Acute symptomatic seizures in cerebral venous thrombosis

Abstract

ObjectiveTo identify characteristics, predictors, and outcomes of acute symptomatic seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281 consecutive adult patients with CVT included from 12 hospitals within the International CVT Consortium.MethodsWe defined ASS as any seizure between symptom onset and 7 days after diagnosis of CVT. We stratified ASS into pre-diagnosis and solely post-diagnosis ASS. Status epilepticus (SE) was also analyzed separately. We analyzed predictors for ASS, and association between ASS and clinical outcome (modified Rankin Scale) with multivariable logistic regression.ResultsOf 1,281 eligible patients, 441 (34%) had ASS. Baseline predictors for ASS were intracerebral hemorrhage ([ICH], adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0–5.5), cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0–4.0), cortical vein thrombosis (aOR 2.1, 95%CI 1.5–2.9), superior sagittal sinus thrombosis (aOR 2.0, 95% CI 1.5–2.6), focal neurologic deficit (aOR 1.9, 95% CI 1.4–2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1–2.5) and female-specific risk factors (aOR 1.5, 95% CI 1.1–2.1). Ninety-three (7%) patients had solely post-diagnosis ASS, best predicted by cortical vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%) patients had SE, independently predicted by ICH, focal neurologic deficits and cerebral edema/infarction. Neither ASS nor SE were independently associated with outcome.ConclusionASS occurred in 1/3 of patients with CVT and was associated with brain parenchymal lesions and thrombosis of the superficial system. In absence of pre-diagnosis ASS, no subgroup was identified with sufficient risk of post-diagnosis ASS to justify prophylactic antiepileptic drug treatment. We found no association between ASS and outcome.

Nonthrombotic internal jugular venous stenosis may facilitate cerebral venous thrombosis

“…Also noteworthy is that a recent study has confirmed the involvement of CCVT in the venous infarctions and seizures. 28 This result was in accordance with the conclusions in our study, as cerebral parenchymal lesions, including ischemia and hemorrhage, along with seizure attacks were more prevailing in the IJVS-CVT group, despite no statistical significance.…”

Dural arteriovenous fistulas in cerebral venous thrombosis

“…Patients were recruited from eight hospital-based consecutive adult CVT registries within the International CVT Consortium [21]. Due to the particularly rare combination of CVT and dAVF, we centrally reviewed all patients with suspected CVT and dAVF within the consortium and discovered five additional patients with suspected CVT and dAVF that did not originate from consecutive CVT registries; the University of Virginia Health System (n = 4, Charlottesville, VA, United States) and the John Hunter Hospital (n = 1, Newcastle, Australia).…”

Updates in Cerebral Venous Thrombosis

“…One recent prospective international study of 1281 individuals found a 34% rate of acute symptomatic seizures, 6% of whom had status epilepticus. Neuroimaging findings associated with acute seizures included intracerebral haemorrhage, non-haemorrhagic lesions, cortical vein or sagittal sinus thrombosis and subarachnoid haemorrhage [46].…”