Cerebral venous thrombosis: influence of risk factors and imaging findings on prognosis

Appenzeller, Simone; Zeller, Carlos Borelli; Annichino-Bizzachi, Joyce; Costallat, Lilian T. L.; Deus-Silva, Leonardo; Voetsch, Barbara; Faria, Andréia V.; Zanardi, Verônica A.; Damasceno, Benito Pereira; Cendes, Fernando

doi:10.1016/j.clineuro.2004.10.004

Cited by 93 publications

(93 citation statements)

References 42 publications

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“…Both arterial and venous thrombosis has been reported with common sites being the pulmonary artery, renal vein, deep leg veins, inferior vena cava, and femoral iliac artery [54,56,57]. Other sites include the cerebral and meningeal arteries, mesenteric and hepatic veins [54,56,58,59].…”

Section: (Ii) Thromboembolismmentioning

confidence: 99%

Steroid Sensitive Nephrotic Syndrome in Children

Bhimma¹

2014

J Nephrol Ther

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Nephrotic Syndrome (NS) is one of the most frequent glomerular diseases seen in children. Children who go into complete remissin following treatment with corticosteroids are classified as having "steroid sensitive" NS. In developed countries over 80% of children with idiopathic NS have steroid sensitive disease although response to steroids is somewhat tempered in developing countries, especially in black children, the majority of whom have steroid resistant disease.The exact pathogenesis of this condition remains elusive. Podocyte injury and proteinuria are the two main issues in the pathogenesis. Recent studies suggest alterations in both innate and adaptive immune responses. There is release of cytokines by T-cells as well as a strong contribution of B-cell immunity. Genetic studies have reported human leucocyte antigen (HLA) class II antigens DR and DQ associations linked to steroid sensitive NS and in small case studies, single gene mutations e.g. PLCE1 although to date no homozygous mutations in NPHS1 or NPHS2 and WT-1 genes have been reported.Most children with steroid sensitive NS have multiple relapses and a significant percentage also develop steroid dependent NS. These children receive multiples courses of steroids and are at high risk of developing steroid toxicity. Patient with frequent relapses who develop steroid dependency thus require alternative treatment. Steroids sparing agents used include levamisole, cyclophosphamide, mycophenolate mofetil (MMF), calcineurin inhibitors (cyclosporine and tacrolimus), rituximab and vincristine. The steroid-sparing effects of these agents have greatly reduced the adverse effects seen with long-term use of steroids.Despite the wide arsenal of agents available, therapy needs to be individualised to achieve optimal care of each child. More randomised controlled trials are required to evaluate the therapeutic and economic efficacy of this agent, define criteria for selection of patients for use of particular agents and to determine the safety profile of these drugs in children.This article reviews the epidemiology, pathogenesis, clinical presentation, diagnosis, complications, management and long term outcome of children with steroid sensitive NS.

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Section: (Ii) Thromboembolismmentioning

confidence: 99%

Steroid Sensitive Nephrotic Syndrome in Children

Bhimma¹

2014

J Nephrol Ther

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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). Además, se trata de una enfermedad de difícil diagnóstico, debido a la gran variabilidad en su presentación clínica, lo que exige un alto grado de sospecha y descartar oportunamente otros diagnósticos diferenciales (3).…”

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

2014

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“…Patients usually present with headache, visual disturbances, and seizures. 2,5 As evidenced by this case, pregnant women presenting with cerebral venous thrombosis should be evaluated for thrombogenic state and any underlying cause, if present, must also be simultaneously treated. The diagnostic modality of choice is MRI with venography.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnostic modality of choice is MRI with venography. [5][6][7] Once the diagnosis is confirmed, the treatment involves the use of antiepileptics and anticoagulants. 2,6 In our case, an addition of diseasemodifying antirheumatic drugs was used in view of the ANA-positive state.…”

Section: Discussionmentioning

confidence: 99%