Controversies in childhood arterial ischemic stroke and cerebral venous sinus thrombosis

Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.

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Ischemic stroke and cerebral venous sinus thrombosis in pregnancy

Handbook of Clinical Neurology - Neurology and Pregnancy: Neuro-Obstetric Disorders ◽

10.1016/b978-0-444-64240-0.00001-5 ◽

2020 ◽

pp. 3-31

Author(s):

Hannah J. Roeder ◽

Jean Rodriguez Lopez ◽

Eliza C. Miller

Keyword(s):

Ischemic Stroke ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

In Pregnancy

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Baseline Characteristics and Readmissions after Cerebral Venous Sinus Thrombosis in a Nationally Representative Database

Cerebrovascular Diseases ◽

10.1159/000495420 ◽

2018 ◽

Vol 46 (5-6) ◽

pp. 249-256 ◽

Cited By ~ 1

Author(s):

Yaowaree Leavell ◽

Mian Khalid ◽

Stanley Tuhrim ◽

Mandip S. Dhamoon

Keyword(s):

Ischemic Stroke ◽

Readmission Rate ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Index Admission ◽

Readmission Rates ◽

Venous Sinus Thrombosis ◽

Baseline Characteristics ◽

Nationally Representative

Background: There are limited epidemiologic data on cerebral venous sinus thrombosis (CVST). We aim to summarize baseline characteristics and outcomes using a large nationally representative administrative database. Methods: Using the 2013 Nationwide Readmissions Database, we used validated International Classification of Disease, Ninth Revision codes to identify baseline characteristics of patients admitted with CVST. We calculated readmission rates (per 100,000 index hospitalizations) for neurological complications. Multivariable Poisson regression yielded rate ratios (RR) of associations between index admission variables and all-cause readmission up to 1 year. Results: Among 2,105 patients with index admission for CVST, mean age was 46.8 (SD 18.4); 65.2% were female, and 6.1% were pregnant. Hemorrhagic stroke (15.6%) was more common than ischemic stroke (10.7%), seizure occurred in 16.3, and 3.7% of patients died during index hospitalization. The 90-day readmission rate (per 100,000 index CVST hospitalizations) was the highest for CVST (1,447) and ischemic stroke (755). Diabetes (RR 1.10, 95% CI 1.002–1.22), cancer (1.23, 1.09–1.39), insurance status (0.92, 0.83–0.97 for Medicare/private insurance vs. others), and discharge home (RR 0.89, 95% CI 0.85–0.99) were associated with increased readmission rate. Conclusions: We provide baseline characteristics and readmission rates after CVST over a 1-year period. In-hospital mortality rate and association with pregnancy were lower than previously observed.

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Republished: Reversible changes in diffusion- and perfusion-based imaging in cerebral venous sinus thrombosis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011447.rep ◽

2015 ◽

Vol 8 (2) ◽

pp. e6-e6 ◽

Cited By ~ 1

Author(s):

Ning Lin ◽

Andrew K Wong ◽

Lindsay J Lipinski ◽

Maxim Mokin ◽

Adnan H Siddiqui

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Prognostic Value ◽

Ct Perfusion ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Imaging Studies ◽

Venous Sinus Thrombosis ◽

Systemic Anticoagulation

Diffusion- and perfusion-based imaging studies are regularly used in patients with ischemic stroke. Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and is primarily treated by systemic anticoagulation. Endovascular intervention can be considered in cases of failed medical therapy, yet the prognostic value of diffusion- and perfusion-based imaging for CVST has not been clearly established. We present a patient with CVST whose abnormal findings on MRI and CT perfusion images were largely reversed after endovascular treatment.

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