scholarly journals Cerebral Venous Thrombosis Associated with COVID-19 Infection: An Observational, Multicenter Study

2021 ◽  
pp. 55-60
Author(s):  
Sajid Hameed ◽  
Mohammad Wasay ◽  
Bashir A. Soomro ◽  
Ossama Mansour ◽  
Foad Abd-allah ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Scale Score ◽  
United Arab Emirates ◽  
Cerebral Venous Thrombosis ◽  
Imaging Finding ◽  
Elevated Serum ◽  
Cerebrovascular Diseases ◽  
Modified Rankin Scale ◽  
Female Ratio ◽  
Presenting Symptoms

<b><i>Background and Purpose:</i></b> Coronavirus disease 2019 (CO­VID-19) has an increased propensity for systemic hypercoagulability and thromboembolism. An association with cerebrovascular diseases, especially cerebral venous thrombosis (CVT), has been reported among these patients. The objective of the present study was to identify risk factors for CVT as well as its presentation and outcome in COVID-19 patients. <b><i>Methods:</i></b> This is a multicenter and multinational observational study. Ten centers in 4 countries (Pakistan, Egypt, Singapore, and the United Arab Emirates) participated in this study. The study included patients (aged &#x3e;18 years) with symptomatic CVT and recent COVID-19 infection. <b><i>Results:</i></b> Twenty patients (70% men) were included. Their mean age was 42.4 years, with a male-to-female ratio of 2.3:1. Headache (85%) and seizures (65%) were the common presenting symptoms, with a mean admission Glasgow Coma Scale (GCS) score of 13. CVT was the presenting feature in 13 cases (65%), while 7 patients (35%) developed CVT while being treated for COVID-19 infection. Respiratory symptoms were absent in 45% of the patients. The most common imaging finding was infarction (65%), followed by hemorrhage (20%). The superior sagittal sinus (65%) was the most common site of thrombosis. Acute inflammatory markers were raised, including elevated serum D-dimer (87.5%), erythrocyte sedimentation rate (69%), and C-reactive protein (47%) levels. Homocysteine was elevated in half of the tested cases. The mortality rate was 20% (4 patients). A good functional outcome was seen in the surviving patients, with a mean modified Rankin Scale score at discharge of 1.3. Nine patients (45%) had a modified Rankin Scale score of 0–1 at discharge. <b><i>Conclusion:</i></b> COVID-19-related CVT is more common among males at older ages when compared to previously reported non-COVID-19-related CVT cases. CVT should be suspected in COVID-19 patients presenting with headache or seizures. Mortality is high, but functional neurological outcome is good among survivors.

scholarly journals Cerebral venous thrombosis requiring invasive treatment for elevated intracranial pressure in women with combined hormonal contraceptive intake: risk factors, anatomical distribution, and clinical presentation

2018 ◽  
Vol 45 (1) ◽  
pp. E12 ◽  
Author(s):  
Michel Roethlisberger ◽  
Lara Gut ◽  
Daniel Walter Zumofen ◽  
Urs Fisch ◽  
Oliver Boss ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Venous Thrombosis ◽  
Scale Score ◽  
Cerebral Venous Thrombosis ◽  
Unfavorable Outcome ◽  
Hormonal Contraceptives ◽  
Induced Hypothermia ◽  
Similar Distribution ◽  
Elevated Intracranial Pressure ◽  
Barbiturate Coma

OBJECTIVEWomen taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population.METHODSThe authors conducted a 2-center, retrospective chart review of 168 cases of CVT in women between 2000 and 2012. Eligible patients were classified as having had a mild or a severe clinical course, the latter category including all patients who underwent invasive or surgical ICP treatment and all who had an unfavorable outcome (modified Rankin Scale score ≥ 3 or Glasgow Outcome Scale score ≤ 3). The Mann-Whitney U-test was used for continuous parameters and Fisher’s exact test for categorical parameters, and odds ratios were calculated with statistical significance set at p ≤ 0.05.RESULTSOf the 168 patients, 57 (age range 16–49 years) were determined to be eligible for the study. Six patients (10.5%) required invasive or surgical ICP treatment. Three patients (5.3%) developed refractory ICP > 30 mm Hg despite early surgical decompression; 2 of them (3.5%) were treated with barbiturate coma and induced hypothermia, with documented infectious, thromboembolic, and hemorrhagic complications. Coma on admission, thrombosis of the deep venous system with consecutive hydrocephalus, intraventricular hemorrhage, and hemorrhagic venous infarction were associated with a higher frequency of surgical intervention. Coma, quadriparesis on admission, and hydrocephalus were more commonly seen among women with unfavorable outcomes. Thrombosis of the transverse sinus was less common in patients with an unfavorable outcome, with similar distribution in patients needing invasive or surgical ICP treatment.CONCLUSIONSThe need for invasive or surgical ICP treatment in women taking CHCs who have CVT is partly predictable on the basis of the clinical and radiological findings on admission. The use of nonsurgical treatments for refractory ICP, such as barbiturate coma and induced hypothermia, is associated with systemic infectious and hematological complications and may worsen morbidity in this patient population. The significance of these factors should be studied in larger multicenter cohorts.

scholarly journals Clinical profile of cerebral venous thrombosis in pregnancy and puerperium in South India

2017 ◽  
Vol 6 (7) ◽  
pp. 3124
Author(s):  
Ramasamy Sasikala ◽  
Jagan Aishwarya ◽  
Syed Dilshath
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
South India ◽  
Total Mortality ◽  
Acute Onset ◽  
Clinical Profile ◽  
Focal Neurological Deficit ◽  
Presenting Symptoms ◽  
Laboratory Investigations ◽  
In Pregnancy

Background: Cerebral venous thrombosis (CVT) is any thrombosis occurring in intracranial veins and sinuses, which is a rare disorder affecting 5 persons per million per year with huge regional variation. Pregnancy and puerperium are the most prevalent prothrombotic states leading to cerebral venous thrombosis. The objective of this study was to analysis the clinical profile of CVT in pregnancy and puerperium.Methods: In this prospective study, we analysed 52 consecutive patients admitted with impairment of consciousness, seizures or focal neurological deficit at our hospital. The diagnosis of CVT was confirmed by neuroimaging. Detailed history, clinical examination and laboratory investigations were carried out in all the cases and analysed.Results: The incidence of CVT associated with pregnancy and puerperium at our Hospital was 3.9 per 1000 obstetric admissions. The age of the patients varied from 18-35 years with a maximum age incidence (77%) in the III decade (21-30 years). The maximum incidence was during the first two weeks of puerperium (61.8%). The most common presenting symptoms were focal or generalised seizures (88.4%) followed by headache (65.3%). In spite of the alarming clinical picture, recovery was rapid and remarkable. Total mortality was 15.5% (8 cases).Conclusions: CVT is more common during the puerperium than in the antenatal period. Obstetric CVT has a more acute onset with excellent recovery when promptly diagnosed and treated.

scholarly journals Prognosis of fasting in patients with cerebral venous thrombosis using oral contraceptives

2019 ◽  
Author(s):  
Masoud Ghiasian ◽  
Maryam Mansour ◽  
Nasrin Moradian
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Oral Contraceptives ◽  
Neurological Deficit ◽  
Cerebral Venous Thrombosis ◽  
Clinical Presentation ◽  
Modified Rankin Scale ◽  
Focal Neurological Deficit ◽  
Muslim Countries

Background: There have been studies that showed a higher incidence of cerebral venous thrombosis (CVT) in Ramadan, a month in which people fast in Muslim countries, which was associated with increasing use of oral contraceptives (OCPs) in women. We aimed to evaluate the effect and prognosis of fasting in patients with CVT using OCPs. Methods: Consecutive patients with diagnosis of CVT in Sina hospital, Hamadan, West of Iran, from May of 2009 to June of 2016 were evaluated, and women using OCPs were included. Other risk factors except fasting were excluded. Clinical presentation and outcomes of CVT was assessed. Patients were followed up for 12 months. Results: 58 patients were included in this study. 31 of these patients had fasting simultaneously. Fasting in patients using OCPs caused significantly higher focal neurological deficit (64.5%, P = 0.018), and higher hemorrhage (66.7%, P = 0.042). At discharge, 51.6% and after three months, 25.8% of patients with fasting had disability [6 > modified Rankin Scale (mRS) >1]. In patients who used OCPs as sole risk factor, 25.9% at discharge and 11.1% after three months had disability. Conclusion: Fasting in patients with CVT using OCPs causes significant increase in focal neurological deficit and hemorrhage, which also increases the hospital stay and lengthens recovery. However, longterm prognosis and mortality of CVT is similar between the two groups. 

scholarly journals Radiological clinical evaluation of cerebral venous thrombosis

2021 ◽  
Author(s):  
Maely Moreira de Abrantes
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Imaging Techniques ◽  
Correct Diagnosis ◽  
Venous Drainage ◽  
Cerebrovascular Diseases ◽  
Cerebral Veins ◽  
Gold Standard Method ◽  
Invasive Method ◽  
Detailed Assessment

Background: Cerebral venous thrombosis (CVT) is a rare disorder, accounting for 0.5- 1% of cerebrovascular diseases and, in general, affects young people. Occurs due to occlusion of venous sinuses and cerebral veins, which are responsible for the venous drainage of the brain. Symptoms and clinical course are extremely variable, making diagnosis difficult. Objective: The present study aims to conduct a review of the literature on the clinical radiological evaluation in patients with cerebral venous thrombosis. Methods:This is a literature review based on the medical literature and scientific articles indexed in the Scientific Eletronic Library Online (SCIELO) and VHL- Brazil. Results: The evolution, introduction and use of relatively recent imaging techniques have contributed to the early diagnosis and treatment of patients with CVT. Skull computed tomography (CT) is usually the first examination performed in emergency care and can be normal in up to 50% of cases. Skull MRI associated with cranial angioresonance (MRA) are currently the exams of choice for the diagnosis of CVT in the acute, subacute and chronic phases. These tests allow a detailed assessment of the thrombus and tissue changes resulting from CVT. Digital angiography of the skull by catheterization is an invasive method and is considered the gold standard method for the diagnosis of CVT. It is reserved for cases in which NMR is not conclusive or when considering the performance of an endovascular procedure. Conclusions: Imaging studies are of great importance in the diagnosis. Although the venous angiographic study is essential, it is also important to observe the conventional sequences in order to allow a correct diagnosis.

scholarly journals Clinical profile of postpartum cerebral venous thrombosis

2017 ◽  
Vol 6 (4) ◽  
pp. 1192
Author(s):  
Umesh G. Rajoor ◽  
Seema B. N.
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Clinical Profile ◽  
Coagulation System ◽  
Common Finding ◽  
Prothrombotic State ◽  
Hemorrhagic Infarction ◽  
Economic Class ◽  
Presenting Symptoms ◽  
Laboratory Investigations

Background: Pregnancy and puerperium are most prevalent prothrombotic states leading to cerebral venous thrombosis (CVT). Pregnancy induces several changes in coagulation system, which persists at least during early puerperium, rendering it a prothrombotic state. The objective of the study was to study the clinical profile of postpartum CVT.Methods: A total of 32 consecutive patients admitted in medicine and obstetrics and gynecology ward between April 2012 and March 2015 with radiologically confirmed diagnosis of CVT were included in the study. Detailed history, clinical examination, and laboratory investigations were carried out in all the cases.Results: Out of 32 patients of CVT studied, the age of patients varied from 18 to 40 years. Maximum incidence was seen in 21-30 age group comprising 74% of the cases, with mean age being 25.5 years. Two-third of the patients belongs to the low socio-economic class. The majority of them had subacute presentation with the headache in 93.75%, followed by altered sensorium (90.6%) and convulsions (75%) being the most common presenting symptoms. Radiologically the most common finding noted was hemorrhagic infarction (85.3%), followed by non-hemorrhagic infarction (15.7%).Conclusions: Pregnancy and puerperium are most prevalent prothrombotic states leading to CVT.

scholarly journals Successful Endovascular Treatment of Cerebral Venous Thrombosis With a Novel, Larger Aspiration Catheter (REACT): A Case Report

2020 ◽  
Author(s):  
Kaushik Sundar ◽  
Sabharisundarvel Paulraj ◽  
Shuvro Roy Choudhury ◽  
Haseeb Hassan ◽  
Judhajit Sengupta ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Medical Management ◽  
Cerebral Venous Thrombosis ◽  
Lower Risk ◽  
Mechanical Thrombectomy ◽  
Treatment Options ◽  
Rare Clinical Entity ◽  
Modified Rankin Scale ◽  
Clinical Presentations ◽  
Hemorrhagic Complications

Cerebral venous thrombosis (CVT) is a rare clinical entity, with clinical presentations extending from headache and seizures to coma and death. For adults developing progressive neurological worsening despite adequate medical management, endovascular thrombolysis and/or mechanical thrombectomy may be considered as treatment options. We present one such patient with CVT who developed seizures and slipped into a coma, despite best medical management. A large-bore aspiration catheter was used as a standalone system for the endovascular procedure. The venous sinuses were successfully re-canalized. The patient was discharged a week later with a modified Rankin scale of 2. Studies show that endovascular thrombolysis used alone or in conjunction with thrombectomy for CVT has a higher risk of hemorrhagic complications. If we were to use mechanical thrombectomy devices (that are specifically designed for intracranial clot retrieval) as a stand-alone system, we would probably have better clinical outcomes with a lower risk of hemorrhagic complications.

scholarly journals A clinical study of cerebral venous thrombosis

2017 ◽  
Vol 4 (5) ◽  
pp. 1236
Author(s):  
Priyadarsini Bose ◽  
Jacinth Preethi Joshua ◽  
Murali Thandavarayan
Keyword(s):  
Clinical Study ◽  
Magnetic Resonance ◽  
Venous Thrombosis ◽  
Ct Scan ◽  
Cerebral Venous Thrombosis ◽  
Clinical Symptoms ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Prospective Clinical Study ◽  
Female Ratio

 Background: Cerebral venous thrombosis (CVT) is an uncommon form of stroke, usually affecting young population. Clinical features of CVT are diverse, and for this reason, high degree of clinical suspect is mandatory to diagnose the conditions. The objectives of the study were to analyse the commonest clinical modes of presentation, possible etiologies, and to evaluate clinical outcome.Methods: This study was prospective, clinical study was conducted on 40 patients during the period of September 2010 to September 2011 in the Department of Emergency, Institute of Internal medicine at Government General Hospital (GGH), Chennai. All the patients included in the study were subjected to neuroimaging techniques like Computed tomography (CT), magnetic resonance imaging (MRI) along with magnetic resonance venography (MRV) according to guidelines and standard protocol.Results: Majority of the patients involved in the study were in the age group of 15-35 years contributing to 75%. Male: female ratio was 1.5: 1. Headache was the most common presenting symptom seen in 36 (87.5%) cases followed by convulsions in 32 (80%) patients. Altered sensorium was observed in 26 (65%), focal deficits in 22 (55%), and 18 (45%) had fever. Two of them had ear discharge and another with diarrhea. Cranial nerve involvement in 35% and pappiledema was noted in 20% of patients. Out of 40, 17 (42.5%) patients were anemic. Eighteen (18) patients who were suspected of meningitis underwent CSF analysis. Abnormality was seen in 10 patients with pleocytosis being the maximum. On CT scan, haemorrhagic infarct was seen in 22 (55%) cases followed by edema in 8 (20%) and 10% showed normal CT picture. On MRI scan, superior sagittal sinus thrombosis was observed in 24 (60%) patients followed by transverse sinus in 20 (50%) patients. Etiology factor were identified in 25 (62.5%) of patients and in 15 (37.5%) cases risk factors could not be identified. The mortality rate in the study was 20%.Conclusions: The clinical symptoms of CVT are not specific, as a result of chances of misdiagnosis tends to be more. CT scan and MRI along with MRV can improve the precision of CVT diagnosis.

scholarly journals Musculoskeletal Brucellosis in Adults in the United Arab Emirates: A Retrospective Study

2021 ◽  
Author(s):  
Shamma Al Nokhatha ◽  
Fatima AlKindi ◽  
Shaima Al Yassi ◽  
Rayhan Hashmey
Keyword(s):  
United Arab Emirates ◽  
Early Recognition ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Raw Milk ◽  
Joint Involvement ◽  
Radiographic Findings ◽  
Female Ratio ◽  
Presenting Symptoms ◽  
Brucella Infection

Introduction: Brucellosis is a zoonotic infection caused by the aerobic Gram-negative bacteria coccobacilli, and is considered a public health problem in the Mediterranean region and Arabian Peninsula. This paper studied the clinical characteristics of musculoskeletal brucellosis and the outcomes of treatment in Al Ain City, United Arab Emirates. Method: A retrospective chart review study was conducted at Tawam Hospital over seven years: January 2009–January 2016. Risk factors for brucellosis, musculoskeletal (MSK) manifestations, duration of Brucella infection (acute, subacute, chronic), and treatment were studied. Results: A total of 99 patients were diagnosed with brucellosis during the study period; the mean age was 44 years, the majority were males (71%), and the male to female ratio was 3:1. The most common risk factor for Brucella infection in the cohort was drinking raw milk (43.4%). Fever was the most common presenting symptoms (93%), followed by arthralgia, fatigue, and loss of appetite in 35, 21, and 14%, respectively. The clinical manifestations of brucellosis in the cohort were MSK involvement (30%), hepatitis (17%), epididymo-orchitis (2%), and endocarditis (1%). Thirty percent of patients (n=30) had MSK-specific symptoms and only one-third (n=10) had confirmatory positive radiographic findings. The majority of patients had lumbar and sacroiliac joint involvement. Most of the patients received antibiotics for a 4–8-week duration and the overall relapse rate of Brucella infection was 10%. Conclusion: This study demonstrates that MSK involvement is a common manifestation in brucellosis, occurring in one-third of the cases. The index of suspicion should be high in brucellosis-endemic countries for early recognition and treatment.

scholarly journals Spectrum of Cerebral Venous Thrombosis in Oman

2018 ◽  
Vol 18 (3) ◽  
pp. 329
Author(s):  
Darshan Lal ◽  
Arunodaya R. Gujjar ◽  
Nandagopal Ramachandiran ◽  
Ammar Obaidi ◽  
Sunil Kumar ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Patient Outcome Assessment ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Neurological Deficits ◽  
Female Ratio ◽  
Sultan Qaboos University ◽  
High Index Of Suspicion

Objectives: Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results: A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion: These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes.Keywords: Venous Thrombosis; Cerebral Thrombosis; Cranial Venous Sinuses; Neurological Manifestations; Patient Outcome Assessment; Oman.

scholarly journals Prevalence of Inherited Procoagulant States in Cerebral Venous Thrombosis and its Correlation with Severity and Outcome

2022 ◽  
Author(s):  
Shaman Gill ◽  
Pawan Dhull ◽  
Madhukar Bhardwaj
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Prospective Observational Study ◽  
Total Population ◽  
Severity Of Illness ◽  
Modified Rankin Scale ◽  
Thrombotic Occlusion ◽  
Stroke In Young Adults ◽  
Functional Assessments ◽  
Stroke In Young

Abstract Background Cerebral venous thrombosis (CVT) is one of the important causes of stroke in young adults. It is caused by complete or partial thrombotic occlusion of the cerebral venous sinuses or cortical veins. There are many risk factors associated with this condition, out of which common ones are oral contraceptives use, genetic, or acquired thrombophilias, infections, malignancy, pregnancy, and puerperium. We aimed to study the prevalence of inherited procoagulant states in patients with CVT and correlate these states with the severity and outcome. Materials and Methods It was a prospective observational study of 2 years duration in which 75 patients, 18 to 50 years old, with confirmed CVT were included. The baseline data, imaging findings were recorded for all the patients. After 3 months of the onset of CVT, anticoagulants were stopped and a procoagulant test was done for all patients. Severity was assessed by Glasgow Coma Score (GCS) at the onset of illness. Functional assessments were done using the modified Rankin Scale (mRS) at presentation, at 7 days, 6 weeks, and 3 months. Results In the present study, any procoagulant state was seen in 9 out of 75 patients with CVT that accounted for 12% of the total population. There was no significant correlation between the presence of procoagulant states and severity of illness as assessed by GCS at presentation. The presence of any thrombophilia did not affect the final outcome at 7 days, 6 weeks or 3 months (p = 0.532, p = 0.944 and p = 0.965 respectively) as assessed by modified Rankin Scale (mRS). Conclusion Inherited procoagulant states are an important risk factor for CVT. The presence of an inherited procoagulant state does not have any correlation with the disease severity and outcome.

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