Background and Purpose:
Studies looking at seasonal variation on cerebral venous thrombosis (CVT) are few with conflicting conclusions. In this region-specific study, we looked for climatic influence and seasonal trends on the incidence of CVT.
Methods:
Imaging proven adult CVT cases treated over a period of 18 years from a specific geographical location with similar seasons and climatic conditions were studied. Metrological parameters prepared using 30 years of data was used. Quantum geographical information system (QGIS software) and SPSS v 22 were used for patient plotting and analysis.
Results:
Total of 970 cases were studied. The incidence was significantly higher in summer 411 (42.3%) compared with autumn 317 (32.7%) and winter 242 (25.05);
P
= 0.038. This trend was consistent across all the 18 years in time series analysis. Mean age was 33.5 years (range 18–88 years). A significant majority 673 (69.4%) were below 40 years of age;
P
= 0.012. Females constituted 394 (40.6%) of cases. Postpartum CVT cases constituted 237 (30%). Interaction analysis showed younger age (<40 years) were more vulnerable for CVT in summer;
P
= 0.009. There was no seasonal influence on postpartum CVT. Apart for a weak positive correlation between rain fall (
r
= 0.18,
P
< 0.01); humidity and cloud cover was not influencing the incidence.
Conclusions:
Higher ambient temperatures were consistently associated with higher incidence of CVT. This is the largest region-specific study on CVT in the world. These results may be applicable to other regions with similar climatic conditions.
Recombinant tissue plasminogen activator (rtPA) may be considered in acute ischemic strokes (AIS) occurring in pregnancy. This recommendation is based on case reports which had demonstrated the efficiency and safety of rtPA in early pregnancy. However, most of the pregnancy-related strokes occur in the peripartum period. There is a paucity of literature on the management of AIS in this clinically relevant period of pregnancy; with only 2 case reports describing the use of IV rt-PA in the last trimester. Here, we report a case of AIS in a full-term pregnancy treated successfully with intravenous rt-PA. The patient went on to have an uncomplicated vaginal delivery after 72 h post thrombolysis. To the best of our knowledge, this is only the third such case in the English literature.
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