scholarly journals Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges

2021 ◽  
Vol 13 (4) ◽  
pp. 570-586
Author(s):  
Amber N. Edinoff ◽  
Sarah E. Kaufman ◽  
Janice W. Hollier ◽  
Celina G. Virgen ◽  
Christian A. Karam ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Case Reports ◽  
Cerebral Venous Sinus Thrombosis ◽  
Definitive Treatment ◽  
Gamma Aminobutyric Acid ◽  
Medical Conditions ◽  
Motor Pathways ◽  
Nmda Receptor Encephalitis ◽  
Excitatory Neurotransmission ◽  
Clinical Overview

Catatonia is a syndrome that has been associated with several mental illness disorders but that has also presented as a result of other medical conditions. Schizophrenia and other psychiatric disorders such as mania and depression are known to be associated with catatonia; however, several case reports have been published of certain medical conditions inducing catatonia, including hyponatremia, cerebral venous sinus thrombosis, and liver transplantation. Neuroleptic Malignant Syndrome and anti-NMDA receptor encephalitis are also prominent causes of catatonia. Patients taking benzodiazepines or clozapine are also at risk of developing catatonia following the withdrawal of these medications—it is speculated that the prolonged use of these medications increases gamma-aminobutyric acid (GABA) activity and that discontinuation may increase excitatory neurotransmission, leading to catatonia. The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, that can be used in combination therapy with antipsychotics. Definitive treatment may be found with electroconvulsive therapy (ECT). Aberrant neuronal activity in different motor pathways, defective neurotransmitter regulation, and impaired oligodendrocyte function have all been proposed as the pathophysiology behind catatonia. There are many clinical challenges that come with catatonia and, as early treatment is associated with better outcomes, it becomes imperative to understand these challenges. The purpose of this manuscript is to provide an overview of these challenges and to look at clinical studies regarding the pathophysiology, diagnosis, and treatment of as well as the complications and risk factors associated with catatonia.

scholarly journals COVID-19 and cerebrovascular diseases: a comprehensive overview

2020 ◽  
Vol 13 ◽  
pp. 175628642097800
Author(s):  
Georgios Tsivgoulis ◽  
Lina Palaiodimou ◽  
Ramin Zand ◽  
Vasileios Arsenios Lioutas ◽  
Christos Krogias ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Clinical Laboratory ◽  
Sinus Thrombosis ◽  
Case Reports ◽  
Cardiac Injury ◽  
Clinical Manifestations ◽  
Relevant Information ◽  
Cerebral Venous Sinus Thrombosis ◽  
Stroke Patients ◽  
Comprehensive Overview

Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

A review of therapeutic strategies for the management of cerebral venous sinus thrombosis

2009 ◽  
Vol 27 (5) ◽  
pp. E6 ◽  
Author(s):  
Ricky Medel ◽  
Stephen J. Monteith ◽  
R. Webster Crowley ◽  
Aaron S. Dumont
Keyword(s):  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Case Reports ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Level Of Evidence ◽  
Venous Sinus Thrombosis ◽  
Systemic Anticoagulation

Object Although initially described in the 19th century, cerebral venous sinus thrombosis (CVST) remains a diagnostic and therapeutic dilemma. It has an unpredictable course, and the propensity for hemorrhagic infarction produces significant consternation among clinicians when considering anticoagulation. It is the purpose of this review to analyze the evidence available on the management of CVST and to provide appropriate recommendations. Methods A thorough literature search was conducted through MEDLINE and PubMed, with additional sources identified through cross-referencing. A classification and level of evidence assignment is provided for recommendations based on the American Heart Association methodologies for guideline composition. Results Of the publications identified, the majority were isolated case reports or small case series. Few prospective trials have been conducted. Existing data support the use of systemic anticoagulation as an initial therapy in all patients even in the presence of intracranial hemorrhage. Chemical and/or mechanical thrombectomy, in conjunction with systemic anticoagulation, is an alternative strategy in patients with progressive deterioration on heparin therapy or in those who are moribund on presentation. Mechanical thrombectomy is probably preferred in patients with preexisting intracranial hemorrhage. Conclusions Effective treatments exist for the management of CVST, and overall outcomes are more favorable than those for arterial stroke. Further research is necessary to determine the role of individual therapies; however, the rarity of the condition poses a significant limitation.

scholarly journals CEREBROVASCULAR COMPLICATIONS OF COVID-19

2021 ◽  
Vol 9 (3) ◽  
Author(s):  
Volodymyr Lychko ◽  
Mykola Burtyka
Keyword(s):  
Cerebrovascular Disease ◽  
Clinical Laboratory ◽  
Sinus Thrombosis ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Relevant Information ◽  
Neurological Complications ◽  
Cerebral Venous Sinus Thrombosis ◽  
Systemic Review ◽  
Stroke Patients

The systematic online search of articles utilizing the search terms ”Coronavirus, SARS-COV-2 and Neurological complications”, published between January 2019 and September 2021, was performed. Neurological manifestations are prevalent during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is a clear association between cerebrovascular disease and coronavirus disease 2019 (COVID-19). But today, whether this association is causal or incidental is still unknown. This systemic review presents the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describes the most often neurological complications and their prognosis, discusses several clinical and laboratory characteristics. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune storm with inflammation, coagulopathy, complications due to critical illness and prolonged hospitalization can all contribute as potential etiological and pathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral haemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients, with a prevalence ranging between 0.5 % and 5.0 %. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients. Understanding of the specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ in recognizing COVID-19-related acute neurological complications.

scholarly journals A rare case of post-partum cerebral venous sinus thrombosis

2018 ◽  
Vol 7 (2) ◽  
pp. 762
Author(s):  
Akhileshwar Singh ◽  
Sanjay Singh ◽  
Shakti Vardhan
Keyword(s):  
Sinus Thrombosis ◽  
Post Partum ◽  
Cerebral Venous Sinus Thrombosis ◽  
Sudden Onset ◽  
Venous Sinus ◽  
Definitive Treatment ◽  
Motor Deficit ◽  
Timely Initiation ◽  
Venous Sinus Thrombosis ◽  
Warfarin Sodium

Cerebral venous sinus thrombosis is a rare neurologic emergency during pregnancy. Life threatening complications can be prevented if it is detected and treated well in time. A 24 years P2L3A2 lady, who had undergone elective caesarean delivery developed sudden onset severe episodic parieto-occipital headache and bilateral diminution of vision on 4th post-partum day. She had no known risk factors for thrombosis. There was no history suggestive of sepsis or pre-eclampsia. On clinical examination her blood pressure was found to be very high (164-180/104-110 mm Hg). There was no sensory or motor deficit. Relevant haematological and biochemical investigations were within normal limits. Urinary protein was negative. With a provisional diagnosis of imminent eclampsia, she was put on antihypertensive and Magnesium Sulphate. However, in view of persistence of the symptoms even after 24 hours, contrast-enhanced computed tomography (CECT) was done, which revealed venous infarction in occipital cortex and subcortical white matter. Magnetic resonance (MR) venography confirmed thrombus in left transverse and sigmoid sinuses. Thus, definitive treatment in the form of heparin in therapeutic doses was started. Antihypertensive was continued and prophylactic anticonvulsant was added in view of presence of the infarction. Patient responded well. Vision improved, and headache resolved completely. The patient was discharged on antihypertensive, anticonvulsant and vitamin K antagonist (Warfarin sodium) with an advice of regular follow-up. Cerebral venous thrombosis (CVT) is an uncommon entity and a high index of suspicion is needed to diagnose it at an earlier stage for timely initiation of treatment and prevention of complications. Prognosis in pregnant cases is better than that during a non-pregnant state.

scholarly journals Thrombosis with Thrombocytopenia Syndrome After Administration of AZD1222 or Ad26.COV2.S Vaccine for COVID-19: A Systematic Review

2021 ◽  
Vol 27 ◽  
pp. 107602962110684
Author(s):  
Usama Waqar ◽  
Shaheer Ahmed ◽  
Syed M.H.Ali Gardezi ◽  
Muhammad Sarmad Tahir ◽  
Zain ul Abidin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Case Reports ◽  
Age Groups ◽  
Cerebral Venous Sinus Thrombosis ◽  
Funding Agency ◽  
For Profit ◽  
Level Data ◽  
Management Approaches

Background Cases of thrombosis with thrombocytopenia syndrome (TTS) have been reported following vaccination with AZD1222 or Ad26.COV2.S. This review aimed to explore the pathophysiology, epidemiology, diagnosis, management, and prognosis of TTS. Methods A systematic review was conducted to identify evidence on TTS till 4th September 2021. Case reports and series reporting patient-level data were included. Descriptive statistics were reported and compared across patients with different sexes, age groups, vaccines, types of thrombosis, and outcomes. Findings Sixty-two studies reporting 160 cases were included from 16 countries. Patients were predominantly females with a median age of 42.50 (22) years. AZD1222 was administered to 140 patients (87·5%). TTS onset occurred in a median of 9 (4) days after vaccination. Venous thrombosis was most common (61.0%). Most patients developed cerebral venous sinus thrombosis (CVST; 66.3%). CVST was significantly more common in female vs male patients (p = 0·001) and in patients aged <45 years vs ≥45 years (p = 0·004). The mortality rate was 36.2%, and patients with suspected TTS, venous thrombosis, CVST, pulmonary embolism, or intraneural complications, patients not managed with non-heparin anticoagulants or IVIG, patients receiving platelet transfusions, and patients requiring intensive care unit admission, mechanical ventilation, or inpatient neurosurgery were more likely to expire than recover. Interpretation These findings help to understand the pathophysiology of TTS while also recommending diagnostic and management approaches to improve prognosis in patients. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Long-term prognosis of cerebral venous sinus thrombosis in childhood

2004 ◽  
Vol 46 (08) ◽  
Author(s):  
Els LLM De Schryver ◽  
Ingrid Blom ◽  
Kees PJ Braun ◽  
L Jaap Kappelle ◽  
Gabriël JE Rinkel ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Long Term Prognosis
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