Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis

Davoudi, Vahid; Keyhanian, Kiandokht; Saadatnia, Mohammad

doi:10.1016/j.seizure.2013.10.011

Cited by 38 publications

(52 citation statements)

References 13 publications

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“…However, in other studies, generalized seizures are reported to have a higher frequency, particularly in severe cases of CVST who underwent thrombolysis …”

Section: Discussionmentioning

confidence: 80%

“…The incidence rate of ASS has a widely varied range in different studies. ASS in CVST are reported in 6.9–76% of patients, with the higher incidence in severe CVST cases (60%) and peripartum CVST (76%) . The risk of PCE is low compared with the high rate of ASS, and is reported in about 4–16% of patients in different studies that followed patients between 12 months to a mean of 77.8 months .…”

Section: Discussionmentioning

confidence: 99%

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Seizure in cerebral venous and sinus thrombosis

2018

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SummaryMany conflicting issues exist about seizure in the setting of cerebral venous and sinus thrombosis (CVST). In this article we aimed to address the existing data regarding incidence, characteristics, predictors, treatment, and prognosis of acute and late seizures in patients with CVST and to prepare more practical information for clinicians. PubMed, Embase, Web of science and Cochrane databases were searched within 1966–2016 using relevant keywords. A total of 63 papers met the inclusion criteria. Seizures are classified as acute symptomatic seizures (ASS; first 14 days) and post‐CVST epilepsy (PCE; after 14 days). The incidence had been reported in a wide range of 6.9–76% for ASS and 4–16% for PCE. Focal and generalized seizures were observed with different predominance. ASS commonly occurred in patients with loss of consciousness, focal neurological deficits, supratentorial lesions and thrombosis in superior sagittal sinus, straight sinus, and cortical veins. PCE had been predisposed by occurrence of ASS, motor deficit, and supratentorial lesions, particularly hemorrhage. Most experts believe that primary prophylaxis with antiepileptic drugs in the acute phase is not indicated. However, the initiation of prophylaxis after the first seizure in patients with supratentorial lesions or focal neurological deficit should be recommended. The quality of current evidence is low and most conclusions are based on expert opinions. More accurate reports of seizure semiology, detailed antiepileptic treatment plans, and outcomes are necessary to answer the existing questions.

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“…However, in other studies, generalized seizures are reported to have a higher frequency, particularly in severe cases of CVST who underwent thrombolysis …”

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Seizure in cerebral venous and sinus thrombosis

2018

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“…135 Supratentorial lesion was a predictor of seizures in several studies. 52,135,136 Seizures are common in CVT and may be a cause of early death. This was the reason to upgrade the strength of the recommendation from uncertain to weak, which was formally achieved by a unanimous consensus through a nominal group technique.…”

Section: (Recommendations)mentioning

confidence: 99%

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

Ferro

Bousser

Canhão

et al. 2017

European Stroke Journal

168

103

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The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer. We recommend parenteral anticoagulation in acute cerebral venous thrombosis and decompressive surgery to prevent death due to brain herniation. We suggest to use preferentially low-molecular weight heparin in the acute phase and not using direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations due to very poor quality of evidence concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that in women who suffered a previous cerebral venous thrombosis, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular weight heparin should be considered throughout pregnancy and puerperium. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of cerebral venous thrombosis. KeywordsCerebral venous thrombosis, dural sinus thrombosis, Grading of Recommendations, Assessment, Development, and Evaluation, angiography, venography, D dimers, prothrombotic screening, cancer screening, anticoagulation, heparin, thrombolysis, thrombectomy, acetazolamide, steroids, decompressive surgery, hemicraniectomy, lumbar puncture, shunt, pregnancy, puerperium, contraception, antiepileptic drugs These guidelines followed the traditional methodology of combining review of scientific evidence with expert opinion and classifying evidence and recommendations in complex grading systems, using a matrix combining classes of recommendations with levels of evidence.Since 2010-2011 new information has accumulated on multiple aspects of the diagnosis and management of CVT. We aim to update previous EFNS guidelines using a clearer and evidence base methodology. To achieve that aim, the current proposal for CVT guidelines followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, 3 formulating relevant diagnostic and treatment questions, performing systematic reviews of all available eviden...

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“…[5] A further study performed on 94 patients by Davoudi et al found that 19.1% of patients experienced presenting seizures and 21.3 % of patients had early seizures in the 2. week after confirmation of the CVST diagnosis. [19] In the study of Kalita et al 46.7% of patients with CVST had presenting seizures and 4.4% had early seizures, which were independently related to supratentorial lesion. [21] The results of all these studies support our findings: all of the patients with seizures had supratentorial lesions (mainly with a hemorrhagic component), 2 patients had motor weakness, and 2 patients were pregnant.…”

Section: Discussionmentioning

confidence: 93%

“…[4,[17][18][19] Patients with CVST are significantly more at risk to develop a seizure than patients with hemorrhage or ischemic stroke. [17] Status epilepticus has a poor prognosis and is one of the main causes of early death in CVST.…”

Section: Discussionmentioning

confidence: 99%

Epileptic Seizures Related to Cerebral Venous Sinus Thrombosis: Clinicoradiological Findings and Cases of Delayed Diagnosis.

Huseyinoglu¹,

Ozlece²,

Hüseyınoğlu³

et al. 2014

Epilepsi

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Amaç: Çalışmamızda, epileptik nöbet ve status epileptikus gelişen serebral venöz sinus trombozlu hastaların klinik ve radyolojik özellikleri ile yanlış veya gecikmiş tanı nedenlerini sunmayı amaçladık. Gereç ve Yöntem:Çalışmaya Kasım 2012-Kasım 2013 tarihleri arasında yoğun bakım ünitesinde epileptik nöbet veya status epileptikus ile takip edilen ve serebral venöz tromboz tanısı alan dokuz hasta alındı. Tüm hastaların ayrıntılı nörolojik ve oftalmolojik muayeneleri ve elektroensefalografi, kranial tomografi, manyetik rezonans görüntüleme ve manyetik rezonans venografileri yapıldı. Ayrıca daha önceki nöropsi-kiyatrik hastalık öyküleri, başvuru semptomları, başvurdukları hekim branşları ve tedavi protokolleri kaydedildi. Bulgular: Tüm hastalarda hastaneye başvuru esnasında en önemli semptom baş ağrısı idi. Tüm hastalar subakut bir progresyon göstermişlerdi. Beş hastada konvulsif ve bir hastada nonkonvulsif status epileptikus tablosu gelişti. Altı hasta nöbet ile başvurmuştu (nöbetler hasta tanı almadan önce oluşmuştu). Beş ve altı numaralı hastalar dışında tüm hastalarda superior sagittal sinüs etkilenmişti. Hastaların ön tanılarından bazıları arasında eklampsi, dissosiyatif bozukluk, subaraknoid hemoraji, migren ve psikiyatrik hastalıklar yer almakta idi.Sonuç: Çok farklı klinik tablolar ile presente olan serebral venöz trombus hastalarının bulguları özellikle psikiyatrik hastalıklar ile benzerlik göstermektedir. Bu nedenle tanı ve tedavide gecikmeler yaşanabilmekte ve bu durum nöbetler ve özellikle status epileptikus gibi ciddi tablolara yol açabilmektedir. Anahtar sözcükler: Serebral venöz sinüs trombozu; tanı; nöbet.

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Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis

Cited by 38 publications

References 13 publications

Seizure in cerebral venous and sinus thrombosis

Seizure in cerebral venous and sinus thrombosis

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

Epileptic Seizures Related to Cerebral Venous Sinus Thrombosis: Clinicoradiological Findings and Cases of Delayed Diagnosis.

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