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

Author(s):  
Masoud Ghiasian ◽  
Maryam Mansour ◽  
Nasrin Moradian

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. 

2021 ◽  
Vol 10 (7) ◽  
pp. 1382
Author(s):  
Zoltan Bajko ◽  
Anca Motataianu ◽  
Adina Stoian ◽  
Laura Barcutean ◽  
Sebastian Andone ◽  
...  

Gender has been shown to be an important variable in cerebral venous thrombosis (CVT) risk and significantly influences its clinical manifestations and outcome. The aim of our study was to investigate the gender-specific risk factor profile and clinical picture of this rare cerebrovascular disorder. Materials and methods: We retrospectively reviewed the medical records of 89 consecutive cases of CVT at a tertiary neurology clinic in Târgu Mures, Romania, between June 2009 and January 2021 to analyze the gender-related differences in etiology, clinical presentation, and outcome. Results: Women comprised 62.5% of the cohort. Females were significantly younger than males (37.3 years versus 48.8 years, respectively, p = 0.001), and the main risk factors were hormone related in 37.9% of the cases, followed by primary thrombophilia (34.4%), smoking (25.8%), obesity (17.2%), infections (17.2%), mechanical factors (17.2%), cancer (8.6%), systemic autoimmune disorders (8.6%), and hematological disorders (8.6%). In male patients, the main risk factors were smoking (41.9%), primary thrombophilia (29%), infections (22.6%), heavy alcohol consumption (16.1%), and venous thromboembolism in the medical history (12.9%). Frequency of headache was higher in females than in males (75.9% versus 67.7%), whereas frequency of coma (6.5% in males versus 1.7% in females) and dizziness (19.4% in males versus 10.3% in females) was higher in males. CVT onset was acute in 41.4% of females and 38.7% of males. The Rankin score at discharge was significantly lower in females compared with males (0.6 versus 1.6), reflecting a more favorable short-term outcome. Mortality was 6.4% in males and 1.7% in females. Conclusions: CVT is a multifactorial disorder that has a broad spectrum of risk factors with important gender-related differences in clinical manifestation and prognosis. Female patients, especially those with hormone-related risk factors, have a more favorable outcome than male patients.


2021 ◽  
Vol 10 (34) ◽  
pp. 2960-2963
Author(s):  
Maria Prothasis ◽  
Yash Gupte ◽  
Sourya Acharya ◽  
Samarth Shukla ◽  
Neema Acharya

Thrombosis of cerebral venous channel is a known complication of hypercoagulable states. Hyperhomocysteinaemia is a known hypercoagulable state. Obesity is a modern-day global epidemic. Disorders such as myocardial infarction (MI), stroke, and venous thromboembolism are on the rising trend and its increased morbidity and mortality is being associated with obesity. To date, however, the knowledge about the association between obesity and adult cerebral venous thrombosis (CVT) is sparse. We report a 44-year-old young morbidly obese metabolically unhealthy female who presented with headache, nausea, vomiting and giddiness. On evaluation, magnetic resonance venogram showed cerebral venous sinus thrombosis. On investigations, she had concomitant hyperhomocysteinaemia and metabolic syndrome. Cerebral venous sinus thrombosis causing stroke in young adults is uncommon with various conditions precipitating it.1,2,3 Severe headache (70 - 90 %), focal lateralized signs (25 % - 75 %), seizures (30 – 40 %) as well as behavioural symptoms such as delirium, amnesia, and disturbances in consciousness are the various associated clinical symptoms. The known inherited hypercoagulable risk factors that cause CVST are gain of function mutations in the genes encoding factor V (factor V Leiden) and prothrombin, Protein C, S and antithrombin III deficiency. Hyperhomocysteinaemia, is a known risk factor for causing venous thrombosis of the lower limbs. However, till date there is no data available showing its role in causing cerebral venous thrombosis. The interaction between genetic and acquired determinants result in high plasma levels of total homocysteine (tHcy).4,5,6 Vitamins such as folic acid, pyridoxine, and cobalamin are involved in the metabolic pathways of homocysteine and its deficiencies represent the acquired determinants. Venous thromboembolism (VTE) comprises of deep vein thrombosis of the leg and pulmonary embolism and obesity is now being recognised as one of the risk factors causing it. The risk of VTE is approximately increased to 2-fold in an individual with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 30 or more compared with a normal BMI (< 25), and higher BMIs increase more risk with approximately 3 times higher risk in individuals with a BMI greater than 40.7, 8,9 Again obesity as a risk factor for CVST is less known.


2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Heng Gee Lee ◽  
Heng Gee Lee ◽  
Heng Gee Lee ◽  
Heng Gee Lee

Cerebral venous thrombosis (CVT) is a relatively rare form of neurovascular emergency, and may present as headache, seizure, or focal neurological deficit. It typically has a higher occurrence in younger women. Recently, there are increasingly cases of CVTreported in association with COVID-19, which fall outside the typical demographics, suggesting a hyper-coagulable state attributable to COVID-19. Here, we present a case of CVTin a young gentleman with concomitant COVID-19, who presented with first-onset seizure.


Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Carlos Cantu-Brito ◽  
Erwin Chiquete ◽  
Antonio Arauz ◽  
Marlon Merloz-Benitez

Background. Seizures is a very common clinical presentation of cerebral venous thrombosis (CVT); however, little is known about the future risk of epilepsy in patients suffering CVT. Our objective was to analyze risk factors for epilepsy in a long-term follow-up after CVT. Methods. This is a cohort descriptive study of consecutive non-selected patients with acute cerebrovascular disease, systematically registered from 1986 to 2010 in a third-level referral center of Mexico City. Here we analyzed 340 patients who survived the first 6 months after CVT, who were not epileptic at baseline and for whom complete long-term information on neurological outcome was available. Results. Seizures occurred in 183 (54%) patients, in 26% of them as a clinical presentation and 74% at some point during follow-up. Focal motor seizures occurred in 6.5%, secondary generalized focal seizures in 13.8% and generalized tonic-clonic seizures in 22.4%. Status epilepticus occurred in 13 (7%) cases. In all, during a median follow-up of 28 months (range 2 to 288 months), epilepsy was present in 14.7% (27.3% of those who presented seizures). In a multivariate analysis adjusted for multiple confounders, risk factors associated with an increased risk of epilepsy during follow-up were presenting seizures as a clinical presentation [odds ratio (OR): 4.32, 95% confidence interval (CI): 2.20-8.48], pregnancy and puerperium (OR: 2.03, 95% CI: 1.11-3.71) and thrombosis of the longitudinal sinus (OR: 1.86, 95% CI: 1.01-3.41). Conclusion. Seizures are common at CVT presentation, but risk increases during the acute phase after thrombotic event. Most seizures resolve during the first month, but epilepsy occurred in 15% of patients with CVT in the long run.


Author(s):  
Khalil Khashei Varnamkhasti

Introduction: Predisposition to cerebral venous thrombosis (CVT) also has a genetic basis and inherited thrombophilias constitute 22.4 % of the CVT cases. CVT with a varied clinical presentation and pathogenesis is one of the important causes of stroke which is not very common. Inherited thrombophilias with concomitant acquired risk factors like pregnancy may increase the risk of CVT manifold. Identification of a number of genetic variants increasing susceptibility to CVT and related traits opened up opportunity, to screening of women at high risk of developing obstetric CVT.  


2020 ◽  
Vol 7 (7) ◽  
pp. 1100
Author(s):  
Josy J. Vallippalam ◽  
Balakrishnan R. ◽  
Saloni Krishna ◽  
Karthik Thamaraikannan ◽  
Nitya Suresh

Background: Cerebral venous thrombosis is a rare cause of stroke, with a predilection to females. Since the past two decades its morbidity and mortality had decreased because of the new effective diagnostic and therapeutic interventions. This study mainly intends to assess, the clinical and aetiological factors of cerebral venous thrombosis and the factors predicting its short-term outcome. Objective was to study the factors influencing the short-term outcome of CVT and to study the pattern of clinical presentation and risk factors for CVT.Methods: It was a cross-sectional study done at a tertiary care Centre in Tamil Nadu, in adult CVT patients from august 2018 to august 2019. Clinical, aetiological and radiological data were collected from patients and assessed and factors influencing the short-term outcome at discharge and at 15 days after discharge were studied. Data was analysed using SPSS16 software. Analysis of the descriptive data was performed and independent factors influencing the short-term outcome were analysed subsequently.Results: Males predominated in the study with a mean age of 38yrs. Most common presentation was headache. Infarct was present in 61 (56.5%). The most common site of venous involvement was superior sagittal sinus 81 (75%). Short term outcome had shown a significant association with hypertension (p value -0.019 and odds ratio-65.439) and baseline MRS (p value- 0.000, OR - 0.004) only.Conclusions: Nowadays, the mortality and morbidity of CVT has decreased. Hypertension has emerged as an independent predictive factor in the short -term outcome of CVT.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Henry Robayo-Amortegui ◽  
Natalia Valenzuela-Faccini ◽  
Cesar Quecano-Rosas ◽  
Darlyng Zabala-Muñoz ◽  
Michel Perez-Garzon

Abstract Background The new coronavirus disease 2019 pandemic has spread throughout most of the world. Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. Case presentation We report the case of a Hispanic woman with Down syndrome who has coronavirus disease 2019 and presents as a complication extensive cerebral venous thrombosis. Conclusions Cerebral venous thrombosis is a rare thromboembolic disease that can present as an extrapulmonary complication in coronavirus disease 2019 infection. In the absence of clinical and epidemiological data, it is important to carry out further investigation of the risk factors and pathophysiological causes related to the development of cerebrovascular thrombotic events in patients with Down syndrome with coronavirus disease 2019 infection.


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