Acute Seizures in Cerebral Venous Sinus Thrombosis

Abstract

Background: Cerebral venous sinus thrombosis (CVST) often presents with acute seizures, and recurrent seizures may also be seen in the long term in some patients. The purpose of this retrospective study was to investigate the frequency and type of acute seizures and to define the risk factors. Methods: Sixty-two patients diagnosed with CVST between September 2007 and October 2018 were retrospectively evaluated for the occurrence of acute seizures. Seizures which developed as a presenting symptom or occurred within 2 weeks of diagnosis were defined as acute seizures. Demographic, clinical, and radiologic characteristics were compared between patients with or without acute seizures. Results: Twenty (32.3%) of the 62 CVST patients had acute seizures. Univariate analysis revealed a significant association between acute seizures and aphasia (P=0.03), motor deficit (P<0.001), sensory deficit (P=0.018), severe (≥3) modified Rankin Scale scores on admission (P=0.017), sagittal sinus thrombosis (P=0.037), cortical vein thrombosis (P<0.001), supratentorial lesions (P<0.001), and hemorrhagic lesions (P<0.001). Multivariate regression analysis identified supratentorial lesions (P=0.015, odds ratio: 9.131, 95% confidence interval: 1.525-54.687) and cortical vein thrombosis (P=0.034, odds ratio: 5.802, 95% confidence interval: 1.146-29.371) as independent factors for acute seizures. Although 25% of patients with acute seizures had recurrent seizures during hospitalization, only 2.6% of the 38 patients with long-term follow-up had recurrent seizures. Conclusions: Approximately one third of patients with CVST had acute seizures. Cortical vein thrombosis, supratentorial, and especially hemorrhagic lesions were the most significant risk factors associated with acute seizures. Although seizure recurrence may occur early in the course, long-term recurrence is rare in CVST.

Predictive Factors for Early-Onset Seizures in Patients With Cerebral Venous Sinus Thrombosis

“…Thus, for patients with anterior SSST, the restriction of CSF return may be more severe, which may be another reason for their greater susceptibility to seizures. Interestingly, cortical vein thrombosis was not found to be an independent risk factor for seizures in this study, which differs from previous findings ( 5 , 9 ). However, univariate analysis results suggest that cortical vein thrombosis was still a risk factor ( P = 0.001, OR = 4.21).…”

A Novel Radiographic and Clinical Assessment Scoring Tool for Seizure Risk Stratification in the Acute Phase of Cerebral Venous Sinus Thrombosis: A Systematic Review and Meta-Analysis

“…A total of 14 studies with 4,414 patients were included for quantitative analyzation for the seizure risk factors in the acute phase of CVST [20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Nine studies were included in the imaging studies, involving 563 patients.…”

Sinus vein thrombosis and epileptic seizures: outcomes of long term follow-up

“…Seizures at the time of diagnosis and in the first seven days after the diagnosis are called acute symptomatic seizures and are reported with a rate of 24-50% in the literature [4][5][6] . Epileptic seizures are known to be more frequent as a presenting symptom in CVST than in other types of stroke 7 . Approximately 35-50% of patients diagnosed with CVST have focal onset or generalized seizures in the acute period, and in approximately 9% of these patients, seizures may persist in the long term 5 .…”