<b><i>Background:</i></b> Cerebral sinus venous thrombosis (CSVT) is a relatively rare, potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. A literature search on PubMed using the keyword “Cerebral sinus venous thrombosis” was performed. We searched for the epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and treatment of CSVT. All full-text articles in the last 10 years, in adults (>18 years), and the English language were included. We aim to give a comprehensive review of CSVT, with a primary focus on the management of the disease. <b><i>Summary:</i></b> The literature search revealed 404 articles that met our criteria. CSVT is a relatively rare condition that accounts for approximately 1% of all forms of stroke. They can be subdivided into acute, subacute, and chronic forms based on the time of onset of clinical symptoms. It is a multifactorial disease, and the major forms of clinical presentation include isolated intracranial hypertension syndrome, focal neurological deficits, and cavernous sinus syndrome. MRI with magnetic resonance venogram (MRV) is considered the gold standard for diagnosis. Anticoagulation with heparin or low-molecular-weight heparin is the mainstay of treatment. Endovascular management is indicated for those cases with severe symptoms or worsening of symptoms despite anticoagulation therapy. Favorable outcomes have been reported in patients who receive early diagnosis and treatment. <b><i>Conclusion:</i></b> CSVT is a potentially fatal neurological condition that is often under-diagnosed due to its nonspecific presentation. Timely diagnosis and treatment can reduce morbidity and mortality, remarkably improving the outcome in affected individuals.
IMPORTANCE Prolonged seizures in super-refractory status epilepticus (SRSE) have been shown to cause neuronal death and reorganization, and visual inspection in individual case studies has demonstrated progressive cortical and subcortical atrophy. At present, magnetic resonance imaging (MRI) studies that evaluate brain atrophy in SRSE are lacking. OBJECTIVES To document and quantify the development of atrophy over time in SRSE. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review included all patients with SRSE who were admitted to a tertiary referral campus of the Mayo Clinic Hospital with SRSE from January 1, 2001, to December 31, 2013. Patients with (1) an initial MRI scan performed within 2 weeks of SRSE onset, (2) a second MRI scan within 6 months of SRSE resolution, and (3) a minimum duration of 1 week between MRI scans were included. The ventricular brain ratio (VBR) was measured on T2-weighted fluid-attenuated inversion recovery (FLAIR) images at disease onset and during follow-up. Measurements were performed on axial FLAIR images with section thickness of less than 5 mm. The plane immediately superior to the caudate head was chosen for analysis. The hypothesis that atrophy develops during SRSE despite seizure control (electroencephalogram background suppression with anesthetic drugs) was tested. Data were analyzed from June 1 to December 31, 2015. MAIN OUTCOMES AND MEASURES Change in VBR (ΔVBR) as a percentage of the starting measure. RESULTS Nineteen patients met the inclusion criteria; these included 10 men (53%) and 9 women (47%) with a median age of 41 (interquartile range [IQR], 25-68) years. Anesthetic agents were required for a median of 13 (IQR, 5-37) days. Initial MRI was performed a median of 2 (IQR, 1-7.5) days from the onset of SRSE, and the second MRI was performed a median of 11 (IQR, 5-15.5) days from the resolution of SRSE, with a median of 40 (IQR, 15-65) days between MRI scans. Median ΔVBR was 23.3% (IQR, 10.5%-70.3%). A significant correlation between the duration of anesthetic agent use and ΔVBR was found (Spearman r = 0.54; P = .02). CONCLUSIONS AND RELEVANCE Atrophy developed in all patients with SRSE who underwent serial imaging, despite administration of agents for seizure control. The degree of atrophy appears to be related to the duration of SRSE.
Surgery antedated GBS in 9.1% of patients. Postsurgical GBS was more common in patients with an active malignancy. A prospective study is needed to determine whether active malignancy represents an independent risk factor for the development of postsurgical GBS.
Background:We sought to identify clinical associations and potential triggers of Guillain-Barré syndrome (GBS) within 8 weeks of surgical procedures.Methods:We retrospectively reviewed consecutive patients diagnosed with GBS within 8 weeks of a surgical procedure between January 1995 and June 2014 at Mayo Clinic. Postsurgical GBS was defined as symptom onset within 8 weeks of a surgical procedure. Patients with postsurgical GBS were compared with patients who did not have a surgery or procedure prior to GBS onset to determine differences between groups.Results:A total of 208 patients with GBS, median age 55 years (interquartile range [IQR] 41–68), were included. Thirty-one patients (15%) developed postsurgical GBS. Median duration from the surgery or procedure to onset of first GBS symptom was 19 days (IQR 11.1–37.5). The main types of surgeries/procedures preceding GBS were gastrointestinal, cardiac, and orthopedic. General anesthesia was used in 18 (58%) and conscious sedation in 13 (42%) patients. Among the 31 patients with postsurgical GBS, 19 (61%) had a known diagnosis of malignancy. Autoimmune conditions were present in 9 (29%) patients. Additional triggering factors were identified in 11 (35.5%) patients. On univariate analysis, the factors that showed an association with postsurgical GBS were age (p = 0.003), malignancy (p < 0.0001), active malignancy (p = 0.05), preexisting autoimmune disorder (p = 0.001), and duration of hospital stay (p = 0.015). On multivariate analysis, age (p = 0.045), malignancy (p < 0.0001), and preexisting autoimmune disorder (p = 0.004) remained associated.Conclusions:Surgical procedures antedated GBS in 15% of patients, which is unexpectedly high. History of malignancy or autoimmune disease may predispose to development of postsurgical GBS.
Objective:To determine risk factors and causes for mortality during childhood in patients with infantile spasms (IS). We describe the overall goals of care for those who died. Methods: This is a retrospective chart review of IS patients born between 2000 and 2011. We examined potential risk factors for mortality, including etiology, neurologic impairment, medication use, persistence of epileptic spasms, and comorbid systemic involvement (requirement for G-tube feedings, respiratory interventions). For patients who died, we describe cause of death and resuscitation status or end-of-life care measures. Results: We identified 150 IS patients with median follow-up of 12 years. During the study period, 25 (17%) patients died, 13 before 5 years of age. Univariate analysis demonstrated that developmental delay, identifiable etiology, hormonal use for IS, persistence of epileptic spasms, polypharmacy with antiseizure medications, refractory epilepsy, respiratory system comorbidity, and the need for a G-tube were significant risk factors for mortality. In a multivariate analysis, mortality was predicted by persistence of epileptic spasms (odds ratio [OR] = 4.30, 95% confidence interval [CI] = 1.11-16.67, P = .035) and significant respiratory system comorbidity (OR = 12.75, 95% CI = 2.88-56.32, P = .001). Mortality was epilepsy-related in one-third of patients who died with sudden unexpected death in epilepsy (SUDEP), accounting for 88% of epilepsy-related deaths. Most deaths before age 5 years were related to respiratory failure, and SUDEP was less common (17%) whereas SUDEP was more common (45%) with deaths after 5 years. For the majority (67%) of patients with early mortality, an end-of-life care plan was in place (based on documentation of resuscitation status, comfort measures, or decision not to escalate medical care). Significance: Mortality at our single-center IS cohort was 17%, and persistence of epileptic spasms and comorbid respiratory system disorders were the most important determinants of mortality. Early deaths were related to neurological impairments/ comorbidities. SUDEP was more common in children who died after 5 years of age than in those who died younger than 5 years.
Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. In view of maternal morbidity and mortality as well as fetal complications, early diagnosis is an utmost necessity in the present scenario. In developing country like India, early detection and prevention will be more cost effective. Oral Glucose Tolerance Test (OGTT) is the crucial method for diagnosing GDM done usually between 24th and 28th week of pregnancy. The proposed work focuses on early detection of GDM without a visit to the hospital for women who are pregnant for the second time onwards (multigravida patients). A decision support system using Multilayer Neural Network which learns to classify GDM and non GDM patients using Back 3328 Priya Shirley Muller et al. Propagation learning algorithm is developed. The classifier proves to be an efficient model for diagnosis of GDM without the conventional method of blood test by providing newly designed parameters as inputs to the network.
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