in predicting and mitigating the risks prior to the proposed embolization.


Asunto(s)
Anestésicos Intravenosos , Fístula Arteriovenosa , Embolización Terapéutica/métodos , Malformaciones Arteriovenosas Intracraneales/terapia , Metohexital , Arteria Cerebral Posterior/anomalías , Anestésicos Intravenosos/farmacología , Fístula Arteriovenosa/fisiopatología , Encéfalo , Electroencefalografía , Potenciales Evocados Motores , Potenciales Evocados Somatosensoriales , Humanos , Malformaciones Arteriovenosas Intracraneales/fisiopatología , Monitorización Neurofisiológica Intraoperatoria/métodos , Metohexital/farmacología , Persona de Mediana Edad
8.
J Neurosurg ; 128(4): 1165-1172, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28665249

RESUMEN

OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive method for thermal destruction of benign or malignant tissue that has been used for selective amygdalohippocampal ablation for the treatment of temporal lobe epilepsy. The authors report their initial experience adopting a real-time MRI-guided stereotactic platform that allows for completion of the entire procedure in the MRI suite. METHODS Between October 2014 and May 2016, 17 patients with mesial temporal sclerosis were selected by a multidisciplinary epilepsy board to undergo a selective amygdalohippocampal ablation for temporal lobe epilepsy using MRgLITT. The first 9 patients underwent standard laser ablation in 2 phases (operating room [OR] and MRI suite), whereas the next 8 patients underwent laser ablation entirely in the MRI suite with the ClearPoint platform. A checklist specific to the real-time MRI-guided laser amydalohippocampal ablation was developed and used for each case. For both cohorts, clinical and operative information, including average case times and accuracy data, was collected and analyzed. RESULTS There was a learning curve associated with using this real-time MRI-guided system. However, operative times decreased in a linear fashion, as did total anesthesia time. In fact, the total mean patient procedure time was less in the MRI cohort (362.8 ± 86.6 minutes) than in the OR cohort (456.9 ± 80.7 minutes). The mean anesthesia time was significantly shorter in the MRI cohort (327.2 ± 79.9 minutes) than in the OR cohort (435.8 ± 78.4 minutes, p = 0.02). CONCLUSIONS The real-time MRI platform for MRgLITT can be adopted in an expedient manner. Completion of MRgLITT entirely in the MRI suite may lead to significant advantages in procedural times.


Asunto(s)
Amígdala del Cerebelo/cirugía , Hipocampo/cirugía , Terapia por Láser/métodos , Imagen por Resonancia Magnética/métodos , Procedimientos Neuroquirúrgicos/métodos , Técnicas Estereotáxicas , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Estudios de Cohortes , Sistemas de Computación , Epilepsia Refractaria/cirugía , Eficiencia , Epilepsia del Lóbulo Temporal/cirugía , Femenino , Humanos , Imagenología Tridimensional , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Tempo Operativo
9.
Neurodiagn J ; 57(1): 53-68, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28436812

RESUMEN

PURPOSE: Although there are guidelines analyzing transcranial motor evoked potentials (MEP) waveform criteria, they vary widely and are not applied universally during intraoperative neurophysiologic monitoring (IONM). The objective is to generate hypotheses to identify early and reliable MEP waveform characteristics prior to complete loss of MEP to predict impending motor spinal cord injuries during spinal surgeries. The ultimate goal is to enhance real-time feedback to prevent injury or detect reversible spinal cord damage. METHODS: Fifteen true positive cases of persistent intraoperative MEP loss and new postoperative motor deficits were retrospectively identified from 2011 to 2013. Waveform characteristics of latency, amplitude, duration, phases, and area-under-the-curve (AUC) were measured, and an intraoperative spinal cord index (ISCI) was calculated for 5 traces prior to complete MEP loss. ISCI = [amplitude x duration x (phases+1) x AUC]/latency. RESULTS: Out of 22 muscles in 15 cases, latency increased in 2, duration decreased in 12, amplitude decreased in 13, AUC decreased in 13, and ISCI decreased in 14. In 11 out of 15 cases (73%), ISCI dropped > 40% in at least one muscle before MEP were completely lost. Thirteen cases had concurrent somatosensory evoked potentials (SSEP) changes, 9 out of 13 had > 50% decrease in SSEP: 2 out of 9 changed before MEP, 5 out of 9 simultaneously, and 2 out of 9 after. CONCLUSIONS: In these cases of motor injury, smaller and simpler MEP waveforms preceded complete loss of signal. An ISCI 40% drop could be tested as a warning threshold for impending motor compromise in future prospective studies and lead to eventual standardization to predict irreversible postoperative deficits.


Asunto(s)
Potenciales Evocados Motores/fisiología , Monitorización Neurofisiológica Intraoperatoria , Trastornos Motores , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Ortopédicos/efectos adversos , Complicaciones Posoperatorias , Adolescente , Adulto , Anciano , Pie/fisiología , Mano/fisiología , Humanos , Persona de Mediana Edad , Trastornos Motores/diagnóstico , Trastornos Motores/etiología , Trastornos Motores/prevención & control , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Procesamiento de Señales Asistido por Computador , Traumatismos de la Médula Espinal/cirugía , Columna Vertebral/cirugía , Adulto Joven
10.
Seizure ; 39: 13-18, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27205871

RESUMEN

PURPOSE: Clinical management of epilepsy and current epilepsy therapy trials rely on paper or electronic diaries often with inaccurate self-reported seizure frequency as the primary outcome. This is the first study addressing the feasibility of detecting and recording generalized tonic-clonic seizures (GTCS) through a biosensor linked to an online seizure database. METHOD: A prospective trial was conducted with video-EEG (vEEG) in an epilepsy monitoring unit. Patients wore a wristwatch accelerometer that detected shaking and transmitted events via Bluetooth® to a bedside electronic tablet and then via Wi-Fi to an online portal. The watch recorded the date, time, audio, duration, frequency and amplitude of events. Events logged by the watch and recorded in a bedside paper diary were measured against vEEG, the "gold standard." RESULTS: Thirty patients were enrolled and 62 seizures were recorded on vEEG: 31 convulsive and 31 non-convulsive. Twelve patients had a total of 31 convulsive seizures, and of those, 10 patients had 13 GTCS. The watch captured 12/13 (92.3%) GTCS. Watch audio recordings were consistent with seizures in 11/12 (91.6%). Data were successfully transferred to the bedside tablet in 11/12 (91.6%), and to the online database in 10/12 (83.3%) GTCS. The watch recorded 81 false positives, of which 42/81 (51%) were cancelled by the patients. Patients and caregivers verbally reported 15/62 seizures (24.2% sensitivity) but no seizures were recorded on paper logs. CONCLUSION: Automatic detection and recording of GTCS to an online database is feasible and may be more informative than seizure logging in a paper diary.


Asunto(s)
Acelerometría/métodos , Electroencefalografía/métodos , Epilepsia Tónico-Clónica/diagnóstico , Monitoreo Ambulatorio/métodos , Acelerometría/instrumentación , Adulto , Anciano , Bases de Datos Factuales , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Monitoreo Ambulatorio/instrumentación , Estudios Prospectivos , Grabación en Video , Adulto Joven
12.
J Neurointerv Surg ; 5(2): e8, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22345146

RESUMEN

BACKGROUND AND IMPORTANCE: It is not uncommon that endovascular balloon test occlusion (BTO) is performed to assess collateral blood flow and risk of injury of permanent occlusion of the internal carotid artery (ICA). This case is the first reported of detection and reversal of the inferolateral trunk (ILT) syndrome in an awake patient during provocative BTO; prompt recognition of the syndrome effectively prevented permanent neurologic deficits. CLINICAL PRESENTATION: The case of a 42-year-old woman is reported who had a left sphenoid wing meningioma with extension into the cavernous sinus and who underwent awake catheter angiography with provocative BTO of the ICA. Serial examinations by intraoperative monitoring neurologists and neurointerventionalists detected acute progressive left retro-orbital pressure followed by sudden inability to adduct the left eye, or a left medial rectus palsy, indicative of the ILT syndrome which led to immediate balloon deflation and resolution of the deficits. The hypothesis was that hypoperfusion of the ILT, an arterial branch of the ICA which provides blood supply to several cranial nerves (CN) III, CN V1 and CN V2, caused her acute symptoms. CONCLUSION: Although cerebral ischemia is a well known complication of endovascular procedures, CN ischemia is a rare potential risk. Knowledge of cerebrovascular anatomy and serial examinations prevented neurologic deficits; this case underscores the added utility of examinations by intraoperative monitoring neurologists and interdisciplinary collaboration.


Asunto(s)
Oclusión con Balón/métodos , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Cateterismo/métodos , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Adulto , Enfermedades de las Arterias Carótidas/complicaciones , Angiografía Cerebral , Femenino , Humanos , Neoplasias Meníngeas/complicaciones , Meningioma/complicaciones , Síndrome
13.
Epilepsy Behav ; 22(4): 705-9, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21975298

RESUMEN

My Epilepsy Diary is a free Web-based application on the public website epilepsy.com, available for patients to track epilepsy and to aid clinicians with data-based, individualized management. The first aim of this descriptive study was to outline electronic diary functions. Second, the study retrospectively profiled a large cohort of 2010 calendar year diary users including demographics, seizure types, temporal distribution of seizures, triggers, and use and side effects of antiepileptic drugs (AEDs). A total of 1944 users provided demographic information and 1877 recorded seizure data. Most (64%) users were women. Average age was 29.9±16.0 years. A total of 70,990 seizure entries and 15,630 AED entries were logged. Events were apportioned as 79% seizures and 21% seizure clusters. Specific AEDs were detailed in 7331 entries: monotherapy was used in 18% and polytherapy in 82%. Mood-related side effects were most commonly reported in 19% of 1027 users.


Asunto(s)
Anticonvulsivantes , Epilepsia/diagnóstico , Epilepsia/tratamiento farmacológico , Sistemas en Línea , Adulto , Anticonvulsivantes/efectos adversos , Estudios de Cohortes , Femenino , Humanos , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Estudios Retrospectivos
14.
Brain ; 134(Pt 10): 2960-8, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21975589

RESUMEN

Hypothalamic hamartomas present with isolated fits of ictal laughter (gelastic epilepsy) or a combination of gelastic and other types of seizures. Many of these patients also suffer from cognitive decline, neuropsychiatric comorbidities and precocious puberty. Although there is a large body of anecdotal evidence about hypothalamic hamartomas and gelastic seizures, many questions still remain to be answered. For instance, which specific hypothalamic regions are most affected by the location of hamartomas causing laughing versus other types of seizures? Does the neuroanatomical localization of the lesions differ in cases with only gelastic seizures or a combination of gelastic and other types of seizures? Does the location of the lesions correlate with the presence of precocious puberty, and does the type of lesion influence the severity or the type of seizures? In a retrospective review of clinical and structural neuroimaging data from 100 cases of gelastic epilepsy and hypothalamic hamartoma, we aimed to address these questions by analysing the clinical presentation and the neuroanatomical features of the hypothalamic lesions in these patients. Our findings suggest that in all 100 cases, lesions were centred at the level of the mammillary bodies in the posterior hypothalamus. Compared with the patients with pure gelastic seizures (n = 32), those with gelastic and other types of seizures (n = 68) had significantly longer duration of epilepsy (P < 0.001), whereas age of seizure onset, the volume of lesions and the proximity to the mammillary bodies were not different between the two groups. In contrast, patients with cognitive or developmental impairment and those with precocious puberty had significantly larger lesions involving the anterior and posterior hypothalamus.


Asunto(s)
Epilepsias Parciales/patología , Hamartoma/patología , Enfermedades Hipotalámicas/patología , Hipotálamo/patología , Risa , Adolescente , Niño , Preescolar , Epilepsias Parciales/etiología , Femenino , Hamartoma/complicaciones , Humanos , Enfermedades Hipotalámicas/complicaciones , Imagen por Resonancia Magnética , Masculino , Tubérculos Mamilares/patología
15.
Neurocrit Care ; 11(3): 330-7, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19777388

RESUMEN

BACKGROUND: Despite recent advances, the clinical features of cerebral venous thrombosis (CVT) remain incompletely characterized. To our knowledge, no case series have been reported from North American centers with detailed long-term outcome data, and few studies have evaluated recanalization rates. METHODS: All cases of CVT at a single tertiary care hospital between 1995 and 2004 were retrospectively reviewed. Follow-up information was obtained from direct patient interviews. RESULTS: Follow-up data were available for 58 of 61 CVT patients (median 50 months). Average age was 40, and 66% were women. Headache and focal neurological deficits were noted in 82% and 72%, respectively. Intracranial hemorrhage was seen in 44%. Hypercoagulable risk factors were identified in 84%. Anticoagulation was initiated acutely in 84%, including in all patients with intraparenchymal hemorrhage (IPH). The percentage of patients with a modified Rankin Score (mRS) of 0 to 2 at admission, hospital discharge and last follow-up were 41%, 67%, 90%, respectively; the rate of favorable long-term outcome did not differ significantly between patients with and without IPH. In the subset of 21 patients with follow-up imaging available for direct review, 90% had partial or complete recanalization. CONCLUSIONS: The demographics, clinical presentation, imaging findings, and risk factors in this large North American cohort of CVT patients strongly support the observations of previous European case series. In addition, the favorable long-term outcome and recanalization rates observed lend further support to the safety and efficacy of acute heparin therapy for the treatment of symptomatic CVT (irrespective of the presence of ICH).


Asunto(s)
Anticoagulantes/uso terapéutico , Venas Cerebrales , Trombosis Intracraneal , Trombosis de la Vena , Adulto , Revascularización Cerebral , Femenino , Estudios de Seguimiento , Cefalea/diagnóstico , Cefalea/tratamiento farmacológico , Cefalea/epidemiología , Humanos , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/tratamiento farmacológico , Hemorragias Intracraneales/epidemiología , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/epidemiología , Masculino , América del Norte/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/epidemiología
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