Cerebral Venous Thrombosis: Analysis of a Multicenter Cohort From the United States

Wasay, Mohammad; Bakshi, Rohit; Bobustuc, George C.; Kojan, Suleiman; Sheikh, Zubair; Dai, Alper; Cheema, Zahid

doi:10.1016/j.jstrokecerebrovasdis.2007.10.001

Cited by 186 publications

(178 citation statements)

References 22 publications

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“…Key multicenter studies examining prognosis of CVT did not have large representations of patients treated with ET, ranging from only 4% to 15% 6, 13, 14…”

Section: Methodsmentioning

confidence: 99%

Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients

Salottolo

Wagner

Frei

et al. 2017

JAHA

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BackgroundCerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis.Methods and ResultsThis was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0–1) were analyzed with multiple logistic regression and presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in (AOR: 7.06 [95% CI, 2.27–21.96], interaction P=0.03) and who had migraine history (AOR: 4.87 [95% CI, 1.01–23.50], P=0.05), whereas negative predictors of full recovery were cerebral edema (AOR: 0.11 [95% CI, 0.04–0.34], P<0.001) and motor weakness (AOR: 0.28 [95% CI, 0.09–0.96], P=0.04).ConclusionsAs one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective treatment for cerebral venous thrombosis when conventional management is inadequate.

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“…Key multicenter studies examining prognosis of CVT did not have large representations of patients treated with ET, ranging from only 4% to 15% 6, 13, 14…”

Section: Methodsmentioning

confidence: 99%

Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients

Salottolo

Wagner

Frei

et al. 2017

JAHA

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“…Neurological deficits are also commonly seen. 4,9 The specific presentation depends on location and extent of the thrombosis and the presence of associated cortical lesions like the diminution of vision noted in our patient were because of venous infarction involving left occipital cortex and subcortical white matter corresponding to visual area. MR Venography is the diagnostic modality of choice for the diagnosis of CVT in pregnant women.…”

Section: Discussionmentioning

confidence: 70%

“…3 Approximately 7 percent of cerebral venous thromboses are associated with pregnancy. 4 Its incidence varies between 1 in 11000 to 1 in 45000 pregnancies. It is very rare in developed world.…”

Section: Discussionmentioning

confidence: 99%

A rare case of post-partum cerebral venous sinus thrombosis

Singh

Vardhan

2018

Int J Reprod Contracept Obstet Gynecol

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Cerebral venous sinus thrombosis is a rare neurologic emergency during pregnancy. Life threatening complications can be prevented if it is detected and treated well in time. A 24 years P2L3A2 lady, who had undergone elective caesarean delivery developed sudden onset severe episodic parieto-occipital headache and bilateral diminution of vision on 4th post-partum day. She had no known risk factors for thrombosis. There was no history suggestive of sepsis or pre-eclampsia. On clinical examination her blood pressure was found to be very high (164-180/104-110 mm Hg). There was no sensory or motor deficit. Relevant haematological and biochemical investigations were within normal limits. Urinary protein was negative. With a provisional diagnosis of imminent eclampsia, she was put on antihypertensive and Magnesium Sulphate. However, in view of persistence of the symptoms even after 24 hours, contrast-enhanced computed tomography (CECT) was done, which revealed venous infarction in occipital cortex and subcortical white matter. Magnetic resonance (MR) venography confirmed thrombus in left transverse and sigmoid sinuses. Thus, definitive treatment in the form of heparin in therapeutic doses was started. Antihypertensive was continued and prophylactic anticonvulsant was added in view of presence of the infarction. Patient responded well. Vision improved, and headache resolved completely. The patient was discharged on antihypertensive, anticonvulsant and vitamin K antagonist (Warfarin sodium) with an advice of regular follow-up. Cerebral venous thrombosis (CVT) is an uncommon entity and a high index of suspicion is needed to diagnose it at an earlier stage for timely initiation of treatment and prevention of complications. Prognosis in pregnant cases is better than that during a non-pregnant state.

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“…La venografía demostró trombosis venosa en el 100 % de los pacientes evaluados con este examen, empleado para descartar aneurismas o malformaciones arteriovenosas como causa de la hemorragia subaracnoidea, o para diferenciar entre hipoplasia y trombosis de senos transversos. En estudios previos se ha reportado la trombosis de seno longitudinal superior como la más frecuente (4,5), contrario a lo hallado en el presente estudio, en el que se encontró un compromiso más frecuente de los senos transversos.…”

Section: Discussionunclassified

“…Aunque puede ocurrir a cualquier edad, se presenta con mayor frecuencia entre los 20 y los 40 años, y tiene una mayor prevalencia en el sexo femenino, con una relación de 3:1 (3); esto se explica por la mayor frecuencia de factores de riesgo propios de las mujeres, como el uso de anticonceptivos hormonales, el embarazo, el puerperio y la terapia de reemplazo hormonal (4). En la literatura científica también se han descrito otros factores de riesgo, como infecciones locales (sinusitis, otitis, meningitis) o sistémicas, trombofilias adquiridas o heredadas, deshidratación, antecedentes de trombosis o enfermedades autoinmunitarias (5).…”

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Trombosis de senos venoso cerebrales: características epidemiológicas, clínicas imaginológicas y pronóstico

2014

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Cerebral Venous Thrombosis: Analysis of a Multicenter Cohort From the United States

Cited by 186 publications

References 22 publications

Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients

Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients

A rare case of post-partum cerebral venous sinus thrombosis

Trombosis de senos venoso cerebrales: características epidemiológicas, clínicas imaginológicas y pronóstico

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